From 89ea4f487f1be804b97c7bece33b9ebb431f845c Mon Sep 17 00:00:00 2001 From: Matt Mayer Date: Tue, 2 Apr 2019 10:45:06 -0400 Subject: [PATCH 1/2] Update gem versions, remove simplexmlparser gem --- Gemfile | 5 +- Gemfile.lock | 125 +++++++++++++++----------------------------- cqm-parsers.gemspec | 10 ++-- 3 files changed, 48 insertions(+), 92 deletions(-) diff --git a/Gemfile b/Gemfile index e53535b1..41710f4f 100644 --- a/Gemfile +++ b/Gemfile @@ -2,9 +2,9 @@ source 'https://rubygems.org' gemspec :development_group => :test -gem 'mongoid', '~> 5.0.0' +gem 'mongoid', '~> 6.4.2' -# gem 'cqm-models', '~> 0.8.4' +# gem 'cqm-models', '~> 1.0.2' gem 'cqm-models', git: 'https://github.com/projecttacoma/cqm-models.git', branch: 'master' # gem 'cqm-models', :path => '../cqm-models' @@ -30,6 +30,5 @@ group :test do gem 'minitest', '~> 5.3' gem 'minitest-reporters' gem 'awesome_print', :require => 'ap' - gem 'simplexml_parser', :git => 'https://github.com/projecttacoma/simplexml_parser.git', :branch => 'master' gem 'vcr' end diff --git a/Gemfile.lock b/Gemfile.lock index ac26e724..0a5f6ff2 100644 --- a/Gemfile.lock +++ b/Gemfile.lock @@ -5,30 +5,21 @@ GIT specs: cqm-models (1.0.2) -GIT - remote: https://github.com/projecttacoma/simplexml_parser.git - revision: 1e8429773abb3e297c03133ae202900f35a6f9ed - branch: master - specs: - simplexml_parser (1.0.1) - health-data-standards (~> 4.0) - tilt (~> 1.4) - PATH remote: . specs: - cqm-parsers (0.2.1) - activesupport (~> 4.2.0) + cqm-parsers (1.0.0) + activesupport (~> 5.0) builder (~> 3.1) erubis (~> 2.7.0) highline (~> 1.7.0) log4r (~> 1.1.10) memoist (~> 0.9.1) - mongoid (~> 5.0.0) - mongoid-tree (~> 2.0.0) + mongoid (~> 6.4.2) + mongoid-tree (~> 2.1.1) mustache nokogiri (~> 1.8.5) - protected_attributes (~> 1.0.5) + protected_attributes_continued (~> 1.4.0) rubyzip (~> 1.2.2) typhoeus uuid (~> 2.3.7) @@ -37,23 +28,22 @@ PATH GEM remote: https://rubygems.org/ specs: - activemodel (4.2.10) - activesupport (= 4.2.10) - builder (~> 3.1) - activesupport (4.2.10) - i18n (~> 0.7) + activemodel (5.2.3) + activesupport (= 5.2.3) + activesupport (5.2.3) + concurrent-ruby (~> 1.0, >= 1.0.2) + i18n (>= 0.7, < 2) minitest (~> 5.1) - thread_safe (~> 0.3, >= 0.3.4) tzinfo (~> 1.1) - addressable (2.5.2) + addressable (2.6.0) public_suffix (>= 2.0.2, < 4.0) ansi (1.5.0) ast (2.4.0) awesome_print (1.8.0) - bson (4.3.0) + bson (4.4.2) builder (3.2.3) - bundler-audit (0.6.0) - bundler (~> 1.2) + bundler-audit (0.6.1) + bundler (>= 1.2.0, < 3) thor (~> 0.18) byebug (6.0.2) cane (2.3.0) @@ -63,74 +53,50 @@ GEM simplecov url coderay (1.1.2) - concurrent-ruby (1.0.5) + concurrent-ruby (1.1.5) crack (0.4.3) safe_yaml (~> 1.0.0) docile (1.3.1) - domain_name (0.5.20180417) - unf (>= 0.0.5, < 1.0.0) erubis (2.7.0) - ethon (0.11.0) + ethon (0.12.0) ffi (>= 1.3.0) factory_girl (4.1.0) activesupport (>= 3.0.0) - ffi (1.9.25) - hashdiff (0.3.7) - health-data-standards (4.1.0) - activesupport (~> 4.2.0) - builder (~> 3.1) - erubis (~> 2.7.0) - highline (~> 1.7.0) - log4r (~> 1.1.10) - memoist (~> 0.9.1) - mongoid (~> 5.0.0) - mongoid-tree (~> 2.0.0) - nokogiri (~> 1.8.2) - protected_attributes (~> 1.0.5) - rest-client (~> 1.8.0) - rubyzip (~> 1.2.1) - uuid (~> 2.3.7) - zip-zip (~> 0.3) + ffi (1.10.0) + hashdiff (0.3.8) highline (1.7.10) - http-cookie (1.0.3) - domain_name (~> 0.5) - i18n (0.9.5) + i18n (1.6.0) concurrent-ruby (~> 1.0) - json (2.1.0) + json (2.2.0) log4r (1.1.10) log_switch (1.0.0) macaddr (1.7.1) systemu (~> 2.6.2) memoist (0.9.3) method_source (0.8.2) - mime-types (2.99.3) mini_portile2 (2.3.0) minitest (5.11.3) - minitest-reporters (1.3.5) + minitest-reporters (1.3.6) ansi builder minitest (>= 5.0) ruby-progressbar - mongo (2.6.2) - bson (>= 4.3.0, < 5.0.0) - mongoid (5.0.2) - activemodel (~> 4.0) - mongo (~> 2.1) - origin (~> 2.1) - tzinfo (>= 0.3.37) - mongoid-tree (2.0.1) - mongoid (>= 4.0, < 6.0) + mongo (2.8.0) + bson (>= 4.4.2, < 5.0.0) + mongoid (6.4.2) + activemodel (>= 5.1, < 6.0.0) + mongo (>= 2.5.1, < 3.0.0) + mongoid-tree (2.1.1) + mongoid (>= 4.0, < 8) mustache (1.1.0) - netrc (0.11.0) nokogiri (1.8.5) mini_portile2 (~> 2.3.0) - origin (2.3.1) - parallel (1.12.1) - parser (2.5.1.2) + parallel (1.17.0) + parser (2.6.2.0) ast (~> 2.4.0) powerpack (0.1.2) - protected_attributes (1.0.9) - activemodel (>= 4.0.1, < 5.0) + protected_attributes_continued (1.4.0) + activemodel (>= 5.0) pry (0.10.4) coderay (~> 1.1.0) method_source (~> 0.8.1) @@ -139,11 +105,7 @@ GEM pry (>= 0.9.10, < 0.11.0) public_suffix (3.0.3) rainbow (3.0.0) - rake (12.3.1) - rest-client (1.8.0) - http-cookie (>= 1.0.2, < 2.0) - mime-types (>= 1.16, < 3.0) - netrc (~> 0.7) + rake (12.3.2) rubocop (0.52.1) parallel (~> 1.10) parser (>= 2.4.0.2, < 3.0) @@ -153,7 +115,7 @@ GEM unicode-display_width (~> 1.0, >= 1.0.1) ruby-progressbar (1.10.0) rubyzip (1.2.2) - safe_yaml (1.0.4) + safe_yaml (1.0.5) simplecov (0.16.1) docile (~> 1.1) json (>= 1.8, < 3) @@ -165,26 +127,22 @@ GEM log_switch (>= 0.3.0) term-ansicolor (>= 1.0.5) text-table (>= 1.2.2) - term-ansicolor (1.6.0) + term-ansicolor (1.7.1) tins (~> 1.0) text-table (1.2.4) - thor (0.20.0) + thor (0.20.3) thread_safe (0.3.6) - tilt (1.4.1) - tins (1.16.3) + tins (1.20.2) typhoeus (1.3.1) ethon (>= 0.9.0) tzinfo (1.2.5) thread_safe (~> 0.1) - unf (0.1.4) - unf_ext - unf_ext (0.0.7.5) - unicode-display_width (1.4.0) + unicode-display_width (1.5.0) url (0.3.2) uuid (2.3.9) macaddr (~> 1.0) - vcr (3.0.3) - webmock (3.4.2) + vcr (4.0.0) + webmock (3.5.1) addressable (>= 2.3.6) crack (>= 0.3.2) hashdiff @@ -205,13 +163,12 @@ DEPENDENCIES factory_girl (~> 4.1.0) minitest (~> 5.3) minitest-reporters - mongoid (~> 5.0.0) + mongoid (~> 6.4.2) pry pry-nav rake rubocop (~> 0.52.1) simplecov - simplexml_parser! tailor (~> 1.1.2) vcr webmock diff --git a/cqm-parsers.gemspec b/cqm-parsers.gemspec index 2e2092c9..cde8ea6d 100644 --- a/cqm-parsers.gemspec +++ b/cqm-parsers.gemspec @@ -9,15 +9,15 @@ Gem::Specification.new do |s| s.authors = ["The MITRE Corporation"] s.license = 'Apache-2.0' - s.version = '0.2.1' + s.version = '1.0.0' s.add_dependency 'mustache' s.add_dependency 'erubis', '~> 2.7.0' - s.add_dependency 'mongoid', '~> 5.0.0' - s.add_dependency 'mongoid-tree', '~> 2.0.0' - s.add_dependency 'activesupport', '~> 4.2.0' + s.add_dependency 'mongoid', '~> 6.4.2' + s.add_dependency 'mongoid-tree', '~> 2.1.1' + s.add_dependency 'activesupport', '~> 5.0' - s.add_dependency 'protected_attributes', '~> 1.0.5' + s.add_dependency 'protected_attributes_continued', '~> 1.4.0' s.add_dependency 'uuid', '~> 2.3.7' s.add_dependency 'builder', '~> 3.1' s.add_dependency 'nokogiri', '~> 1.8.5' From 94d45bedeb59de5f005809fdba237cc03ace09ee Mon Sep 17 00:00:00 2001 From: Matt Mayer Date: Tue, 2 Apr 2019 10:49:36 -0400 Subject: [PATCH 2/2] Remove all things simplexml --- .../hqmf/simplexml/CMS100v4_SimpleXML.xml | 17 - .../hqmf/simplexml/CMS102v4_SimpleXML.xml | 14 - .../hqmf/simplexml/CMS104v4_SimpleXML.xml | 17 - .../hqmf/simplexml/CMS105v4_SimpleXML.xml | 19 - .../hqmf/simplexml/CMS107v4_SimpleXML.xml | 16 - .../hqmf/simplexml/CMS108v4_SimpleXML.xml | 33 -- .../hqmf/simplexml/CMS109v4_SimpleXML.xml | 20 - .../hqmf/simplexml/CMS110v4_SimpleXML.xml | 19 - .../hqmf/simplexml/CMS111v4_SimpleXML.xml | 16 - .../hqmf/simplexml/CMS113v4_SimpleXML.xml | 15 - .../hqmf/simplexml/CMS114v4_SimpleXML.xml | 13 - .../hqmf/simplexml/CMS117v4_SimpleXML.xml | 86 ---- .../hqmf/simplexml/CMS122v4_SimpleXML.xml | 32 -- .../hqmf/simplexml/CMS123v4_SimpleXML.xml | 15 - .../hqmf/simplexml/CMS124v4_SimpleXML.xml | 26 -- .../hqmf/simplexml/CMS125v4_SimpleXML.xml | 26 -- .../hqmf/simplexml/CMS126v4_SimpleXML.xml | 32 -- .../hqmf/simplexml/CMS127v4_SimpleXML.xml | 21 - .../hqmf/simplexml/CMS128v4_SimpleXML.xml | 42 -- .../hqmf/simplexml/CMS129v5_SimpleXML.xml | 19 - .../hqmf/simplexml/CMS130v4_SimpleXML.xml | 44 -- .../hqmf/simplexml/CMS131v4_SimpleXML.xml | 28 -- .../hqmf/simplexml/CMS132v4_SimpleXML.xml | 31 -- .../hqmf/simplexml/CMS133v4_SimpleXML.xml | 33 -- .../hqmf/simplexml/CMS134v4_SimpleXML.xml | 29 -- .../hqmf/simplexml/CMS135v4_SimpleXML.xml | 50 --- .../hqmf/simplexml/CMS136v5_SimpleXML.xml | 55 --- .../hqmf/simplexml/CMS137v4_SimpleXML.xml | 38 -- .../hqmf/simplexml/CMS138v4_SimpleXML.xml | 27 -- .../hqmf/simplexml/CMS139v4_SimpleXML.xml | 19 - .../hqmf/simplexml/CMS140v4_SimpleXML.xml | 43 -- .../hqmf/simplexml/CMS141v5_SimpleXML.xml | 21 - .../hqmf/simplexml/CMS142v4_SimpleXML.xml | 19 - .../hqmf/simplexml/CMS143v4_SimpleXML.xml | 25 -- .../hqmf/simplexml/CMS144v4_SimpleXML.xml | 41 -- .../hqmf/simplexml/CMS145v4_SimpleXML.xml | 24 -- .../hqmf/simplexml/CMS146v4_SimpleXML.xml | 27 -- .../hqmf/simplexml/CMS147v5_SimpleXML.xml | 18 - .../hqmf/simplexml/CMS148v4_SimpleXML.xml | 21 - .../hqmf/simplexml/CMS149v4_SimpleXML.xml | 25 -- .../hqmf/simplexml/CMS153v4_SimpleXML.xml | 35 -- .../hqmf/simplexml/CMS154v4_SimpleXML.xml | 25 -- .../hqmf/simplexml/CMS155v4_SimpleXML.xml | 38 -- .../hqmf/simplexml/CMS156v4_SimpleXML.xml | 31 -- .../hqmf/simplexml/CMS157v4_SimpleXML.xml | 17 - .../hqmf/simplexml/CMS158v4_SimpleXML.xml | 7 - .../hqmf/simplexml/CMS159v4_SimpleXML.xml | 18 - .../hqmf/simplexml/CMS160v4_SimpleXML.xml | 15 - .../hqmf/simplexml/CMS161v4_SimpleXML.xml | 72 ---- .../hqmf/simplexml/CMS163v4_SimpleXML.xml | 19 - .../hqmf/simplexml/CMS164v4_SimpleXML.xml | 31 -- .../hqmf/simplexml/CMS165v4_SimpleXML.xml | 23 -- .../hqmf/simplexml/CMS166v5_SimpleXML.xml | 31 -- .../hqmf/simplexml/CMS167v4_SimpleXML.xml | 20 - .../hqmf/simplexml/CMS169v4_SimpleXML.xml | 11 - .../hqmf/simplexml/CMS171v5_SimpleXML.xml | 29 -- .../hqmf/simplexml/CMS172v5_SimpleXML.xml | 26 -- .../hqmf/simplexml/CMS177v4_SimpleXML.xml | 28 -- .../hqmf/simplexml/CMS178v5_SimpleXML.xml | 20 - .../hqmf/simplexml/CMS179v4_SimpleXML.xml | 49 --- .../hqmf/simplexml/CMS182v5_SimpleXML.xml | 33 -- .../hqmf/simplexml/CMS185v4_SimpleXML.xml | 15 - .../hqmf/simplexml/CMS188v5_SimpleXML.xml | 102 ----- .../hqmf/simplexml/CMS190v4_SimpleXML.xml | 28 -- .../hqmf/simplexml/CMS22v4_SimpleXML.xml | 55 --- .../hqmf/simplexml/CMS26v3_SimpleXML.xml | 42 -- .../hqmf/simplexml/CMS2v5_SimpleXML.xml | 73 ---- .../hqmf/simplexml/CMS30v5_SimpleXML.xml | 21 - .../hqmf/simplexml/CMS31v4_SimpleXML.xml | 3 - .../hqmf/simplexml/CMS32v5_SimpleXML.xml | 14 - .../hqmf/simplexml/CMS50v4_SimpleXML.xml | 22 - .../hqmf/simplexml/CMS52v4_SimpleXML.xml | 30 -- .../hqmf/simplexml/CMS53v4_SimpleXML.xml | 31 -- .../hqmf/simplexml/CMS55v4_SimpleXML.xml | 16 - .../hqmf/simplexml/CMS56v4_SimpleXML.xml | 11 - .../hqmf/simplexml/CMS60v4_SimpleXML.xml | 24 -- .../hqmf/simplexml/CMS61v5_SimpleXML.xml | 122 ------ .../hqmf/simplexml/CMS62v4_SimpleXML.xml | 11 - .../hqmf/simplexml/CMS64v5_SimpleXML.xml | 128 ------ .../hqmf/simplexml/CMS65v5_SimpleXML.xml | 30 -- .../hqmf/simplexml/CMS66v4_SimpleXML.xml | 11 - .../hqmf/simplexml/CMS68v5_SimpleXML.xml | 48 --- .../hqmf/simplexml/CMS69v4_SimpleXML.xml | 71 ---- .../hqmf/simplexml/CMS71v5_SimpleXML.xml | 15 - .../hqmf/simplexml/CMS72v4_SimpleXML.xml | 15 - .../hqmf/simplexml/CMS73v4_SimpleXML.xml | 26 -- .../hqmf/simplexml/CMS74v5_SimpleXML.xml | 11 - .../hqmf/simplexml/CMS75v4_SimpleXML.xml | 9 - .../hqmf/simplexml/CMS77v4_SimpleXML.xml | 10 - .../hqmf/simplexml/CMS82v3_SimpleXML.xml | 40 -- .../hqmf/simplexml/CMS90v5_SimpleXML.xml | 15 - .../hqmf/simplexml/CMS91v5_SimpleXML.xml | 24 -- .../hqmf/simplexml/CMS9v4_SimpleXML.xml | 17 - test/unit/hqmf/2.0/hqmf_vs_simple_test.rb | 390 ------------------ 94 files changed, 3174 deletions(-) delete mode 100755 test/fixtures/hqmf/simplexml/CMS100v4_SimpleXML.xml delete mode 100755 test/fixtures/hqmf/simplexml/CMS102v4_SimpleXML.xml delete mode 100755 test/fixtures/hqmf/simplexml/CMS104v4_SimpleXML.xml delete mode 100755 test/fixtures/hqmf/simplexml/CMS105v4_SimpleXML.xml delete mode 100755 test/fixtures/hqmf/simplexml/CMS107v4_SimpleXML.xml delete mode 100755 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test/fixtures/hqmf/simplexml/CMS82v3_SimpleXML.xml delete mode 100755 test/fixtures/hqmf/simplexml/CMS90v5_SimpleXML.xml delete mode 100755 test/fixtures/hqmf/simplexml/CMS91v5_SimpleXML.xml delete mode 100755 test/fixtures/hqmf/simplexml/CMS9v4_SimpleXML.xml delete mode 100644 test/unit/hqmf/2.0/hqmf_vs_simple_test.rb diff --git a/test/fixtures/hqmf/simplexml/CMS100v4_SimpleXML.xml b/test/fixtures/hqmf/simplexml/CMS100v4_SimpleXML.xml deleted file mode 100755 index 25b2b899..00000000 --- a/test/fixtures/hqmf/simplexml/CMS100v4_SimpleXML.xml +++ /dev/null @@ -1,17 +0,0 @@ -40280381-4be2-53b3-014b-e66bed0703d0Aspirin Prescribed at DischargeAMI-2100bb481284-30dd-4383-928c-82385bbf1b174.0.0000000010100001231Centers for Medicare & Medicaid Services (CMS)Oklahoma Foundation for Medical QualityNational Quality ForumAcute myocardial infarction (AMI) patients who are prescribed aspirin at hospital dischargeMeasure specifications are in the Public Domain. - -LOINC (R) is a registered trademark of the Regenstrief Institute. - -This material contains SNOMED Clinical Terms (R) (SNOMED CT (C)) copyright 2004-2014 International Health Terminology Standards Development Organization. All rights reserved.These performance measures are not clinical guidelines and do not establish a standard of medical care, and have not been tested for all potential applications. The measures and specifications are provided without warranty. CMS has contracted with Mathematical Policy Research and its subcontractors, Lantana and Telligen, for the continued maintenance of this electronic measure.ProportionProcessNoneNoneNoneAspirin therapy in patients who have suffered an acute myocardial infarction reduces the risk of adverse events and mortality. Studies have demonstrated that aspirin can reduce this risk by 20% (Antiplatelet Trialists' Collaboration, 1994). National guidelines strongly recommend long-term aspirin for the secondary prevention of subsequent cardiovascular events in eligible older patients discharged after AMI (O'Gara, 2013; Jneid, 2012; and Smith, 2011).National guidelines strongly recommend long-term aspirin for the secondary prevention of subsequent cardiovascular events in eligible older patients discharged after AMIImprovement noted as an increase in rateAnderson JL, Adams CD, Antman EM, Bridges CR, Califf RM, Casey DE Jr, et al. ACC/AHA 2007 guidelines for the management of patients with unstable angina/non-ST-elevation myocardial infarction: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Revise the 2002 Guidelines for the Management of Patients With Unstable Angina/Non-ST-Elevation Myocardial Infarction): developed in collaboration with the American College of Emergency Physicians, American College of Physicians, Society for Academic Emergency Medicine, Society for Cardiovascular Angiography and Interventions, and Society of Thoracic Surgeons. J Am Coll Cardiol. 2007;50:e1-157. -Antiplatelet Trialists' Collaboration. Collaborative overview of randomized trials of antiplatelet therapy - I: prevention of death, myocardial infarction, and stroke by prolonged antiplatelet therapy in various categories of patients. BMJ. 1994;308:81-106. -Jneid H, Anderson JL, Wright RS, Adams CD, Bridges CR, Casey DE Jr, et al. 2012 ACCF/AHA focused update of the guideline for the management of patients with unstable angina/non-ST-elevation myocardial infarction (updating the 2007 guideline and replacing the 2011 focused update): a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines. J Am Coll Cardiol 2012;60:645-81. -Krumholz HM, Anderson JL, Bachelder BL, Fesmire FM, Fihn SD, Foody JM, et al. ACC/AHA 2008 performance measures for adults with ST-elevation and non-ST-elevation myocardial infarction: a report of the American College of Cardiology/American Heart Association Task Force on Performance Measures (Writing Committee to Develop Performance Measures for ST-Elevation and Non-ST-Elevation Myocardial Infarction). J Am Coll Cardiol. 2008;52:2046-99. -O'Gara PT, Kushner FG, Ascheim DD, Casey DE, Jr, Chung MK, de Lemos JA, et al. 2013 ACCF/AHA guideline for the management of ST-elevation myocardial infarction: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines. J Am Coll Cardiol 2013;61:485-510.Smith SC Jr, Benjamin EJ, Bonow RO, Braun LT, Creager MA, et al. AHA/ACCF secondary prevention and risk reduction therapy for patients with coronary and other atherosclerotic vascular disease: 2011 update: a guideline from the American Heart Association and American College of Cardiology Foundation. Circulation. 2011;124:2458-2473.NoneExclusion element guidance: -Medical or patient reasons for not performing a test or giving a medication are categories for valid medical or patient reasons that are not specifically listed in the exclusion section of the measure. Each is expected to be captured and made available for measurement or clinical decision support within the EHR workflow but the exact method or location of capture is a local or vendor decision.NonePatients age 18 and older at the time of hospital admission with a principal diagnosis of Acute Myocardial Infarction (AMI) and a length of stay less than or equal to 120 days, during the measurement period.Equals Initial PopulationPatients with Comfort Measures documented. -Patients discharged to another hospital. -Patients who left against medical advice. -Patients who expired. -Patients discharged to home for hospice care. -Patients discharged to a health care facility for hospice care.Acute Myocardial Infarction patients prescribed aspirin at hospital discharge.NonePatients with a documented reason for not prescribing aspirin at discharge. This includes patients with an aspirin allergy; discharged on warfarin or other specific anticoagulant medications; the administration of aspirin medications are on HOLD; or a medical or patient reason for not prescribing aspirin.Not applicableNot applicableNot applicableFor every patient evaluated by this measure also identify payer, race, ethnicity, and sex.Acute Myocardial Infarction (AMI) - - \ No newline at end of file diff --git a/test/fixtures/hqmf/simplexml/CMS102v4_SimpleXML.xml b/test/fixtures/hqmf/simplexml/CMS102v4_SimpleXML.xml deleted file mode 100755 index a80bced5..00000000 --- a/test/fixtures/hqmf/simplexml/CMS102v4_SimpleXML.xml +++ /dev/null @@ -1,14 +0,0 @@ -40280381-4b9a-3825-014b-c21e526d0806Assessed for RehabilitationAssessed for Rehabilitation1027dc26160-e615-4cc2-879c-75985189ec1a4.0.0000000010100001231The Joint CommissionThe Joint CommissionNational Quality ForumIschemic or hemorrhagic stroke patients who were assessed for rehabilitation services.Measure specifications are in the Public Domain - -LOINC(R) is a registered trademark of the Regenstrief Institute. - -This material contains SNOMED Clinical Terms (R) (SNOMED CT(C) ) copyright 2004 - 2014 International Health Terminology Standards Development Organization. All rights reserved.These performance measures are not clinical guidelines and do not establish a standard of medical care, and have not been tested for all potential applications. The measures and specifications are provided without warranty.ProportionProcessNoneNoneNoneEach year about 700,000 people experience a new or recurrent stroke, which is the nation's third leading cause of death. Approximately two thirds of these individuals survive and require rehabilitation. Stroke is a leading cause of serious, long- term disability in the United States, with about 4.4 million stroke survivors alive today. Forty percent of stroke patients are left with moderate functional impairment and 15 to 30 percent with severe disability. More than 60% of those who have experienced stroke, serious injury, or a disabling disease have never received rehabilitation. Stroke rehabilitation should begin as soon as the diagnosis of stroke is established and life- threatening problems are under control. Among the high priorities for stroke are to mobilize the patient and encourage resumption of self-care activities as soon as possible. A considerable body of evidence indicates better clinical outcomes when patients with stroke are treated in a setting that provides coordinated, multidisciplinary stroke-related evaluation and services. Effective rehabilitation interventions initiated early following stroke can enhance the recovery process and minimize functional disability. The primary goal of rehabilitation is to prevent complications, minimize impairments, and maximize function.A considerable body of evidence indicates better clinical outcomes when patients with stroke are treated in a setting that provides coordinated, multidisciplinary stroke-related evaluation and services. Effective rehabilitation interventions initiated early following stroke can enhance the recovery process and minimize functional disability.Improvement noted as an increase in rate.Affairs, Department of Veterans, and Department of Defense. "Va/Dod Clinical Practice Guideline for the Management of Stroke Rehabilitation in the Primary Care Setting," In, (2003).Bates, B., J. Y. Choi, P. W. Duncan, J. J. Glasberg, G. D. Graham, R. C. Katz, K. Lamberty, et al. "Veterans Affairs/Department of Defense Clinical Practice Guideline for the Management of Adult Stroke Rehabilitation Care: Executive Summary." [In eng]. Stroke 36, no. 9 (Sep 2005): 2049-56Duncan, P. W., R. Zorowitz, B. Bates, J. Y. Choi, J. J. Glasberg, G. D. Graham, R. C. Katz, K. Lamberty, and D. Reker. "Management of Adult Stroke Rehabilitation Care: A Clinical Practice Guideline." [In eng]. Stroke 36, no. 9 (Sep 2005): e100-43.Ottenbacher, K. J., and S. Jannell. "The Results of Clinical Trials in Stroke Rehabilitation Research." [In eng]. Arch Neurol 50, no. 1 (Jan 1993): 37-44."Outcomes in Stroke Rehabilitation." Topics in Stroke Rehabilitation 12, no. 4 (Fall 2005): 1-10, 11-19, 20-27, 28-36, 37-49.NoneThe unit of measurement for this measure is an inpatient episode of care. Each distinct hospitalization should be reported, regardless of whether the same patient is admitted for inpatient care more than once during the measurement period. In addition, the eMeasure logic intends to represent events within or surrounding a single occurrence of an inpatient hospitalization. - -The "Non-elective Inpatient Encounter" value set intends to capture all non-scheduled hospitalizations. This value set is a subset of the "Inpatient encounter" value set, excluding concepts that specifically refer to elective hospital admissions. Non-elective admissions include emergency, urgent and unplanned admissions.TBDPatients age 18 and older discharged from inpatient care (non-elective admissions) with a principal diagnosis of ischemic or hemorrhagic stroke and a length of stay less or equal to 120 days.Initial PopulationPatients with comfort measures documented -Patients discharged to another hospital -Patients who left against medical advice -Patients who expired -Patients discharged to home for hospice care -Patients discharged to a health care facility for hospice careIschemic or hemorrhagic stroke patients assessed for or who received rehabilitation services.Not ApplicableNoneNot ApplicableNot ApplicableNot ApplicableFor every patient evaluated by this measure also identify payer, race, ethnicity, and sex.eMeasure Stroke (eSTK) - - \ No newline at end of file diff --git a/test/fixtures/hqmf/simplexml/CMS104v4_SimpleXML.xml b/test/fixtures/hqmf/simplexml/CMS104v4_SimpleXML.xml deleted file mode 100755 index 57fc20fa..00000000 --- a/test/fixtures/hqmf/simplexml/CMS104v4_SimpleXML.xml +++ /dev/null @@ -1,17 +0,0 @@ -40280381-4c72-51df-014c-8f7b539207a9Discharged on Antithrombotic TherapyDischarged on Antithrombotic The10442bf391f-38a3-4c0f-9ece-dcd47e9609d94.1.0000000010100001231The Joint CommissionThe Joint CommissionNational Quality ForumIschemic stroke patients prescribed antithrombotic therapy at hospital dischargeMeasure specifications are in the Public Domain - -LOINC(R) is a registered trademark of the Regenstrief Institute. - -This material contains SNOMED Clinical Terms (R) (SNOMED CT(C) ) copyright 2004-2014 International Health Terminology Standards Development Organization. All rights reserved.These performance measures are not clinical guidelines and do not establish a standard of medical care, and have not been tested for all potential applications. The measures and specifications are provided without warranty.ProportionProcessNoneNoneNoneThe effectiveness of antithrombotic agents in reducing stroke mortality, stroke- related morbidity and recurrence rates has been studied in several large clinical trials. While the use of these agents for patients with acute ischemic stroke and transient ischemic attacks continues to be the subject of study, substantial evidence is available from completed studies. Data at this time suggest that antithrombotic therapy should be prescribed at discharge following acute ischemic stroke to reduce stroke mortality and morbidity as long as no contraindications exist -For patients with a stroke due to a cardioembolic source (eg atrial fibrillation, mechanical heart valve), warfarin is recommended unless contraindicated. In recent years, novel oral anticoagulant agents (NOACs) have been developed and approved by the U.S. Food and Drug Administration (FDA) for stroke prevention, and may be considered as an alternative to warfarin for select patients. Anticoagulation therapy is not generally recommended for secondary stroke prevention in patients presumed to have a non-cardioembolic stroke. -Anticoagulants at doses to prevent venous thromboembolism are insufficient antithrombotic therapy to prevent recurrent ischemic stroke or TIA.Clinical trial results suggest that antithrombotic therapy should be prescribed at discharge following acute ischemic stroke to reduce stroke mortality and morbidity as long as no contraindications exist.Improvement noted as an increase in rateAdams HP, del Zoppo G, Alberts MJ, Bhatt DL, Brass L, Furlan A, Grubb RL, Higashida RT, Jauch EC, Kidwell C, Lyden PD, Morgenstern LB, Qureshi AI, Rosenwasser RH, Scott PA, Wijdicks E. Guidelines for the Early Management of Adults with Ischemic Stroke: A Guideline From the American Heart Association/American Stroke Association Stroke Council, Clinical CardiologyCouncil, Cardiovascular Radiology and Intervention Council, and the Atherosclerotic Peripheral Vascular Disease and Quality of Care Outcomes in Research Interdisciplinary Working Groups. Stroke. 2007;38:1655-1711.Adams H, Adams R, Del Zoppo G, Goldstein LB. Guidelines for the Early Management of Patients With Ischemic Stroke: Guidelines Update A Scientific Statement From the Stroke Council of the American Heart Association/American Stroke Association. Stroke Vol. 36, 2005: 916:923.Albers GW, Amarenco P, Easton JD, Sacco RL, Teal P. Antithrombotic and Thrombolytic Therapy for Ischemic Stroke. Chest Vol. 119, 2001: 300-320.Brott TG, Clark WM, Grotta JC, et al. Stroke the first hours. Guidelines for acute treatment. Consensus Statement. National Stroke Association. 2000.Chen ZM, Sandercock P, Pan HC, et al. Indications for early aspirin use in acute ischemic stroke: a combined analysis of 40,000 randomized patients from the Chinese acute stroke trial and the international stroke trial. On behalf of the CAST and IST collaborative groups, Stroke 2000;31:1240-1249.Coull BM, Williams LS, Goldstein LB, et al. Anticoagulants and Antiplatelet Agents in Acute Ischemic Stroke. Report of the Joint Stroke Guideline Development Committee of the American Academy of Neurology and the American Stroke Association (a Division of the American Heart Association) Stroke. 2002;33:1934 - 1942.Guideline on the Use of Aspirin as Secondary Prophylaxis for Vascular Disease in Primary Care, Centre for Health Services Research University of Newcastle upon Tyne, & Centre for Health Economics of York, 1998.Sacco RL, Adams R, Albers G, Alberts MJ, Benavente O, Furie K, Goldstein LB, Gorelick P, Halperin J, Harbaugh R, Johnston SC, Katzan I, Kelly-Hayes M, Kenton EJ, Marks M, Schwamm LH, Tomsick T. Guidelines for Prevention of Stroke in Patients With Ischemic Stroke or Transient Ischemic Attack: A Statement for Healthcare Professionals From the American Heart Association/American Stroke Association Council on Stroke: Co-Sponsored by the Council on Cardiovascular Radiology and Intervention. Stroke. Vol. 37, 2006:577.NoneThe unit of measurement for this measure is an inpatient episode of care. Each distinct hospitalization should be reported, regardless of whether the same patient is admitted for inpatient care more than once during the measurement period. In addition, the eMeasure logic intends to represent events within or surrounding a single occurrence of an inpatient hospitalization. - -The "Non-elective Inpatient Encounter" value set intends to capture all non-scheduled hospitalizations. This value set is a subset of the "Inpatient encounter" value set, excluding concepts that specifically refer to elective hospital admissions. Non-elective admissions include emergency, urgent and unplanned admissions.TBDPatients age 18 and older discharged from inpatient care (non-elective admissions) with a principal diagnosis of ischemic or hemorrhagic stroke and a length of stay less or equal to 120 days, during the measurement period.Patients with a principal diagnosis of Ischemic stroke.Patients with comfort measures documented. -Patients admitted for elective carotid intervention. This exclusion is implicitly modeled by only including non-elective hospitalizations. -Patients discharged to another hospital -Patients who left against medical advice -Patients who expired -Patients discharged to home for hospice care -Patients discharged to a health care facility for hospice carePatients prescribed antithrombotic therapy at hospital discharge.Not ApplicablePatients with a documented reason for not prescribing antithrombotic therapy at discharge.Not ApplicableNot ApplicableNot ApplicableFor every patient evaluated by this measure also identify payer, race, ethnicity, and sex.eMeasure Stroke (eSTK) - - \ No newline at end of file diff --git a/test/fixtures/hqmf/simplexml/CMS105v4_SimpleXML.xml b/test/fixtures/hqmf/simplexml/CMS105v4_SimpleXML.xml deleted file mode 100755 index 77882248..00000000 --- a/test/fixtures/hqmf/simplexml/CMS105v4_SimpleXML.xml +++ /dev/null @@ -1,19 +0,0 @@ -40280381-4be2-53b3-014c-09f5e7c01618Discharged on Statin MedicationDischarged on Statin Medication1051f503318-bb8d-4b91-af63-223ae0a2328e4.0.0000000010100001231The Joint CommissionThe Joint CommissionNational Quality ForumIschemic stroke patients who are prescribed statin medication at hospital discharge.Measure specifications are in the Public Domain. - -LOINC(R) is a registered trademark of the Regenstrief Institute. - -This material contains SNOMED Clinical Terms (R) (SNOMED CT[C]) copyright 2004-2014 International Health Terminology Standards Development Organization. All rights reserved.These performance measures are not clinical guidelines and do not establish a standard of medical care, and have not been tested for all potential applications. The measures and specifications are provided without warranty.ProportionProcessNoneNoneNoneThere is an extensive and consistent body of evidence supporting the use of statins for secondary prevention in patients with clinically evident atherosclerotic cardiovascular disease (ASCVD), which includes individuals with ischemic stroke due to large artery atherosclerosis, individuals with ischemic stroke due to intrinsic small vessel disease, and individuals with ischemic stroke not directly due to atherosclerosis but with clinically evident atherosclerotic disease in an uninvolved cerebral or noncerebral bed. Both women and men with clinical ASCVD are at increased risk for recurrent ASCVD and ASCVD death. High-intensity statin therapy should be initiated or continued as first-line therapy in women and men less than or equal to 75 years of age who have clinical ASCVD, unless contraindicated. In patients with clinical ASCVD and a contraindication to high-intensity statin therapy, moderate-intensity therapy should be considered as an alternative if it can be tolerated. In individuals greater than 75 years of age, the potential for ASCVD risk reduction benefits, adverse effects, drug-drug interactions, and patient preferences should be considered, and statin therapy individualized based on these considerations (Stone, 2013).For patients with stroke of atherosclerotic origin, intensive lipid lowering therapy with statins should be initiated.Improvement noted as an increase in rateStone NJ, Robinson J, Lichtenstein AH, Noel Bairey Merz C, Blum CB, Eckel RH, Goldberg AC, Gordon D, Levy D, Lloyd-Jones DM, McBride P, Schwartz JS, Shero Jr, ST, Smith SC, Watson K, Wilson PWF. "Guideline on the Treatment of Blood Cholesterol to Reduce Atherosclerotic Cardiovascular Disease in Adults: A Report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines." [In eng]. Circulation 11, (Nov 2013): 1-84. Amarenco, P., J. Bogousslavsky, A. Callahan, 3rd, L. B. Goldstein, M. Hennerici, A. E. Rudolph, H. Sillesen, et al. "High-Dose Atorvastatin after Stroke or Transient Ischemic Attack." [In eng]. N Engl J Med 355, no. 6 (Aug 10 2006): 549-59 -Feher, A., G. Pusch, K. Koltai, A. Tibold, B. Gasztonyi, L. Szapary, and G. Feher. "Statintherapy in the Primary and the Secondary Prevention of Ischaemic Cerebrovascular Diseases." [In eng]. Int J Cardiol 148, no. 2 (Apr 14 2011): 131-8. -Furie, K. L., S. E. Kasner, R. J. Adams, G. W. Albers, R. L. Bush, S. C. Fagan, J. L. Halperin, et al. "Guidelines for the Prevention of Stroke in Patients with Stroke or Transient Ischemic Attack: A Guideline for Healthcare Professionals from the American Heart Association/American Stroke Association." [In eng]. Stroke 42, no. 1 (Jan 2011): 227-76. -National Cholesterol Education Program Expert Panel on Detection, Evaluation, and Adults Treatment of High Blood Cholesterol in Adults."Third Report of the National Cholesterol Education Program (Ncep) Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (Adult Treatment Panel Iii) Final Report." [In eng]. Circulation 106, no. 25 (Dec 17 2002): 3143-421.Squizzato, A., E. Romualdi, F. Dentali, and W. Ageno. "Statins for Acute Ischemic Stroke." [In eng]. Cochrane Database Syst Rev, no. 8 (2011): CD007551.NoneThe unit of measurement for this measure is an inpatient episode of care. Each distinct hospitalization should be reported, regardless of whether the same patient is admitted for inpatient care more than once during the measurement period. In addition, the eMeasure logic intends to represent events within or surrounding a single occurrence of an inpatient hospitalization. - -The "Non-elective Inpatient Encounter" value set intends to capture all non-scheduled hospitalizations. This value set is a subset of the "Inpatient encounter" value set, excluding concepts that specifically refer to elective hospital admissions. Non-elective admissions include emergency, urgent and unplanned admissions.TBDPatients age 18 and older discharged from inpatient care (non-elective admissions) with a principal diagnosis of ischemic or hemorrhagic stroke and a length of stay less or equal to 120 days.Patients with a principal diagnosis of ischemic stroke.Patients admitted for elective carotid intervention. This exclusion is implicitly modeled by only including non-elective hospitalizations. -Patients with comfort measures documented -Patients discharged to another hospital -Patients who left against medical advice -Patients who expired -Patients discharged to home for hospice care -Patients discharged to a health care facility for hospice care -Patients with an LDL-c of less than 70 mg/dL <30 days prior to arrival or any time during the hospital stayPatients prescribed statin medication at hospital discharge.Not ApplicablePatients with a reason for not prescribing statin medication at discharge.Not ApplicableNot ApplicableNot ApplicableFor every patient evaluated by this measure also identify payer, race, ethnicity and sex.eMeasure Stroke (eSTK) - - \ No newline at end of file diff --git a/test/fixtures/hqmf/simplexml/CMS107v4_SimpleXML.xml b/test/fixtures/hqmf/simplexml/CMS107v4_SimpleXML.xml deleted file mode 100755 index a3b6acaf..00000000 --- a/test/fixtures/hqmf/simplexml/CMS107v4_SimpleXML.xml +++ /dev/null @@ -1,16 +0,0 @@ -40280381-4b9a-3825-014b-c1ce20f40785Stroke EducationStroke Education107217fdf0d-3d64-4720-9116-d5e5afa27f2c4.0.0000000010100001231The Joint CommissionThe Joint CommissionIschemic or hemorrhagic stroke patients or their caregivers who were given educational materials during the hospital stay addressing all of the following: activation of emergency medical system, need for follow-up after discharge, medications prescribed at discharge, risk factors for stroke, and warning signs and symptoms of stroke.Measure specifications are in the Public Domain - -LOINC(R) is a registered trademark of the Regenstrief Institute. - -This material contains SNOMED Clinical Terms (R) (SNOMED CT[C]) copyright 2004-2014 International Health Terminology Standards Development Organization. All rights reserved.These performance measures are not clinical guidelines and do not establish a standard of medical care, and have not been tested for all potential applications. The measures and specifications are provided without warranty.ProportionProcessNoneNoneNoneThere are many examples of how patient education programs for specific chronic conditions have increased healthful behaviors, improved health status, and/or decreased health care costs of their participants. Clinical practice guidelines include recommendations for patient and family education during hospitalization as well as information about resources for social support services. Some clinical trials have shown measurable benefits in patient and caregiver outcomes with the application of education and support strategies. The type of stroke experienced and the resulting outcomes will play a large role in determining not only the course of treatment but also what education will be required. Patient education should include information about the event (eg, cause, treatment, and risk factors), the role of various medications or strategies, as well as desirable lifestyle modifications to reduce risk or improve outcomes. Family/caregivers will also need guidance in planning effective and realistic care strategies appropriate to the patient's prognosis and potential for rehabilitation.Some clinical trials have shown measurable benefits in patient and caregiver outcomes with the application of education and support strategies. Patient education should include information about the event (eg, cause, treatment, and risk factors), the role of various medications or strategies, as well as desirable lifestyle modifications to reduce risk or improve outcomes. Family/caregivers will also need guidance in planning effective and realistic care strategies appropriate to the patient's prognosis and potential for rehabilitation.Improvement noted as an increase in rate.Eames, S., T. Hoffmann, L. Worrall, and S. Read. "Stroke Patients' and Carers' Perception of Barriers to Accessing Stroke Information." [In eng]. Top Stroke Rehabil 17, no. 2 (Mar-Apr 2010): 69-78.Furie, K. L., S. E. Kasner, R. J. Adams, G. W. Albers, R. L. Bush, S. C. Fagan, J. L. Halperin, et al. "Guidelines for the Prevention of Stroke in Patients with Stroke or Transient Ischemic Attack: A Guideline for Healthcare Professionals from the American Heart Association/American Stroke Association." [In eng]. Stroke 42, no. 1 (Jan 2011): 227-76.Goldstein, L. B., C. D. Bushnell, R. J. Adams, L. J. Appel, L. T. Braun, S. Chaturvedi, M. A. Creager, et al. "Guidelines for the Primary Prevention of Stroke: A Guideline for Healthcare Professionals from the American Heart Association/American Stroke Association." [In eng]. Stroke 42, no. 2 (Feb 2011): 517-84.Hafsteinsdottir, T. B., M. Vergunst, E. Lindeman, and M. Schuurmans. "Educational Needs of Patients with a Stroke and Their Caregivers: A Systematic Review of the Literature." [In eng]. Patient Educ Couns 85, no. 1 (Oct 2011): 14-25Jauch, E. C., J. L. Saver, H. P. Adams, Jr., A. Bruno, J. J. Connors, B. M. Demaerschalk, P. Khatri, et al. "Guidelines for the Early Management of Patients with Acute Ischemic Stroke: A Guideline for Healthcare Professionals from the American Heart Association/American Stroke Association." [In Eng]. Stroke (Jan 31 2013).Lorig, K. R., D. S. Sobel, A. L. Stewart, B. W. Brown, Jr., A. Bandura, P. Ritter, V. M. Gonzalez, D. D. Laurent, and H. R. Holman. "Evidence Suggesting That a Chronic Disease Self-Management Program Can Improve Health Status While Reducing Hospitalization: A Randomized Trial." [In eng]. Med Care 37, no. 1 (Jan 1999): 5-14.NoneThe unit of measurement for this measure is an inpatient episode of care. Each distinct hospitalization should be reported, regardless of whether the same patient is admitted for inpatient care more than once during the measurement period. In addition, the eMeasure logic intends to represent events within or surrounding a single occurrence of an inpatient hospitalization. - -Written information given to the patient is required to address each and every one of the educational components. These components are modeled in the population criteria and data criteria as communication from provider to patient :activation of emergency medical system, follow-up after discharge, medications prescribed at discharge, risk factors and signs and symptoms, and are intended to be specific to stroke. - -The "Non-elective admissions" value set intends to capture all non-scheduled hospitalizations. This value set is a subset of the "Inpatient encounter" value set, excluding concepts that specifically refer to elective hospital admissions. Non-elective admissions include emergency, urgent and unplanned admissions.TBDPatients age 18 and older discharged from inpatient care (non-elective admissions) with a principal diagnosis of ischemic or hemorrhagic stroke and a length of stay less or equal to 120 days.Ischemic stroke or hemorrhagic stroke patients discharged to home, home care, or court/law enforcement.Patients with comfort measures documented.Ischemic or hemorrhagic stroke patients with written documentation that they or their caregivers were given educational material addressing all of the following: -1. Activation of emergency medical system -2. Follow-up after discharge -3. Medications prescribed at discharge -4. Risk factors for stroke -5. Warning signs and symptoms of stroke.Not ApplicableNoneNot ApplicableNot ApplicableNot ApplicableFor every patient evaluated by this measure also identify payer, race, ethnicity and sex.eMeasure Stroke (eSTK) - - \ No newline at end of file diff --git a/test/fixtures/hqmf/simplexml/CMS108v4_SimpleXML.xml b/test/fixtures/hqmf/simplexml/CMS108v4_SimpleXML.xml deleted file mode 100755 index f9434651..00000000 --- a/test/fixtures/hqmf/simplexml/CMS108v4_SimpleXML.xml +++ /dev/null @@ -1,33 +0,0 @@ -40280381-4c18-79df-014c-2d6dc6ce0a53Venous Thromboembolism ProphylaxisVenous Thromboembolism Prophyla10838b0b5ec-0f63-466f-8fe3-2cd20ddd16224.0.0000000010100001231The Joint CommissionThe Joint CommissionNational Quality ForumThis measure assesses the number of patients who received VTE prophylaxis or have documentation why no VTE prophylaxis was given the day of or the day after hospital admission or surgery end date for surgeries that start the day of or the day after hospital admission.Measure specifications are in the Public Domain - -LOINC(R) is a registered trademark of the Regenstrief Institute. - -This material contains SNOMED Clinical Terms (R) (SNOMED CT[C]) copyright 2004-2014 International Health Terminology Standards Development Organization. All rights reserved.These performance measures are not clinical guidelines and do not establish a standard of medical care, and have not been tested for all potential applications. The measures and specifications are provided without warrantyProportionProcessNoneNoneNoneHospitalized patients at high-risk for VTE may develop an asymptomatic deep vein thrombosis (DVT), and die from pulmonary embolism (PE) even before the diagnosis is suspected. The majority of fatal events occur as sudden or abrupt death, underscoring the importance of prevention as the most critical action step for reducing death from PE (Geerts, et al, 2008). - -The estimated annual incidence of deep-vein thrombosis (DVT) and pulmonary embolism (PE), known collectively as venous thromboembolism (VTE), is approximately 900,000 (Geerts, et al, 2008). Approximately two-thirds of cases of DVT or PE are associated with recent hospitalization. This is consistent with the 2001 report by The Agency for Healthcare Research and Quality (AHRQ). AHRQ indicates that "the appropriate application of effective preventive measures in hospitals has major potential for improving patient safety by reducing the incidence of venous thromboembolism" (Shojania, 2001). - -Despite its proven effectiveness, rates of appropriate thromboprophylaxis remain low in both medical and surgical patients. A recent analysis from the ENDORSE survey, which evaluated prophylaxis rates in 17,084 major surgery patients, found that more than one third of patients at risk for VTE (38%) did not receive prophylaxis and that rates varied by surgery type (Cohen, et al., 2008). - -In a review of evidence-based patient safety practices, the Agency for Healthcare Research and Quality defined thromboprophylaxis against VTE as the "number one patient safety practice" for hospitalized patients (Shojania, 2001). Updated "safe practices" published by the National Quality Forum (NQF) recommend routine evaluation of hospitalized patients for risk of VTE and use of appropriate prophylaxis (National Quality Forum. National Voluntary Consensus Standards for Prevention and Care of Venous Thromboembolism, 2006). - -As noted by the ACCP, a vast number of randomized clinical trials provide irrefutable evidence that thromboprophylaxis reduces VTE events, and there are studies that have also shown that fatal PE is prevented by thromboprophylaxis (Geerts, et al. 2008). - -Some select surgeries have previously been monitored in the Surgical Care Improvement Project; since performance on these surgeries has achieved very high levels, they are not included in this measure.Failure to recognize and protect patients at risk for venous thromboembolism (VTE) increases the chances for acutely ill hospitalized patients at high risk for developing a deep vein thrombosis or dying from a pulmonary emboli. Screening all patients is the only evidence based practice in reducing incidence of disease. All hospitalized patients should be evaluated for primary VTE prophylaxis, and given appropriate prophylaxis when indicated.Improvement noted as an increase in rateCohen AT, Tapson VF, Bergmann JF, et al. Venous thromboembolism risk and prophylaxis in the acute hospital care setting (ENDORSE study): a multinational cross-sectional study. Lancet. 2008;371:387-394.Geerts WH, Bergqvist D, Pineo GF, Heit JA, Samama CM, Lassen MR, Colwell CW. Prevention of venous thromboembolism. The Eighth ACCP Conference on antithrombotic and thrombolytic therapy. Chest. 2008; 133:381S-453SGuyatt, G.H., Akl, E.A., Crowther, M., Gutterman, D., Schunemann, H. Antithrombotic Therapy and Prevention of Thrombosis, 9th edition: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines. CHEST 2012; 141(2)(Supp):7S-47SKearon C, Akl EA, Comerota AJ, Prandoni P, Bounameaux H, Goldhaber SZ, Nelson ME, Wells PS, Gould MK, Dentali F, Crowther M, Kahn SR. Antithrombotic therapy for VTE disease: Antithrombotic Therapy and Prevention of Thrombosis, 9th Edition: American College of Chest Physicians Evidence-based Clinical Practice Guidelines. CHEST 2012 Feb; 141(2) (Supp):e419S-94S. National Quality Forum. National Voluntary Consensus Standards for Prevention and Care of Venous Thromboembolism: Policy, Preferred Practices, and Initial Performance Measures. A Consensus Report. Washington, DC. NQF; 2006Shojania KG, Duncan BW, McDonald DM, et al. (Eds.). (2001). Making healthcare safer; A critical analysis of patient safety practices (Evidence Report/Technology Assessment No. 43). Prepared by the University of California at San Francisco-Stanford Evidenced-based Practice Center under Contract no. 290-97-0013 (AHRQ Publication NO.01-E058). Rockville, MD:Agency for Healthcare Research and Quality.NoneThe unit of measurement for this measure is an inpatient episode of care. Each distinct hospitalization should be reported, regardless of whether the same patient is admitted for inpatient care more than once during the measurement period. In addition, the eMeasure logic intends to represent events within or surrounding a single occurrence of an inpatient hospitalization. - -When low dose unfractionated heparin is not administered due to medical reasons, the intended administration route is subcutaneous. - -The construct of Unfractionated Heparin (route: 'Intravenous route') intends to capture continually infused heparin rather than heparin flushes or pushes.TBDPatients age 18 and older discharged during the measurement period from hospital inpatient acute care with a length of stay less than or equal to 120 days, without a diagnosis of venous thromboembolism (VTE) or obstetrics. All patients in the initial populationPatients who have a length of stay less than 2 days -Patients with comfort measures documented anytime between arrival and the day after hospital admission -Patients with comfort measures documented by the day after surgery end date for surgeries that start the day of or the day after hospital admission -Patients who are direct admits to intensive care unit (ICU), or transferred to ICU the day of or the day after hospital admission with ICU length of stay greater than or equal to one day -Patients with a principal diagnosis of mental disorders or stroke -Patients with a principal procedure of Surgical Care Improvement Project (SCIP) VTE selected surgeriesPatients who received VTE prophylaxis: --the day of or the day after hospital admission --the day of or the day after surgery end date for surgeries that end the day of or the day after hospital admission - -Patients who have documentation of a reason why no VTE prophylaxis was given: -- between arrival and hospital admission -- the day of or the day after hospital admission -- the day of or the day after surgery end date (for surgeries that end the day of or the day after hospital admission)Not ApplicableNoneNot ApplicableNot ApplicableNot ApplicableFor every patient evaluated by this measure also identify payer, race, ethnicity and sex.eMeasure Venous Thromboembolism (eVTE) - -VTE prophylaxis optionsReasons for no VTE prophylaxis \ No newline at end of file diff --git a/test/fixtures/hqmf/simplexml/CMS109v4_SimpleXML.xml b/test/fixtures/hqmf/simplexml/CMS109v4_SimpleXML.xml deleted file mode 100755 index fbe867bf..00000000 --- a/test/fixtures/hqmf/simplexml/CMS109v4_SimpleXML.xml +++ /dev/null @@ -1,20 +0,0 @@ -40280381-4c18-79df-014c-2d6122a30a44Venous Thromboembolism Patients Receiving Unfractionated Heparin with Dosages/Platelet Count Monitoring by Protocol or NomogramVenous Thromboembolism Patients109bcce43dd-08e3-46c3-bfdd-0b1b472690f04.0.0000000010100001231The Joint CommissionThe Joint CommissionThis measure assesses the number of patients diagnosed with confirmed VTE who received intravenous (IV) UFH therapy dosages AND had their platelet counts monitored using defined parameters such as a nomogram or protocol.Measure specifications are in the Public Domain. - -LOINC(R) is a registered trademark of the Regenstrief Institute. - -This material contains SNOMED Clinical Terms(R) (SNOMED CT(C)) copyright 2004-2014 International Health Terminology Standards Development Organization. All rights reserved.These performance measures are not clinical guidelines and do not establish a standard of medical care, and have not been tested for all potential applications. The measures and specifications are provided without warranty.ProportionProcessNoneNoneNoneHeparin is commonly involved in adverse drug events (Geerts et al., 2008). Sub-therapeutic and supratherapeutic levels can lead to thromboembolic or bleeding complications that may increase the patient's length of stay. The use of weight-based nomograms has increased the likelihood that a therapeutic partial prothromboplastin time (aPTT) will be achieved within the first 24 to 48 hours of therapy. The risk of recurrent thromboembolism is reduced when a therapeutic level of heparin is reached quickly. Unfractionated heparin (UFH) management by weight-based aPTT adjusted protocols have demonstrated their ability through clinical trials to achieve a therapeutic aPTT more rapidly than with standard UFH dosing without increasing major bleeding (Rashke et al., 1993). - -Heparin nomograms are superior compared to routine care in the timely achievement of therapeutic anticoagulation despite the trend toward patients having aPTTs above the target range (http://archive.ahrq.gov/clinic/ptsafety/chap9.htm, retrieved March 13, 2015). Heparin-induced thrombocytopenia (HIT) occurs more commonly in patients who receive UFH than in those who receive low molecular weight heparin (Martel et al., 2005). HIT is defined as an unexplained fall in platelet count (specifically, a 50% fall in platelet count from baseline, even if the platelet count remains above 150 x 109/L) (Warkentin et al., 2003). Platelet counts generally begin to fall 5-10 days after the initiation of heparin therapy. Prompt recognition of HIT is important so that heparin can be discontinued and the risk of venous and arterial thrombosis minimized. To detect HIT, platelet count monitoring is recommended for all patients treated with UFH (Warkentin et al., 2003).Heparin-induced thrombocytopenia (HIT) may occur in patients who receive unfractionated heparin (UHF) for treatment of thromboembolism. Prompt recognition of HIT by evaluation of platelet counts can allow for detection of HIT, and the subsequent discontinuation of UFH. Management of UFH by nomogram/protocol is recommended to decrease the time outside of the therapeutic range.Improvement noted as an increase in rateGandi TK, Shojania KG, Bates DW. Chapter 9. Protocols for High-Risk Drugs: Reducing Adverse Drugs Events Related to Anticoagulants. Retrieved from the World Wide Web at http://archive.ahrq.gov/clinic/ptsafety/chap9.htm accessed on March 13, 2015.Geerts WH, Bergquist D., Pineo,GF., Heit, J.A., Samama, CM., Lassen, MR., Colwell, CW. Prevention of venous thromboembolism: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines (8th Edition). CHEST. 2008:133; 381-453.Guyatt, G.H., Akl, E.A., Crowther, M., Gutterman, D., Schunemann, H. Antithromboitic Therapy and Prevention of Thrombosis, 9th edition: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines. CHEST 2012; 141(2) (Supp):7S-47S.Kearon C, Akl EA, Comerota AJ, Prandoni P, Bounameaux H, Goldhaber SZ, Nelson ME, Wells PS, Gould MK, Dentali F, Crowther M, Kahn SR. Antithrombotic therapy for VTE disease: antithrombotic therapy and prevention of thrombosis, 9th ed: American College of Chest Physicians evidence-based clinical practice guidelines. Chest. 2012 Feb;141(2 Suppl):e419S-94S.Martel, N., Lee, J., and Wells, P.S. Risk for heparin induced thrombocytopenia with unfractionated and low-molecular-weight heparin thromboprophylaxis: a meta-analysis. Blood 2005 June; 106:2710-2715.Raschke RA, Reilly BM, Guidry JR et al. The weight-based heparin dosing nomogram compared with 'standard care' nomogram. Ann Intern Med. 1993 Nov 1; 119(9):874-81.Warkentin TE, Roberts RS, Hirsh J, et al. An improved definition of immune heparin-induced thrombocytopenia in postoperative orthopedic patients. Arch Intern Med 2003; 163:2518-24.NoneCMS recognizes the difficulty in capturing the VTE confirmed concept required in this measure and suggests eligible hospitals participating in the Medicare & Medicaid EHR Incentive Programs consider selecting alternative electronic clinical quality measures (eCQMs) to meet program requirements for meaningful use. If suitable alternatives are unavailable, CMS will accept a 0 denominator submission for the eCQM version only for this measure. - -The unit of measurement for this measure is an inpatient episode of care. Each distinct hospitalization should be reported, regardless of whether the same patient is admitted for inpatient care more than once during the measurement period. In addition, the eMeasure logic intends to represent events within or surrounding a single occurrence of an inpatient hospitalization. - -Treatment adjustment by protocol and/or use of a clinical pathway must be specific to unfractionated heparin therapy. Heparin protocols and clinical pathways may include use of a nomogram. - -The construct of Unfractionated Heparin (route: 'Intravenous route') intends to capture continually infused heparin rather than heparin flushes or pushes.TBDPatients age 18 and older discharged from hospital inpatient acute care during the measurement period with a length of stay less than or equal to 120 days and a diagnosis of venous thromboembolism (VTE) Patients with VTE confirmed through a diagnostic test and receiving IV UFH therapyPatients with comfort measures documented -Patients discharged to an acute care facility -Patients who left against medical advice -Patients who expired -Patients discharged to home for hospice care -Patients discharged to a health care facility for hospice carePatients who have their IV UFH therapy dosages and platelet counts monitored according to defined parameters such as a nomogram or protocol.Not ApplicableNoneNot ApplicableNot ApplicableNot ApplicableFor every patient evaluated by this measure also identify payer, race, ethnicity and sex.eMeasure Venous Thromboembolism (eVTE) - - \ No newline at end of file diff --git a/test/fixtures/hqmf/simplexml/CMS110v4_SimpleXML.xml b/test/fixtures/hqmf/simplexml/CMS110v4_SimpleXML.xml deleted file mode 100755 index 8ebcc646..00000000 --- a/test/fixtures/hqmf/simplexml/CMS110v4_SimpleXML.xml +++ /dev/null @@ -1,19 +0,0 @@ -40280381-4c18-79df-014c-2d98d1d60addVenous Thromboembolism Discharge InstructionsVenous Thromboembolism Discharge1107fe69617-fa28-4305-a2b8-ceb6bcd9693d4.0.0000000010100001231The Joint CommissionThe Joint CommissionThis measure assesses the number of patients diagnosed with confirmed VTE that are discharged to home, home care, court/law enforcement or home on hospice care on warfarin with written discharge instructions that address all four criteria: compliance issues, dietary advice, follow-up monitoring, and information about the potential for adverse drug reactions/interactions.Measure specifications are in the Public Domain - -LOINC(R) is a registered trademark of the Regenstrief Institute. - -This material contains SNOMED Clinical Terms(R) (SNOMED CT[C]) copyright 2004-2014 International Health Terminology Standards Development Organization. All rights reserved.These performance measures are not clinical guidelines and do not establish a standard of medical care, and have not been tested for all potential applications. The measures and specifications are provided without warranty.ProportionProcessNoneNoneNoneIn anticoagulation therapy programs, patient education is a vital component to achieve successful outcomes and reduce the hospital readmission rate. Patients benefit from education about the potential consequences of both their disease and its treatment (Institute for Clinical Systems Improvement 2006). Warfarin is commonly involved in adverse drug events (Ansell, J. 2008). Adverse drug events can include subtherapeutic clot formation, and supertherapeutic hemorrhage. Anticoagulation therapy poses risks to patients due to complex dosing, requisite follow-up monitoring and inconsistent patient compliance. The use of standardized practices for anticoagulation therapy that includes patient/caregiver involvement may reduce the risk of adverse drug events (van Walraven, et al. 2006). - -The Joint Commission National Patient Safety Goal "Reduce the likelihood of patient harm associated with the use of anticoagulant therapy" states that the organization provides education regarding anticoagulation therapy to patients/family that includes the importance of follow-up monitoring, compliance issues, dietary restrictions, and potential for adverse drug reactions and interactions.Patients discharged to home on warfarin should be educated on and given written discharge instructions or other educational material regarding compliance issues, dietary advice, follow up monitoring and information about the potential for adverse drug reactions and interactions.Improvement noted as an increase in rateAnsell J, Hirsch J, Hylek E, Jacobson A, Crowther M, Palareti G. Pharmacology and management of the vitamin K antagonists: The Eighth ACCP Conference on Antithrombotic and Thrombolytic Therapy. Chest. 2008 133:160S-198S.Guyatt, G.H., Akl, E.A., Crowther, M., Gutterman, D., Schunemann, H. Antithrombotic Therapy and Prevention of Thrombosis, 9th edition: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines. CHEST 2012; 141(2) (Supp):7S-47S.Institute for Clinical Systems Improvement (ICSI). Anticoagulation therapy supplement. Bloomington (MN): Institute for Clinical Systems Improvement (ICSI); 2006 Apr.49p. [91 references]Kearon C, Akl EA, Comerota AJ, Prandoni P, Bounameaux H, Goldhaber SZ, Nelson ME, Wells PS, Gould MK, Dentali F, Crowther M, Kahn SR. Antithrombotic therapy for VTE disease: antithrombotic therapy and prevention of thrombosis, 9th ed: American College of Chest Physicians evidence-based clinical practice guidelines. Chest. 2012 Feb;141(2 Suppl):e419S-94S.The Joint Commission. National Patient Safety Goals. Retrieved from the World Wide Web on March 17, 2015. http://www.jointcommission.org/standards_information/npsgs.aspx.Van Walraven, C., Jennings, A., Oake, N., Fergusson, D., and Forster, A.J. Effect of Study Setting on Anticoagulation Control: A Systematic Review and Metagression. Chest 2006; 129; 1155-1166.NoneCMS recognizes the difficulty in capturing the VTE confirmed concept required in this measure and suggests eligible hospitals participating in the Medicare & Medicaid EHR Incentive Programs consider selecting alternative electronic clinical quality measures (eCQMs) to meet program requirements for meaningful use. If suitable alternatives are unavailable, CMS will accept a 0 denominator submission for the eCQM version only for this measure. - -The unit of measurement for this measure is an inpatient episode of care. Each distinct hospitalization should be reported, regardless of whether the same patient is admitted for inpatient care more than once during the measurement period. In addition, the eMeasure logic intends to represent events within or surrounding a single occurrence of an inpatient hospitalization. - -Written information given to the patient is required to address each and every one of the educational components. These components are modeled in the population criteria and data criteria as communication from provider to patient: adverse reactions and interactions, INR monitoring and medication compliance, dietary advice and follow-up monitoring, and are intended to be specific to discharge instructions for warfarin therapy. The educational components are intended as discharge instructions and not as verbal education.TBDPatients age 18 and older discharged from hospital inpatient acute care during the measurement period with a length of stay less than or equal to 120 days and a diagnosis of venous thromboembolism (VTE)Patients with VTE confirmed through a diagnostic test and discharged to home or court/law enforcement on warfarin therapy.NonePatients with documentation that they or their caregivers were given written discharge instructions or other educational material about warfarin that addressed all of the following: -1. compliance issues -2. dietary advice -3. follow-up monitoring -4. potential for adverse drug reactions and interactions - -Patients who refuse written discharge instructions or other educational material about warfarin.Not ApplicableNoneNot ApplicableNot ApplicableNot ApplicableFor every patient evaluated by this measure also identify payer, race, ethnicity and sex.eMeasure Venous Thromboembolism (eVTE) - - \ No newline at end of file diff --git a/test/fixtures/hqmf/simplexml/CMS111v4_SimpleXML.xml b/test/fixtures/hqmf/simplexml/CMS111v4_SimpleXML.xml deleted file mode 100755 index 35a68455..00000000 --- a/test/fixtures/hqmf/simplexml/CMS111v4_SimpleXML.xml +++ /dev/null @@ -1,16 +0,0 @@ -40280381-4c18-79df-014c-242d05bb02cdMedian Admit Decision Time to ED Departure Time for Admitted PatientsMedian Admit Decision Time111979f21bd-3f93-4cdd-8273-b23dfe9c05134.0.0000000010100001231Centers for Medicare & Medicaid Services (CMS)Oklahoma Foundation for Medical QualityNational Quality ForumMedian time (in minutes) from admit decision time to time of discharge from the emergency department for emergency department patients admitted to inpatient status.Measure specifications are in the Public Domain - -LOINC(R) is a registered trademark of the Regenstrief Institute. - -This material contains SNOMED Clinical Terms(R) (SNOMED CT[C]) copyright 2004-2014 International Health Terminology Standards Development Organization. All rights reserved.These performance measures are not clinical guidelines and do not establish a standard of medical care, and have not been tested for all potential applications. The measures and specifications are provided without warranty. - -CMS has contracted with Mathematica Policy Research and its subcontractors, Lantana and Telligen, for the continued maintenance of this electronic measure.Continuous VariableProcessReport total score and the following strata: -Stratum 1 - all patients seen in the ED and admitted as an inpatient who do not have a principal diagnosis consistent with psychiatric/mental health disorders -Stratum 2 - all patients seen in the ED and admitted as an inpatient who have a principal diagnosis consistent with psychiatric/mental health disordersNoneCalculate the duration in minutes between the Decision to Admit time and the discharge time for each ED encounter in the measure population; report the median time for all calculations performed. The specification provides elements from the clinical electronic record required to calculate for each ED encounter, i.e., the duration the patient was in the Emergency Department after the decision to admit, also stated as: the Datetime difference between the Emergency Department discharge time and the Decision to Admit time. The calculation requires the median across all ED encounter durations.Reducing the time patients remain in the emergency department (ED) can improve access to treatment and increase quality of care. Reducing this time potentially improves access to care specific to the patient condition and increases the capability to provide additional treatment. In recent times, EDs have experienced significant overcrowding. Although once only a problem in large, urban, teaching hospitals, the phenomenon has spread to other suburban and rural healthcare organizations. According to a 2002 national U.S. survey, more than 90 percent of large hospitals report EDs operating "at" or "over" capacity. Approximately one third of hospitals in the U.S. report increases in ambulance diversion in a given year, whereas up to half report crowded conditions in the ED. In a recent national survey, 40 percent of hospital leaders viewed ED crowding as a symptom of workforce shortages. ED crowding may result in delays in the administration of medication such as antibiotics for pneumonia and has been associated with perceptions of compromised emergency care. For patients with non-ST-segment-elevation myocardial infarction, long ED stays were associated with decreased use of guideline-recommended therapies and a higher risk of recurrent myocardial infarction. Overcrowding and heavy emergency resource demand have led to a number of problems, including ambulance refusals, prolonged patient waiting times, increased suffering for those who wait, rushed and unpleasant treatment environments, and potentially poor patient outcomes. When EDs are overwhelmed, their ability to respond to community emergencies and disasters may be compromised.The most common cause of ED crowding is the boarding of admitted patients in the ED. Numerous studies have demonstrated the potential for errors, life threatening delays in treatment, and diminished overall quality is enormous.Improvement noted as a decrease in the median valueDiercks DB, et al. Prolonged emergency department stays of non-ST-segment-elevation myocardial infarction patients are associated with worse adherence to the American College of Cardiology/American Heart Association guidelines for management and increased adverse events. Ann Emerg Med. 2007;50:489-96.Derlet RW, Richards JR. Emergency department overcrowding in Florida, New York, and Texas. South Med J. 2002;95:846-9.Derlet RW, Richards JR. Overcrowding in the nation's emergency departments: complex causes and disturbing effects. Ann Emerg Med. 2000;35:63-8.Fatovich DM, Hirsch RL. Entry overload, emergency department overcrowding, and ambulance bypass. Emerg Med J. 2003;20:406-9. -Hwang U, Richardson LD, Sonuyi TO, Morrison RS. The effect of emergency department crowding on the management of pain in older adults with hip fracture. J Am Geriatr Soc. 2006;54:270-5.Institute of Medicine of the National Academies. Future of emergency care: Hospital-based emergency care at the breaking point. The National Academies Press 2006.Krochmal P, Riley TA. Increased health care costs associated with ED overcrowding. Am J Emerg Med. 1994;12:265-6.Kyriacou DN, Ricketts V, Dyne PL, McCollough MD, Talan DA. A 5-year time study analysis of emergency department patient care efficiency. Ann Emerg Med. 1999;34:326-35.Nawar ED, Niska RW, Xu J. National Hospital Ambulatory Medical Care Survey: 2005 emergency department summary. Adv Data. 2007; (386):1-32.Richardson DB. Increase in patient mortality at 10 days associated with emergency department overcrowding. Med J Aust. 2006;184:213-6.Sprivulis PC, et al. The association between hospital overcrowding and mortality among patients admitted via Western Australian emergency departments. Med J Aust. 2006;184:208-12.Trzeciak S, Rivers EP. Emergency department overcrowding in the United States: an emerging threat to patient safety and public health. Emerg Med J. 2003;20:402-5.United States General Accounting Office GAO. Hospital Emergency Departments: crowded conditions vary among hospitals and communities. 2003; GAO-03-460.Wilper AP, Woolhandler S, Lasser KE, McCormick D, Cutrona SL, Bor DH, Himmelstein DU. Waits to see an emergency department physician: U.S. trends and predictors, 1997-2004. Health Aff (Millwood). 2008;27:w84-95.NoneThis measure specification defines how to determine the duration from a Decision to Admit and the discharge from an Emergency Department stay. Reporting requires the median of all admit decision to ED discharge durations defined as [Encounter: encounter ED]. decision to admit date and time minus [Encounter: encounter ED]. ED admit decision date and time. - -Calculate the ED time in minutes for each person in the measure population; report the median time for all calculations performed. The specification provides elements from the clinical electronic record required to calculate for each ED encounter, i.e., the length of time the patient was in the Emergency Department from the time of decision to admit, also stated as: the Datetime difference for the Emergency Department discharge time minus the Decision to Admit Time. The calculation requires the median across all ED encounter durations. - -For each population, results should be reported without stratification and then with each stratum applied. For this measure, the number of encounters that fall into the Initial Population are reported without stratification, then reported according to the defined stratification. The number of encounters that fall into the Measure Population are reported without stratification, then reported according to the defined stratification. The computed continuous variable defined by the Measure Observation is reported for the Measure Population also, then reported according to the defined stratification.TBDInpatient Encounters ending during the measurement period with Length of Stay (Discharge Date minus Admission Date) less than or equal to 120 days.Not ApplicableNot ApplicableNot ApplicableNot ApplicableNot ApplicableInpatient Encounters where the decision to admit was made during the preceding emergency department visit.Not ApplicableTime (in minutes) from Decision to Admit to ED discharge for patients admitted to the facility from the emergency department.For every patient evaluated by this measure, also identify payer, race, ethnicity and sex.Emergency Department - - \ No newline at end of file diff --git a/test/fixtures/hqmf/simplexml/CMS113v4_SimpleXML.xml b/test/fixtures/hqmf/simplexml/CMS113v4_SimpleXML.xml deleted file mode 100755 index 051f3072..00000000 --- a/test/fixtures/hqmf/simplexml/CMS113v4_SimpleXML.xml +++ /dev/null @@ -1,15 +0,0 @@ -40280381-4c18-79df-014c-234fb44c0145Elective DeliveryElective Delivery113fd7ca18d-b56d-4bca-af35-71ce36b152464.0.0000000010100001231The Joint CommissionThe Joint CommissionNational Quality ForumPatients with elective vaginal deliveries or elective cesarean births at >= 37 and < 39 weeks of gestation completedMeasure specifications are in the Public Domain - -LOINC(R) is a registered trademark of the Regenstrief Institute. - -This material contains SNOMED Clinical Terms (R) (SNOMED CT(c)) copyright 2004-2014 International Health Terminology Standards Development Organization. All rights reserved.These performance measures are not clinical guidelines and do not establish a standard of medical care, and have not been tested for all potential applications. The measures and specifications are provided without warranty.ProportionProcessNoneNoneNoneFor almost 3 decades, the American College of Obstetricians and Gynecologists (ACOG) and the American Academy of Pediatrics (AAP) have had in place a standard requiring 39 completed weeks gestation prior to ELECTIVE delivery, either vaginal or operative (ACOG, 1996). A survey conducted in 2007 of almost 20,000 births in HCA hospitals throughout the U.S. carried out in conjunction with the March of Dimes at the request of ACOG revealed that almost 1/3 of all babies delivered in the United States are electively delivered with 5% of all deliveries in the U.S. delivered in a manner violating ACOG/AAP guidelines. Most of these are for convenience, and result in significant short term neonatal morbidity (neonatal intensive care unit admission rates of 13- 21%) (Clark et al., 2009). - -According to Glantz (2005), compared to spontaneous labor, elective inductions result in more cesarean births and longer maternal length of stay. The American Academy of Family Physicians (2000) also notes that elective induction doubles the cesarean delivery rate. Repeat elective cesarean births before 39 weeks gestation also result in higher rates of adverse respiratory outcomes, mechanical ventilation, sepsis and hypoglycemia for the newborns (Tita et al., 2009).Guidelines from the American College of Obstetricians and Gynecologists and the American Academy of Pediatrics do not support non-medically indicated elective deliveries at <39 weeks gestation. Evidence suggests that early term deliveries result in significant short term neonatal morbidity. Therefore, it is recommended that elective deliveries should not be performed at <39 weeks gestation unless medically-indicated.Improvement noted as a decrease in the rateAmerican Academy of Family Physicians. (2000). Tips from Other Journals: Elective induction doubles cesarean delivery rate, 61, 4.Retrieved December 29, 2008 at: http://www.aafp.org/afp/2000/0215/p1173.htmlAmerican College of Obstetricians and Gynecologists. (November 1996). ACOG Educational Bulletin. Clark, S., Miller, D., Belfort, M., Dildy, G., Frye, D., & Meyers, J. (2009). Neonatal and maternal outcomes associated with elective delivery. [Electronic Version]. Am J Obstet Gynecol. 200:156.e1-156.e4. Glantz, J. (Apr.2005). Elective induction vs. spontaneous labor associations and outcomes. [Electronic Version]. J Reprod Med. 50(4):235-40.Tita, A., Landon, M., Spong, C., Lai, Y., Leveno, K., Varner, M, et al. (2009). Timing of elective repeat cesarean delivery at term and neonatal outcomes. [Electronic Version]. NEJM. 360:2, 111-120.NoneThe unit of measurement for this measure is an inpatient episode of care. Each distinct hospitalization should be reported, regardless of whether the same patient is admitted for inpatient care more than once during the measurement period. In addition, the eMeasure logic intends to represent events within or surrounding a single occurrence of an inpatient hospitalization. - -Wherever the gestational age is mentioned with relative timing to delivery, the intent is to capture the estimated gestational age on the day of delivery. - -Gestational age should be rounded off to the nearest completed week, not the following week. For example, an infant born on the 5th day of the 36th week (35 weeks and 5/7 days) is at a gestational age of 35 weeks, not 36 weeks.TBDPatients age >= 8 years and < 65 admitted to the hospital for inpatient acute care and had a length of stay < 120 days who undergo a delivery procedurePatients delivering newborns with >= 37 and < 39 weeks of gestation completedPatients with conditions possibly justifying elective delivery prior to 39 weeks gestationPatients with elective deliveries by either: - - Medical induction of labor while not in labor prior to the procedure - - Cesarean birth while not in labor and with no history of a prior uterine surgeryNot ApplicableNoneNot ApplicableNot ApplicableNot ApplicableFor every patient evaluated by this measure also identify payer, race, ethnicity and sex.eMeasure Perinatal Care (ePC) - - \ No newline at end of file diff --git a/test/fixtures/hqmf/simplexml/CMS114v4_SimpleXML.xml b/test/fixtures/hqmf/simplexml/CMS114v4_SimpleXML.xml deleted file mode 100755 index 981d8a3e..00000000 --- a/test/fixtures/hqmf/simplexml/CMS114v4_SimpleXML.xml +++ /dev/null @@ -1,13 +0,0 @@ -40280381-4c18-79df-014c-2e3345ce0c63Incidence of Potentially-Preventable Venous ThromboembolismVTE-611432cfc834-843a-4f45-b359-8e158eac43964.0.0000000010100001231The Joint CommissionThe Joint CommissionThis measure assesses the number of patients diagnosed with confirmed VTE during hospitalization (not present at admission) who did not receive VTE prophylaxis between hospital admission and the day before the VTE diagnostic testing order date.Measure specifications are in the Public Domain. - -LOINC(R) is a registered trademark of the Regenstrief Institute. - -This material contains SNOMED Clinical Terms (R) (SNOMED CT[C]) copyright 2004-2014 International Health Terminology Standards Development Organization. All rights reserved.These performance measures are not clinical guidelines and do not establish a standard of medical care, and have not been tested for all potential applications. The measures and specifications are provided without warranty.ProportionOutcomeNoneNoneNoneThe concept of "failure to prevent" has generated interest in national health policy organizations to identify evidence-based practice that will improve patient safety in the hospital setting (Wachter et al 2001). The incidence of preventable venous thromboembolism (VTE) among hospitalized patients is overwhelming, and contributes to extended hospital stays, and the rising cost of health care. Zhan 2003, states that "VTE was the second most common medical complication of postoperative patients, the second most common cause of excess length of stay, and the third most common cause of excess mortality and excess charges". According to Arnold, D.M. (2001), preventable VTE is defined as "objectively diagnosed Deep Vein Thrombosis (DVT) or Pulmonary Emboli (PE) that occurred in a setting in which thromboprophylaxis was indicated but was either administered inadequately or not administered at all." In spite of formal guidelines, and recommendations for preventative care, pulmonary embolism is still the most common preventable cause of death among hospitalized patients (Wachter et al, 2001).Failure to prevent VTE can result in delayed hospital discharge or readmission, increased risk for long-term morbidity from post-thrombotic syndrome, and recurrent thrombosis in the future.Improvement noted as a decrease in the rateArnold DM, Kahn SR, Shrier I. Missed opportunities for prevention of venous thromboembolism: an evaluation of the use of thromboprophylaxis guidelines. Chest. 2001 Dec;120(6):1964-71.Guyatt, G.H., Akl, E.A., Crowther, M., Gutterman, D., Schunemann, H. Antithromboitic Therapy and Prevention of Thrombosis, 9th edition: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines. CHEST 2012; 141(2)(Supp):7S-47S.Kearon C, Akl EA, Comerota AJ, Prandoni P, Bounameaux H, Goldhaber SZ, Nelson ME, Wells PS, Gould MK, Dentali F, Crowther M, Kahn SR. Antithrombotic therapy for VTE disease: antithrombotic therapy and prevention of thrombosis, 9th ed: American College of Chest Physicians evidence-based clinical practice guidelines. Chest. 2012 Feb;141(2 Suppl):e419S-94S.Wachter, R., Shojania KG, Duncan, B.W., McDonald, K.W., et al. Making health care safer: a critical analysis of patient safety practices; evidence report/ technology assessment No 43. Agency for Healthcare Research and Quality. Publication 01-E0582001.2001. Retrieved March 11, 2015 from http://archive.ahrq.gov/clinic/tp/ptsaftp.htm.Zhan, C., Miller M.R. Excessive length of stay, charges and mortality attributable to medical injures during hospitalization. JAMA 2003; 290:1868-1874.NoneCMS recognizes the difficulty in capturing the VTE confirmed concept required in this measure and suggests eligible hospitals participating in the Medicare & Medicaid EHR Incentive Programs consider selecting alternative electronic clinical quality measures (eCQMs) to meet program requirements for meaningful use. If suitable alternatives are unavailable, CMS will accept a 0 denominator submission for the eCQM version only for this measure. - -The unit of measurement for this measure is an inpatient episode of care. Each distinct hospitalization should be reported, regardless of whether the same patient is admitted for inpatient care more than once during the measurement period. In addition, the eMeasure logic intends to represent events within or surrounding a single occurrence of an inpatient hospitalization. - -When low dose unfractionated heparin is not administered due to medical reasons, the intended administration route is subcutaneous.TBDPatients age 18 and older discharged from hospital inpatient acute care during the measurement period with a length of stay less than or equal to 120 days with a non-principal diagnosis of venous thromboembolism (VTE). Patients who developed VTE confirmed by a diagnostic test during hospitalization.Patients with comfort measures documented -Patients with VTE present at admission -Patients with reasons for not administering mechanical and pharmacologic prophylaxisPatients who received no VTE prophylaxis prior to the VTE diagnostic test order date.Not ApplicableNoneNot ApplicableNot ApplicableNot ApplicableFor every patient evaluated by this measure also identify payer, race, ethnicity and sex.eMeasure Venous Thromboembolism (eVTE) - -Comfort measuresVTE present at admissionReasons for not administering mechanical and pharmacologic prophylaxis \ No newline at end of file diff --git a/test/fixtures/hqmf/simplexml/CMS117v4_SimpleXML.xml b/test/fixtures/hqmf/simplexml/CMS117v4_SimpleXML.xml deleted file mode 100755 index 8f3da5a5..00000000 --- a/test/fixtures/hqmf/simplexml/CMS117v4_SimpleXML.xml +++ /dev/null @@ -1,86 +0,0 @@ -40280381-4be2-53b3-014c-056c3662131dChildhood Immunization StatusChild_Imm_Status117b2802b7a-3580-4be8-9458-921aea62b78c4.0.0000000010100001231National Committee for Quality AssuranceNational Committee for Quality AssuranceNational Quality ForumPercentage of children 2 years of age who had four diphtheria, tetanus and acellular pertussis (DTaP); three polio (IPV), one measles, mumps and rubella (MMR); three H influenza type B (HiB); three hepatitis B (Hep B); one chicken pox (VZV); four pneumococcal conjugate (PCV); one hepatitis A (Hep A); two or three rotavirus (RV); and two influenza (flu) vaccines by their second birthday.Physician Performance Measure (Measures) and related data specifications were developed by the National Committee for Quality Assurance (NCQA). - -The Measures are copyrighted but can be reproduced and distributed, without modification, for noncommercial purposes (eg, use by healthcare providers in connection with their practices). Commercial use is defined as the sale, licensing, or distribution of the Measures for commercial gain, or incorporation of the Measures into a product or service that is sold, licensed or distributed for commercial gain. Commercial use of the Measures requires a license agreement between the user and NCQA. NCQA is not responsible for any use of the Measures. - -(c) 2008-2015 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 CPT or other codes contained in the specifications. - -CPT(R) contained in the Measure specifications is copyright 2004-2014 American Medical Association. LOINC(R) copyright 2004-2014 Regenstrief Institute, Inc. This material contains SNOMED Clinical Terms(R) (SNOMED CT[R]) copyright 2004-2014 International Health Terminology Standards Development Organisation. ICD-10 copyright 2014 World Health Organization. All Rights Reserved.These performance Measures are not clinical guidelines and do not establish a standard of medical care, and have not been tested for all potential applications. - -THE MEASURES 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].ProportionProcessNoneNoneNoneInfants and toddlers are particularly vulnerable to infectious diseases because their immune systems have not built up the necessary defenses to fight infection (Centers for Disease Control and Prevention 2011). Most childhood vaccines are between 90 and 99 percent effective in preventing diseases (HealthyChildren 2011). Immunization is a critical aspect of preventive care for children. Lack of proper immunization leads to an increase in illness, doctor visits and hospitalizations, all of which translate into higher costs. (Tatzlandrew, Brown, and Halpern). Vaccination of each U.S. birth cohort with the current childhood immunization schedule prevents approximately 42,000 deaths and 20 million cases of disease, and saves nearly $14 billion in direct costs and $69 billion in societal costs each year (Zhou 2011; Centers for Disease Control and Prevention 2011b). - -Immunizing a child not only protects that child's health but also the health of the community, especially for those who are not immunized or are unable to be immunized due to other health complications (Centers for Disease Control and Prevention 2009). When the majority of the community is immunized against a disease, other members of the community are also protected because herd immunity shields them. (National Institute of Allergy and Infectious Diseases 2010).Summary of Recommendations for Child/Teen Immunization (Ages birth through 18 years) (Immunization Action Coalition) based on recommendations of the Advisory Committee on Immunization Practices (ACIP, 2012) - -Hepatitis B (HepB) -- Vaccinate all children age 0 through 18 years -- Vaccinate all newborns with monovalent vaccine prior to hospital discharge. Give dose #2 at age 1-2 months and the final dose at age 6-18 months (the last dose in the infant series should not be given earlier than age 24 weeks). After the birth dose, the series may be completed using 2 doses of single-antigen vaccine or up to 3 doses of Comvax(r) (ages 2 months, 4 months 12-15 months) or Pediatrix(r) (ages 2 months, 4 months, 6 months), which may result in giving a total of 4 doses of hepatitis B vaccine. -- If mother is HBsAg-positive: give the newborn HBIG + dose #1 within 12 hours of birth; complete series at age 6 months or, if using Comvax(r), at age 12-15 months. -- If mother is HBsAg status is unknown: given the newborn dose #1 within 12 hours of birth. If low birth weight (less than 2000 grams), also give HBIG within 12 hours. For infants weighing 2000 grams or more whose mother is subsequently found to be HBsAg positive, give the infant HBIG ASAP (no later than 7 days of birth) and follow HepB immunization schedule for infants born to HBsAg-positive mothers. - -DTaP, DT vaccinations (4 Diptheria, tetanus, acellular pertussis) -- Give to children at ages 2 months, 4 months, 6 months, 15-18 months, 4-6 years.- May give dose #1 as early as age 6 weeks. -- May give #4 as early as age 12 months if 6 months have elapsed since #3. -- Do not give DTaP/DT to children age 7 years and older. -- If possible, use the same DTaP product for all doses. - -Hib (Haemophilus influenzae type b) -- ActHib(r) (PRP-T): give at age 2 months, 4 months, 6 months, 12-15 months (booster dose). -- PedvaxHIB(r) or Comvax(r) (containing PRP-OMP): give at age 2 months, 4 months, 12-15 months (booster dose). -- Dose #1 of Hib vaccine should not be given earlier than age 6 weeks. -- Give final dose (booster dose) no earlier than age 12 months and a minimum of 8 weeks after the previous dose. -- Hib vaccines are interchangeable; however, if different brands of Hib vaccines are administered for dose #1 and dose #2, a total of 3 doses is necessary to complete the primary series in infants. -- Any Hib vaccine may be used for the booster dose. -- Hib is not routinely given to children age 5 years and older. -- Hiberix(r) is approved ONLY for the booster dose at age 12 months through 4 years. - -Polio (IPV) -- Give to children at ages 2 months, 4 months, 6-18 months, 4-6 years. -- May give dose #1 as early as age 6 weeks. -- Not routinely recommended for U.S. residents age 18 years and older (except certain travelers). - -MMR (Measles, mumps, rubella) -- Give dose #1 at age 12-15 months. -- Give MMR at age 6 through 11 months if traveling internationally; then revaccinate at age 12 months (and at least 4 weeks from previous dose). The dose given at younger than 12 months does not count toward the 2-dose series. -- Give dose #2 at age 4-6 years. Dose #2 may be given earlier if at least 4 weeks since dose #1. For MMRV: dose #2 may be given earlier if at least 3 months since dose #1. -- Give a 2nd dose to all older children and teens with history of only 1 dose. - -MMRV may be used in children age 12 months through 12 years. For the first dose of MMR and varicella given at age 12-47 months, either MMR and Varicella (Var) or MMRV may be used. Unless the parent or caregiver expresses a preference for MMRV, CDC recommends that MMR and Var should be given for the first dose in this age group. - -Pneumococcal conjugate (PCV13) -- Give at ages 2 months, 4 months, 6 months, 12-15 months. -- Dose #1 may be given as early as age 6 weeks. -- When children are behind on PCV schedule, minimum interval for doses given to children younger than age 12 months is 4 weeks; for doses given at 12 months and older, it is 8 weeks. -- Give 1 dose to unvaccinated healthy children age 24-59 months. -- For high-risk children ages 24-71 months: give 2 doses at least 8 weeks apart if they previously received fewer than 3 doses; give 1 dose at least 8 weeks after the most recent dose if they previously received 3 doses. (High risk: those with sickle cell disease; anatomic or functional asplenia; chronic cardiac, pulmonary, or renal disease; diabetes; cerebrospinal fluid leaks; HIV infection; immunosuppression; diseases associated with immunosuppressive and/or radiation therapy; or who have or will have a cochlear implant.) -- PCV13 is not routinely given to healthy children age 5 years and older. - -Varicella (Var) (Chickenpox) -- Give dose #1 at age 12-15 months. -- Give dose #2 at age 4-6 years. Dose #2 of Var or MMRV may be given earlier if at least 3 months since dose #1. -- Give a 2nd dose to all older children/teens with history of only 1 dose. -- MMRV may be used in children age 12 months through 12 years. For the first dose of MMR and varicella given at age 12-47 months, either MMR and Var or MMRV may be used. Unless the parent or caregiver expresses a preference for MMRV, CDC recommends that MMR and Var should be given for the first dose in this age group. - -Hepatitis A (HepA) -- Give 2 doses spaced 6 to 18 months apart to all children at age 1 year (12-23 months). - -Rotavirus (RV) -- Rotarix(r) (RV1): give at age 2 months, 4 months. -- RotaTeq(r) (RV5): give at age 2 months, 4 months, 6 months. -- May give dose #1 as early as age 6 weeks. -- Give final dose no later than age 8 months 0 days. - -Influenza (trivalent inactivated influenza (TIV), live attenuated influenza vaccine (LAIV)) -- Vaccinate all children and teens age 6 months through 18 years. -- LAIV may be given to healthy, non-pregnant people age 2-49 years. -- Give 2 doses, spaced 4 weeks apart, to children age 6 months through 8 years who 1) are first-time vaccines or 2) failed to receive at least 1 dose of the 2010-2011 vaccine. -- For TIV, give 0.25 mL dose to children age 6-35 months and 0.5 mL dose if age 3 years and older. -- If LAIV and either MMR, Var, and/or yellow fever vaccine are not given on the same day, space them at least 28 days apart. - -Technical content reviewed by the Centers for Disease Control and Prevention, January 2012.Higher score equals better quality.Centers for Disease Control and Prevention. 2011a. "Vaccines & Immunizations: Infants and Toddlers." http://www.cdc.gov/vaccines/spec-grps/infants-toddlers.htm HealthyChildren. 2011. "Safety & Prevention: Why Immunize Your Child." http://www.healthychildren.org/english/safety-prevention/immunizations/Pages/Why-Immunize-Your-Child.aspx?nfstatus=401&nftoken=00000000-0000-0000-0000-000000000000&nfstatusdescription=ERROR%3a+No+local+token Tatzlandrew, E.J., R.E. Brown, and M.T. Halpern. 1994. "A cost-benefit analysis of the measles-mumps-rubella (MMR) vaccine." Arlington: Batelle Medical Technology Assessment and Policy Research Program.Zhou, F. 2011. "Updated economic evaluation of the routine childhood immunization schedule in the United States." Presented at the 45th National Immunization Conference. Washington, DC; March 28-31.Centers for Disease Control and Prevention. 2011b. "Ten Great Public Health Achievements --- United States, 2001-2010." MMWR 60(19):619-623.Centers for Disease Control and Prevention. 2009. "Vaccines & Immunizations: How Vaccines Prevent Disease." http://www.cdc.gov/vaccines/vac-gen/howvpd.htm National Institute of Allergy and Infectious Diseases. 2010. "Community Immunity ("Herd" Immunity)." http://www.niaid.nih.gov/topics/pages/communityimmunity.aspx Centers for Disease Control and Prevention. 2012. "Recommended Immunization Schedule for Persons Aged 0 Through 6 years - United States, 2012." MMWR 61(05):1-4.Immunization Action Coalition. 2012. "Summary of Recommendations for Child/Teen Immunization (Ages birth through 18 years)." http://www.immunize.org/catg.d/p2010.pdf Recommended vaccines: Vaccines and the schedule of vaccines as recommended by the Advisory Committee in Immunization Practices (ACIP) for children two years of age. The measure may differ slightly from the ACIP recommendations because the measure focuses on immunizations that are appropriate by age 2. Also, there may be small differences when there are shortages for a particular vaccine.For the MMR, hepatitis B, VZV and hepatitis A vaccines, numerator inclusion criteria include: evidence of receipt of the recommended vaccine; documented history of the illness; or, a seropositive test result for the antigen. For the DTaP, IPV, HiB, pneumococcal conjugate, rotavirus, and influenza vaccines, numerator inclusion criteria include only evidence of receipt of the recommended vaccine. Patients may be excepted from a particular antigen if they had an anaphylactic reaction to the vaccine. Patients may be excepted from the DTaP vaccine if they have encephalopathy. Patients may be excepted from the IPV vaccine if they have had an anaphylactic reaction to streptomycin, polymyxin B, or neomycin. Patients may be excepted from the influenza vaccines if they have cancer of lymphoreticular or histiocytic tissue, multiple myeloma, leukemia, or have had an anaphylactic reaction to neomycin. Patients may be excepted from the MMR or VZV vaccines if they have cancer of lymphoreticular or histiocytic tissue, multiple myeloma, leukemia, or have had an anaphylactic reaction to neomycin. Patients may be excepted from the hepatitis B vaccine if they have had an anaphylactic reaction to common baker's yeast. - -The measure allows a grace period by measuring compliance with these recommendations between birth and age two.TBDChildren who turn 2 years of age during the measurement period and who have a visit during the measurement periodEquals Initial PopulationNoneChildren who have evidence showing they received recommended vaccines, had documented history of the illness, had a seropositive test result, or had an allergic reaction to the vaccine by their second birthdayNot ApplicableNoneNot ApplicableNot ApplicableNot ApplicableFor every patient evaluated by this measure also identify payer, race, ethnicity and sex.None - - \ No newline at end of file diff --git a/test/fixtures/hqmf/simplexml/CMS122v4_SimpleXML.xml b/test/fixtures/hqmf/simplexml/CMS122v4_SimpleXML.xml deleted file mode 100755 index 1a59a501..00000000 --- a/test/fixtures/hqmf/simplexml/CMS122v4_SimpleXML.xml +++ /dev/null @@ -1,32 +0,0 @@ -40280381-4b9a-3825-014b-e0a9409212a3Diabetes: Hemoglobin A1c Poor ControlDiab_HbA1c_Ctrl122f2986519-5a4e-4149-a8f2-af0a1dc7f6bc4.0.0000000010100001231National Committee for Quality AssuranceNational Committee for Quality AssuranceNational Quality ForumPercentage of patients 18-75 years of age with diabetes who had hemoglobin A1c > 9.0% during the measurement period.Physician Performance Measure (Measures) and related data specifications were developed by the National Committee for Quality Assurance (NCQA). - -The Measures are copyrighted but can be reproduced and distributed, without modification, for noncommercial purposes (eg, use by healthcare providers in connection with their practices). Commercial use is defined as the sale, licensing, or distribution of the Measures for commercial gain, or incorporation of the Measures into a product or service that is sold, licensed or distributed for commercial gain. Commercial use of the Measures requires a license agreement between the user and NCQA. NCQA is not responsible for any use of the Measures. - -(C) 2008-2015 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 CPT or other codes contained in the specifications. - -CPT(R) contained in the Measure specifications is copyright 2004-2014 American Medical Association. LOINC(R) copyright 2004-2014 Regenstrief Institute, Inc. This material contains SNOMED Clinical Terms(R) (SNOMED CT[R]) copyright 2004-2014 International Health Terminology Standards Development Organisation. ICD-10 copyright 2014 World Health Organization. All Rights Reserved.These performance Measures are not clinical guidelines and do not establish a standard of medical care, and have not been tested for all potential applications. - -THE MEASURES 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].ProportionOutcomeNoneNoneNoneDiabetes mellitus (diabetes) is a group of diseases characterized by high blood glucose levels caused by the body's inability to correctly produce or utilize the hormone insulin. It is recognized as a leading cause of death and disability in the U.S. and is highly underreported as a cause of death. Diabetes may cause life-threatening, life-ending or life-altering complications, including poor circulation, nerve damage or neuropathy in the feet and eventual amputation. Nearly 60-70 percent of diabetics suffer from mild or severe nervous system damage (American Diabetes Association 2009). - -Randomized clinical trials have demonstrated that improved glycemic control, as evidenced by reduced levels of glycohemoglobin, correlates with a reduction in the development of microvascular complications in both Type 1 and Type 2 diabetes (Diabetes Control and Complications Trial Research Group 1993; Ohkubo 1995). In particular, the Diabetes Control and Complications Trial (DCCT) showed that for patients with Type 1 diabetes mellitus, important clinical outcomes such as retinopathy (an important precursor to blindness), nephropathy (which precedes renal failure), and neuropathy (a significant cause of foot ulcers and amputation in patients with diabetes) are directly related to level of glycemic control (Diabetes Control and Complications Trial Research Group 1993). Similar reductions in complications were noted in a smaller study of intensive therapy of patients with Type 2 diabetes by Ohkubo and co-workers, which was conducted in the Japanese population (Ohkubo et al. 1995).American Geriatrics Society (Brown et al. 2003): - -For frail older adults, persons with life expectancy of less than 5 years, and others in whom the risks of intensive glycemic control appear to outweigh the benefits, a less stringent target such as 8% is appropriate. (Quality of Evidence: Level III; Strength of Evidence: Grade B) - - -American Diabetes Association (2009): - -Lowering A1C to below or around 7% has been shown to reduce microvascular and neuropathic complications of type 1 and type 2 diabetes. Therefore, for microvascular disease prevention, the A1C goal for non-pregnant adults in general is <7%. (Level of Evidence: A) - -In type 1 and type 2 diabetes, randomized controlled trials of intensive versus standard glycemic control have not shown a significant reduction in CVD outcomes during the randomized portion of the trials. Long-term follow-up of the Diabetes Control and Complications Trial (DCCT) and UK Prospective Diabetes Study (UKPDS) cohorts suggests that treatment to A1C targets below or around 7% in the years soon after the diagnosis of diabetes is associated with long-term reduction in risk of macrovascular disease. Until more evidence becomes available, the general goal of <7% appears reasonable for many adults for macrovascular risk reduction. (Level of Evidence: B) - -Subgroup analyses of clinical trials such as the DCCT and UKPDS and the microvascular evidence from the Action in Diabetes and Vascular Disease: Preterax and Diamicron MR Controlled Evaluation (ADVANCE) trial suggest a small but incremental benefit in microvascular outcomes with A1C values closer to normal. Therefore, for selected individual patients, providers might reasonably suggest even lower A1C goals than the general goal of <7%, if this can be achieved without significant hypoglycemia or other adverse effects of treatment. Such patients might include those with short duration of diabetes, long life expectancy, and no significant CVD. (Level of Evidence: B) - -Conversely, less stringent A1C goals than the general goal of <7% may be appropriate for patients with a history of severe hypoglycemia, limited life expectancy, advanced microvascular or macrovascular complications, and extensive comorbid conditions and those with longstanding diabetes in whom the general goal is difficult to attain despite diabetes self-management education, appropriate glucose monitoring, and effective doses of multiple glucose lowering agents including insulin. (Level of Evidence: C)Lower score indicates better qualityAmerican Diabetes Association. 2009. "Standards of Medical Care in Diabetes-2009." Diabetes Care 2009 32 (Suppl 1):S6-S12.Brown, A.F., C.M. Mangione, D. Saliba, C.A. Sarkisian. California Healthcare Foundation/American Geriatrics Society Panel on Improving Care for Elders with Diabetes. 2003. "Guidelines for Improving the Care of the Older Person with Diabetes Mellitus." J Am Geriatr Soc 51(5 Suppl Guidelines):S265-80.The Diabetes Control and Complications Trial Research Group. 1994. "The effect of intensive treatment of diabetes and progression of long-term complications in insulin-dependent mellitus." N Engl J Med 329:977-86.Ohkubo Y., H. Kishikawa, E. Araki, T. Miyata, S. Isami, S. Motoyoshi, Y. Kojima, N. Furuyoshi, M. Shichiri. 1995. "Intensive insulin therapy prevents the progression of diabetic microvascular complications in Japanese patients with non-insulin-dependent diabetes mellitus: a randomized prospective 6-year study." Diabetes Res Clin Pract 28(2):103-17.NonePatient is numerator compliant if most recent HbA1c level >9%, the most recent HbA1c result is missing, or if there are no HbA1c tests performed and results documented during the measurement period. - -Only patients with a diagnosis of Type 1 or Type 2 diabetes should be included in the denominator of this measure; patients with a diagnosis of secondary diabetes due to another condition should not be included.TBDPatients 18-75 years of age with diabetes with a visit during the measurement periodEquals Initial PopulationNonePatients whose most recent HbA1c level (performed during the measurement period) is >9.0%Not ApplicableNoneNot ApplicableNot ApplicableNot ApplicableFor every patient evaluated by this measure also identify payer, race, ethnicity and sex.None - - \ No newline at end of file diff --git a/test/fixtures/hqmf/simplexml/CMS123v4_SimpleXML.xml b/test/fixtures/hqmf/simplexml/CMS123v4_SimpleXML.xml deleted file mode 100755 index 562e6970..00000000 --- a/test/fixtures/hqmf/simplexml/CMS123v4_SimpleXML.xml +++ /dev/null @@ -1,15 +0,0 @@ -40280381-4c18-79df-014c-2e72bd870d38Diabetes: Foot ExamDiab_Foot123c0d72444-7c26-4863-9b51-8080f8928a854.0.0000000010100001231National Committee for Quality AssuranceNational Committee for Quality AssuranceNational Quality ForumPercentage of patients aged 18-75 years of age with diabetes who had a foot exam during the measurement period.Physician Performance Measure (Measures) and related data specifications were developed by the National Committee for Quality Assurance (NCQA). - -The Measures are copyrighted but can be reproduced and distributed, without modification, for noncommercial purposes (eg, use by healthcare providers in connection with their practices). Commercial use is defined as the sale, licensing, or distribution of the Measures for commercial gain, or incorporation of the Measures into a product or service that is sold, licensed or distributed for commercial gain. Commercial use of the Measures requires a license agreement between the user and NCQA. NCQA is not responsible for any use of the Measures. - -(C) 2008-2015 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 CPT or other codes contained in the specifications. - -CPT(R) contained in the Measure specifications is copyright 2004-2014 American Medical Association. LOINC(R) copyright 2004-2014 Regenstrief Institute, Inc. This material contains SNOMED Clinical Terms(R) (SNOMED CT[R]) copyright 2004-2014 International Health Terminology Standards Development Organisation. ICD-10 copyright 2014 World Health Organization. All Rights Reserved.These performance Measures are not clinical guidelines and do not establish a standard of medical care, and have not been tested for all potential applications. - -THE MEASURES 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].ProportionProcessNoneNoneNoneDiabetes mellitus (diabetes) is a group of diseases characterized by high blood glucose levels caused by the body's inability to correctly produce or utilize the hormone insulin. It is recognized as a leading cause of death and disability in the U.S. and is highly underreported as a cause of death. Diabetes may cause life-threatening, life-ending or life-altering complications, including poor circulation, nerve damage or neuropathy in the feet and eventual amputation. Nearly 60-70 percent of diabetics suffer from mild or severe nervous system damage. The consensus among established clinical guidelines is that patients with diabetes should have a foot exam soon after diagnosis and annually thereafter. Comprehensive foot care programs can lower amputation rates by 45-85 percent (American Diabetes Association 2009).American Diabetes Association (2009) Guidelines/ Recommendations: Perform annual comprehensive foot examination to identify risk factors predictive of ulcers and amputations. The foot examination should include inspection, assessment of foot pulses, and testing for loss of protective sensation (10-g monofilament plus testing any one of: vibration using 128-Hz tuning fork, pinprick sensation, ankle reflexes, or vibration perception threshold).Higher score indicates better qualityAmerican Diabetes Association. 2009. "Standards of Medical Care in Diabetes-2009." Diabetes Care 2009 32 (Suppl 1):S6-S12. doi:10.2337/dc09-S006.Foot exam: visual inspection with either a sensory exam or a pulse examOnly patients with a diagnosis of Type 1 or Type 2 diabetes should be included in the denominator of this measure; patients with a diagnosis of secondary diabetes due to another condition should not be included.TBDPatients 18-75 years of age with diabetes with a visit during the measurement periodEquals Initial PopulationPatients who have had either a bilateral amputation above or below the knee, or both a left and right amputation above or below the knee before or during the measurement periodPatients who received visual, pulse and sensory foot examinations during the measurement periodNoneNoneNot ApplicableNot ApplicableNot ApplicableFor every patient evaluated by this measure also identify payer, race, ethnicity and sex.None - - \ No newline at end of file diff --git a/test/fixtures/hqmf/simplexml/CMS124v4_SimpleXML.xml b/test/fixtures/hqmf/simplexml/CMS124v4_SimpleXML.xml deleted file mode 100755 index 2986995d..00000000 --- a/test/fixtures/hqmf/simplexml/CMS124v4_SimpleXML.xml +++ /dev/null @@ -1,26 +0,0 @@ -40280381-4b9a-3825-014b-e05f923d1119Cervical Cancer ScreeningCervical_Cancer12442e7e489-790f-427a-a1a6-d6e807f65a6d4.0.0000000010100001231National Committee for Quality AssuranceNational Committee for Quality AssuranceNational Quality ForumPercentage of women 21-64 years of age, who received one or more Pap tests to screen for cervical cancer.Physician Performance Measure (Measures) and related data specifications were developed by the National Committee for Quality Assurance (NCQA). - -The Measures are copyrighted but can be reproduced and distributed, without modification, for noncommercial purposes (eg, use by healthcare providers in connection with their practices). Commercial use is defined as the sale, licensing, or distribution of the Measures for commercial gain, or incorporation of the Measures into a product or service that is sold, licensed or distributed for commercial gain. Commercial use of the Measures requires a license agreement between the user and NCQA. NCQA is not responsible for any use of the Measures. - -(C) 2008-2015 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 CPT or other codes contained in the specifications. - -CPT(R) contained in the Measure specifications is copyright 2004-2014 American Medical Association. LOINC(R) copyright 2004-2014 Regenstrief Institute, Inc. This material contains SNOMED Clinical Terms(R) (SNOMED CT[R]) copyright 2004-2014 International Health Terminology Standards Development Organisation. ICD-10 copyright 2014 World Health Organization. All Rights Reserved.These performance Measures are not clinical guidelines and do not establish a standard of medical care, and have not been tested for all potential applications. - -THE MEASURES 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].ProportionProcessNoneNoneNoneCervical cancer has a high survival rate when detected early, yet it is the second most common cancer among women worldwide (Myers et al. 2008). In the United States, about 12,000 women are diagnosed with cervical cancer each year. In 2010, more than 4,000 women died from cervical cancer (American Cancer Society 2010). For women in whom pre-cancerous lesions have been detected through Pap tests, the likelihood of survival is nearly 100 percent with appropriate evaluation, treatment and follow-up (American Cancer Society 2011). For women under 50 years old, cervical cancer is diagnosed in the early stage 61 percent of the time (American Cancer Society 2010). In 2008, the prevalence of recent Pap test use was lowest among older women, women with no health insurance and recent immigrants (American Cancer Society 2011).U.S. Preventive Services Task Force (USPSTF) (2003) -Grade: A Recommendation. The USPSTF strongly recommends screening for cervical cancer in women who have been sexually active and have a cervix. -Grade: D Recommendation. The USPSTF recommends against routinely screening women older than age 65 for cervical cancer if they have had adequate recent screening with normal Pap smears and are not otherwise at high risk for cervical cancer. -Grade: D Recommendation. The USPSTF recommends against routine Pap smear screening in women who have had a total hysterectomy for benign disease. -Grade: I Statement. The USPSTF concludes that the evidence is insufficient to recommend for or against the routine use of new technologies to screen for cervical cancer. -Grade: I recommendation. The USPSTF concludes that the evidence is insufficient to recommend for or against the routine use of human papillomavirus (HPV) testing as a primary screening test for cervical cancer. -Kaiser Permanente National Cervical Cancer Screening Guideline Development Team, 2006 -Recommendations 1A-D: Effectiveness of Cervical Cancer Primary Screening Tests in Asymptomatic, Average-Risk Women -* Routine cervical cancer screening is recommended for all asymptomatic, average-risk women. (Evidence-based: B) -* Either of the following tests are options for cervical cancer screening in asymptomatic, average-risk women under age 30. -* Conventional cytology (Evidence-based: B) -* Liquid-based cytology (Consensus-based)Higher score equals better quality.American Cancer Society. 2011. Cancer Prevention & Early Detection Facts & Figures 2011. Atlanta: American Cancer Society. Myers, E., K.H. Warner, J.D. Wright, J.S. Smith. 2008. "The current and future role of screening in the era of HPV vaccination." Gynecologic Oncology 109:S31-S39.U.S. Preventive Services Task Force. 2003. Screening for cervical cancer: recommendations and rationale. Rockville: Agency for Healthcare Research and Quality. Kaiser Permanente National Cervical Cancer Screening Guideline Development Team. 2006. Cervical cancer screening guideline. Oakland: Kaiser Permanente Care Management Institute.American Cancer Society. 2010. Cancer Facts & Figures 2010. Atlanta: American Cancer Society. NoneNoneTBDWomen 23-64 years of age with a visit during the measurement periodEquals Initial PopulationWomen who had a hysterectomy with no residual cervixWomen with one or more Pap tests during the measurement period or the two years prior to the measurement periodNot ApplicableNoneNot ApplicableNot ApplicableNot ApplicableFor every patient evaluated by this measure also identify payer, race, ethnicity and sex.None - - \ No newline at end of file diff --git a/test/fixtures/hqmf/simplexml/CMS125v4_SimpleXML.xml b/test/fixtures/hqmf/simplexml/CMS125v4_SimpleXML.xml deleted file mode 100755 index 60030c8e..00000000 --- a/test/fixtures/hqmf/simplexml/CMS125v4_SimpleXML.xml +++ /dev/null @@ -1,26 +0,0 @@ -40280381-4b9a-3825-014b-e10b1e0a13dbBreast Cancer ScreeningBreast_Cancer_Screen12519783c1b-4fd1-46c1-8a96-a2f192b97ee04.0.0000000010100001231National Committee for Quality AssuranceNational Committee for Quality AssurancePercentage of women 40-69 years of age who had a mammogram to screen for breast cancer.Physician Performance Measure (Measures) and related data specifications were developed by the National Committee for Quality Assurance (NCQA). - -The Measures are copyrighted but can be reproduced and distributed, without modification, for noncommercial purposes (eg, use by healthcare providers in connection with their practices). Commercial use is defined as the sale, licensing, or distribution of the Measures for commercial gain, or incorporation of the Measures into a product or service that is sold, licensed or distributed for commercial gain. Commercial use of the Measures requires a license agreement between the user and NCQA. NCQA is not responsible for any use of the Measures. - -(C) 2008-2015 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 CPT or other codes contained in the specifications. - -CPT(R) contained in the Measure specifications is copyright 2004-2014 American Medical Association. LOINC(R) copyright 2004-2014 Regenstrief Institute, Inc. This material contains SNOMED Clinical Terms(R) (SNOMED CT[R]) copyright 2004-2014 International Health Terminology Standards Development Organisation. ICD-10 copyright 2014 World Health Organization. All Rights Reserved.These performance Measures are not clinical guidelines and do not establish a standard of medical care, and have not been tested for all potential applications. - -THE MEASURES 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].ProportionProcessNoneNoneNoneBreast cancer is one of the most common types of cancers, accounting for a quarter of all new cancer diagnoses for women in the U.S. (BreastCancer.Org, 2011). It ranks as the second leading cause of cancer-related mortality in women, accounting for nearly 40,000 estimated deaths in 2013 (American Cancer Society, 2011). - -According to the National Cancer Institute's Surveillance Epidemiology and End Results program, the chance of a woman being diagnosed with breast cancer in a given year increases with age. By age 30, it is one in 2,212. By age 40, the chances increase to one in 235, by age 50, it becomes one in 54, and, by age 60, it is one in 25. From 2004 to 2008, the median age at the time of breast cancer diagnosis was 61 years among adult women (Tangka et al, 2010). - -In the U.S., costs associated with a diagnosis of breast cancer range from $451 to $2,520, factoring in continued testing, multiple office visits and varying procedures. The total costs related to breast cancer add up to nearly $7 billion per year in the U.S., including $2 billion spent on late-stage treatment (Lavigne et al, 2008; Boykoff et al, 2009).The U.S. Preventive Services Task Force (USPSTF) recommends biennial screening mammography for women aged 50-74 years (B recommendation). The decision to start regular, biennial screening mammography before the age of 50 years should be an individual one and take patient context into account, including the patient's values regarding specific benefits and harms (C recommendation). (USPSTF, 2009) The Task Force concludes the evidence is insufficient to assess the additional benefits and harms of screening mammography in women 75 years and older (I statement). -U.S. Preventive Services Task Force (2009) -Grade: B recommendation. The USPSTF recommends biennial screening mammography for women aged 50 to 74 years. -Grade: C recommendation. The decision to start regular, biennial screening mammography before the age of 50 years should be an individual one and take patient context into account, including the patient's values regarding specific benefits and harms. -Grade: I Statement. The USPSTF concludes that the current evidence is insufficient to assess the additional benefits and harms of screening mammography in women 75 years or older. -Grade: D recommendation. The USPSTF recommends against teaching breast self-examination (BSE). -Grade: I Statement. The USPSTF concludes that the current evidence is insufficient to assess the additional benefits and harms of clinical breast examination (CBE) beyond screening mammography in women 40 years or older. -Grade: I Statement. The USPSTF concludes that the current evidence is insufficient to assess the additional benefits and harms of either digital mammography or magnetic resonance imaging (MRI) instead of film mammography as screening modalities for breast cancer.Higher score equals better quality.American Cancer Society. 2010. Cancer Facts & Figures 2010. Atlanta: American Cancer Society. National Cancer Institute. 2010. "Breast Cancer Screening." http://www.cancer.gov/cancertopics/pdq/screening/breast/healthprofessionalNational Business Group on Health. 2011. Pathways to Managing Cancer in the Workplace. Washington: National Business Group on Health. U.S. Preventive Services Task Force (USPSTF). 2009. 1) "Screening for breast cancer: U.S. Preventive Services Task Force recommendation statement." 2) "December 2009 addendum." Ann Intern Med 151(10):716-726.American Cancer Society. 2010. Cancer Facts & Figures 2010. Atlanta: American Cancer Society. National Cancer Institute. 2010. "Breast Cancer Screening." http://www.cancer.gov/cancertopics/pdq/screening/breast/healthprofessionalNational Business Group on Health. 2011. Pathways to Managing Cancer in the Workplace. Washington: National Business Group on Health. U.S. Preventive Services Task Force (USPSTF). 2009. 1) "Screening for breast cancer: U.S. Preventive Services Task Force recommendation statement." 2) "December 2009 addendum." Ann Intern Med 151(10):716-726.BreastCancer.org. 2012. U.S. Breast Cancer Statistics. www.breastcancer.org/symptoms/understand_bc/statistics.jspNoneNoneTBDWomen 41-69 years of age with a visit during the measurement periodEquals Initial PopulationWomen who had a bilateral mastectomy or for whom there is evidence of two unilateral mastectomiesWomen with one or more mammograms during the measurement period or the year prior to the measurement periodNot ApplicableNoneNot ApplicableNot ApplicableNot ApplicableFor every patient evaluated by this measure also identify payer, race, ethnicity and sex.None - - \ No newline at end of file diff --git a/test/fixtures/hqmf/simplexml/CMS126v4_SimpleXML.xml b/test/fixtures/hqmf/simplexml/CMS126v4_SimpleXML.xml deleted file mode 100755 index 1eb58fc1..00000000 --- a/test/fixtures/hqmf/simplexml/CMS126v4_SimpleXML.xml +++ /dev/null @@ -1,32 +0,0 @@ -40280381-4b9a-3825-014b-bd9841640641Use of Appropriate Medications for AsthmaMed for Asthma12659e84144-6332-4369-aebd-03a7899ca3da4.0.0000000010100001231National Committee for Quality AssuranceNational Committee for Quality AssuranceNational Quality ForumPercentage of patients 5-64 years of age who were identified as having persistent asthma and were appropriately prescribed medication during the measurement period.Physician Performance Measure (Measures) and related data specifications were developed by the National Committee for Quality Assurance (NCQA). - -The Measures are copyrighted but can be reproduced and distributed, without modification, for noncommercial purposes (eg, use by healthcare providers in connection with their practices). Commercial use is defined as the sale, licensing, or distribution of the Measures for commercial gain, or incorporation of the Measures into a product or service that is sold, licensed or distributed for commercial gain. Commercial use of the Measures requires a license agreement between the user and NCQA. NCQA is not responsible for any use of the Measures. - -(C) 2008-2015 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 CPT or other codes contained in the specifications. - -CPT(R) contained in the Measure specifications is copyright 2004-2014 American Medical Association. LOINC(R) copyright 2004-2014 Regenstrief Institute, Inc. This material contains SNOMED Clinical Terms(R) (SNOMED CT[R]) copyright 2004-2014 International Health Terminology Standards Development Organisation. ICD-10 copyright 2014 World Health Organization. All Rights Reserved.These performance Measures are not clinical guidelines and do not establish a standard of medical care, and have not been tested for all potential applications. - -THE MEASURES 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].ProportionProcessReport a total score, and each of the following strata: -Stratum 1: Patients age 5-11 -Stratum 2: Patients age 12-18 -Stratum 3: Patients age 19-50 -Stratum 4: Patients age 51-64NoneNoneAsthma is one of the most prevalent chronic diseases, becoming increasingly more commonplace over the past twenty years. Approximately 24.6 million Americans have asthma, and it is responsible for over 3,000 deaths in the U.S. annually (American Lung Association 2010). In 2006, 13.3 million clinical visits (hospital, outpatient, emergency department, and physician offices) were attributed to asthma (Centers for Disease Control and Prevention 2009). The incidence rate, and subsequently the number of asthma-related health visits, is expected to increase by an additional 100 million globally by 2025 (World Health Organization 2007). - -Asthma accounts for over $20 billion spent on health care in the United States. Direct costs, including prescriptions, make up $15.6 billion of that total. Indirect costs, such as lost productivity, add an additional $5.1 billion (Centers for Disease Control and Prevention 2009). Inpatient hospitalization accounts for over 50 percent of overall asthma-related costs (Bahadori et al. 2009). In addition to the direct financial burden, asthma is also a leading cause of absenteeism and productivity, accounting for an estimated 14.2 million missed workdays for adults and over 14 million missed school days for children (Akinbami et al. 2009). Studies have shown that the indirect costs of asthma are becoming a growing financial burden on patients, and resulting in significant additional costs (Bahadori et al. 2009). - -Appropriate medication management could potentially prevent a significant proportion of asthma-related costs (hospitalizations, emergency room visits and missed work and school days) (Akinbami et al. 2009). The Asthma Regional Council supported this inference, stating that proper management could potentially save at least 25 percent of total asthma costs, or $5 billion, nationally by reducing health care costs (American Lung Association 2009). - -Another initiative, the Children's Health Fund's Childhood Asthma Initiative, examined patients enrolled in an asthma intervention program. Results illustrated that treatment that aligned with clinical guidelines reduced the severity of symptoms experienced, as well as asthma-related events (e.g., hospitalizations, emergency room visits, etc.) (Columbia University 2010). Additionally, subsequent savings attributed to improved clinical outcomes totaled to nearly $4.2 million or $4,525 per patient. This translated to a significant reduction in federally subsidized and private insurance-based costs for this population (Columbia University 2010).National Heart Lung and Blood Institute/National Asthma and Education Prevention Program (2007) -* Long-term control medications (include inhaled corticosteroids (ICSs), inhaled long-acting bronchodilators, leukotriene modifiers, cromolyn, theophylline, and immunomodulators) are used daily to achieve and maintain control of persistent asthma. The most effective are those that attenuate the underlying inflammation characteristic of asthma. The Expert Panel defines anti-inflammatory medications as those that cause a reduction in the markers of airway inflammation in airway tissue or airway secretions (e.g., eosinophils, mast cells, activated lymphocytes, macrophages, and cytokines; or Eosinophil cationic protein (ECP) and tryptase; or extravascular leakage of albumin, fibrinogen, or other vascular protein). -* Inhaled corticosteroids are the preferred treatment option for mild persistent asthma in adults and children. Leukotriene Receptor Antagonists (LTRAs) are an alternative, although not preferred, treatment. -* Long-acting beta-2 agonists (LABAs) should only be used in combination with ICSs for long-term control and prevention of symptoms in moderate or severe persistent asthma (step 3 care or higher in children =5 years of age and adults). There is a strong recommendation against the use of LABAs as monotherapy. Of the adjunctive therapies available, long-acting beta-2 agonists is the preferred therapy to combine with ICS in youths =12 years of age and adults. -* The beneficial effects of long-acting beta-2 agonists in combination therapy for the great majority of patients who require more therapy than low-dose ICS alone to control asthma (i.e., require step 3 care or higher) should be weighed against the increased risk of severe exacerbations, although uncommon, associated with the daily use of long-acting beta-2 agonists (see discussion in text). -* The NHLBI/NAEPP guideline strongly recommends against the use of long-acting beta-2 agonists for the treatment of acute symptoms or exacerbations.Higher score indicates better qualityAkinbami, L.J., J.E. Moorman, P.L. Garbe, E.J. Sondik. 2009. "Status of Childhood Asthma, United States, 1980-2007." Pediatrics 123 (Supplement 3):S131-45. American Lung Association. 2010. Trends in Asthma Morbidity and Mortality. http://www.lung.org/finding-cures/our-research/trend-reports/asthma-trend-report.pdf -Bahadori, K., M.M. Doyle-Waters, C. Marra, L. Lynd, K. Alasaly, J. Swiston, J.M. FitzGerald. 2009. "Economic burden of asthma: a systematic review." BMC Pulm Med 9(24): 1-16. -Centers for Disease Control and Prevention. 2009. "Asthma: A Presentation of Asthma Management and Prevention." http://www.cdc.gov/asthma/speakit/default.htmColumbia University. 2010. "Best Practice Asthma Program Saves the US Healthcare System More than $4500 a Year per Child." http://www.mailman.columbia.edu/news/best-practice-asthma-program-saves-us-healthcare-system-more-4500-year-child National Heart Lung and Blood Institute/National Asthma Education and Prevention Program. 2007. Measures of asthma assessment and monitoring: Expert panel report 3: guidelines for the diagnosis and management of asthma. Washington: National Heart Lung and Blood Institute (NHLBI).World Health Organization. 2007. Global surveillance, prevention and control of chronic respiratory diseases: a comprehensive approach. http://www.who.int/gard/publications/GARD_Manual/en/index.htmlNoneNoneTBDPatients 5-64 years of age with persistent asthma and a visit during the measurement periodEquals Initial PopulationPatients with emphysema, COPD, cystic fibrosis or acute respiratory failure during or prior to the measurement periodPatients who were dispensed at least one prescription for a preferred therapy during the measurement periodNot ApplicableNoneNot ApplicableNot ApplicableNot ApplicableFor every patient evaluated by this measure also identify payer, race, ethnicity and sex.None - - \ No newline at end of file diff --git a/test/fixtures/hqmf/simplexml/CMS127v4_SimpleXML.xml b/test/fixtures/hqmf/simplexml/CMS127v4_SimpleXML.xml deleted file mode 100755 index 7c194ae5..00000000 --- a/test/fixtures/hqmf/simplexml/CMS127v4_SimpleXML.xml +++ /dev/null @@ -1,21 +0,0 @@ -40280381-4be2-53b3-014c-0f589c1a1c39Pneumonia Vaccination Status for Older AdultsPneu_Vacc_Status12759657b9b-01bf-4979-a090-8534da1d05164.0.0000000010100001231National Committee for Quality AssuranceNational Committee for Quality AssuranceNational Quality ForumPercentage of patients 65 years of age and older who have ever received a pneumococcal vaccine.Physician Performance Measure (Measures) and related data specifications were developed by the National Committee for Quality Assurance (NCQA). - -The Measures are copyrighted but can be reproduced and distributed, without modification, for noncommercial purposes (eg, use by healthcare providers in connection with their practices). Commercial use is defined as the sale, licensing, or distribution of the Measures for commercial gain, or incorporation of the Measures into a product or service that is sold, licensed or distributed for commercial gain. Commercial use of the Measures requires a license agreement between the user and NCQA. NCQA is not responsible for any use of the Measures. - -(c) 2008-2015 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 CPT or other codes contained in the specifications. - -CPT(R) contained in the Measure specifications is copyright 2004-2014 American Medical Association. LOINC(R) copyright 2004-2014 Regenstrief Institute, Inc. This material contains SNOMED Clinical Terms(R) (SNOMED CT[R]) copyright 2004-2014 International Health Terminology Standards Development Organisation. ICD-10 copyright 2014 World Health Organization. All Rights Reserved.These performance Measures are not clinical guidelines and do not establish a standard of medical care, and have not been tested for all potential applications. - -THE MEASURES 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].ProportionProcessNoneNoneNonePneumonia is a common cause of illness and death in the elderly and persons with certain underlying conditions such as heart failure, diabetes, cystic fibrosis, asthma, sickle cell anemia, or chronic obstructive pulmonary disease (NHLBI, 2011). In 1998, an estimated 3,400 adults aged > 65 years died as a result of invasive pneumococcal disease (IPD) (CDC, 2003). - -Among the 91.5 million US adults aged > 50 years, 29,500 cases of IPD, 502,600 cases of nonbacteremic pneumococcal pneumonia and 25,400 pneumococcal-related deaths are estimated to occur yearly; annual direct and indirect costs are estimated to total $3.7 billion and $1.8 billion, respectively. Pneumococcal disease remains a substantial burden among older US adults, despite increased coverage with 23-valent pneumococcal polysaccharide vaccine, (PPV23) and indirect benefits afforded by PCV7 vaccination of young children (Weycker, et al., 2011). - -Vaccination has been found to be effective against bacteremic cases (OR: 0.34; 95% CI: 0.27-0.66) as well as nonbacteremic cases (OR: 0.58; 95% CI: 0.39-0.86). Vaccine effectiveness was highest against bacteremic infections caused by vaccine types (OR: 0.24; 95% CI: 0.09-0.66) (Vila-Corcoles, et al., 2009).The Advisory Committee on Immunization Practices' (ACIP) Updated Recommendations for Prevention of Invasive Pneumococcal Disease Among Adults Using the 23-Valent Pneumococcal Polysaccharide Vaccine recommends pneumococcal vaccine for all immunocompetent individuals who are 65 and older or otherwise at increased risk for pneumococcal disease. Routine revaccination is not recommended, but a second dose is appropriate for those who received PPV23 before age 65 years for any indication if at least 5 years have passed since their previous dose (USPSTF, 1989; ACIP, 2010). - -The major updates for the 2010 update are: 1) the indications for which PPSV23 vaccination is recommended now include smoking and asthma, and 2) routine use of PPSV23 is no longer recommended for Alaska Natives or American Indians aged <65 years unless they have medical or other indications for PPV23.Higher score indicates better qualityCenters for Disease Control and Prevention. Advisory Committee on Immunization Practices. 2010. "Updated Recommendations for Prevention of Invasive Pneumococcal Disease Among Adults Using the 23-Valent Pneumococcal Polysaccharide Vaccine (PPSV23)." MMWR 59(34):1102-6.Centers for Disease Control and Prevention. 2003. "Public health and aging: influenza vaccination coverage among adults aged >50 years and pneumococcal vaccination coverage among adults aged >65 years - United States, 2002." MMWR 52:987-92.National Heart, Lung and Blood Institute. 2011. "Pneumonia." http://www.nhlbi.nih.gov/health/dci/Diseases/pnu/pnu_whatis.htmlWeycker, D., D. Strutton, J. Edelsberg, R. Sato, L.A. Jackson. 2011. "Clinical and Economic Burden of Pneumococcal Disease in Older US Adults." Vaccine 28(31): 4955-60.Vila-Corcoles, A., E. Salsench, T. Rodriguez-Blanco, O. Ochoa-Gondar, C. de Diego, A. Valdivieso, I. Hospital, F. Gomez-Bertemeu, X. Raga. 2009. "Clinical effectiveness of 23-valent pneumococcal polysaccharide vaccine against pneumonia in middle-aged and older adults: A matched case-control study." Vaccine 27(10):1504-10.NoneIt is recommended that patients 65 years of age or older receive one pneumococcal vaccination in their lifetime.NonePatients 65 years of age and older with a visit during the measurement periodEquals Initial PopulationNonePatients who have ever received a pneumococcal vaccinationNot ApplicableNoneNot ApplicableNot ApplicableNot ApplicableFor every patient evaluated by this measure also identify payer, race, ethnicity and sex.None - - \ No newline at end of file diff --git a/test/fixtures/hqmf/simplexml/CMS128v4_SimpleXML.xml b/test/fixtures/hqmf/simplexml/CMS128v4_SimpleXML.xml deleted file mode 100755 index 3041c059..00000000 --- a/test/fixtures/hqmf/simplexml/CMS128v4_SimpleXML.xml +++ /dev/null @@ -1,42 +0,0 @@ -40280381-4de7-db4d-014d-e80fb801009eAnti-depressant Medication ManagementAntidep_Med_Mgmt1288924f2b3-ec06-4650-b634-d70a53dee5774.1.0000000010100001231National Committee for Quality AssuranceNational Committee for Quality AssuranceNational Quality ForumPercentage of patients 18 years of age and older who were diagnosed with major depression and treated with antidepressant medication, and who remained on antidepressant medication treatment. Two rates are reported. -a. Percentage of patients who remained on an antidepressant medication for at least 84 days (12 weeks). -b. Percentage of patients who remained on an antidepressant medication for at least 180 days (6 months).Physician Performance Measure (Measures) and related data specifications were developed by the National Committee for Quality Assurance (NCQA). - -The Measures are copyrighted but can be reproduced and distributed, without modification, for noncommercial purposes (eg, use by healthcare providers in connection with their practices). Commercial use is defined as the sale, licensing, or distribution of the Measures for commercial gain, or incorporation of the Measures into a product or service that is sold, licensed or distributed for commercial gain. Commercial use of the Measures requires a license agreement between the user and NCQA. NCQA is not responsible for any use of the Measures. - -(C) 2008-2015 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 CPT or other codes contained in the specifications. - -CPT(R) contained in the Measure specifications is copyright 2004-2014 American Medical Association. LOINC(R) copyright 2004-2014 Regenstrief Institute, Inc. This material contains SNOMED Clinical Terms(R) (SNOMED CT[R]) copyright 2004-2014 International Health Terminology Standards Development Organisation. ICD-10 copyright 2014 World Health Organization. All Rights Reserved.These performance Measures are not clinical guidelines and do not establish a standard of medical care, and have not been tested for all potential applications. - -THE MEASURES 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].ProportionProcessNoneNoneNoneDepression affects nearly 15 million adults in the U.S. (National Alliance on Mental Illness 2009) and is estimated to affect nearly a quarter of adults in their lifetime (Burcusa and Iacono 2007). Symptoms of depression include appetite and sleep disturbances, anxiety, irritability and decreased concentration (Charbonneau et al. 2005). The American Psychiatric Association recommends use of antidepressant medication and behavioral therapies, such as psychotherapy, to treat depression (American Psychiatric Association 2010). - -For the past 50 years, antidepressant medication has proven to be effective especially for patients with more severe symptoms (Fournier et al. 2010). Among patients who initiate antidepressant treatment, one in three discontinues treatment within one month, before the effect of medication can be assessed, and nearly one in two discontinues treatment within three months (Simon 2002). - -Due to increased risky behaviors for chronic disease (eg, physical inactivity, smoking, excessive drinking and insufficient sleep), evidence has shown that depressive disorders are strongly related to the occurrence of many chronic diseases including diabetes, cancer, cardiovascular disease and asthma (Centers for Disease Control and Prevention 2011). - -Aligning depression quality improvement with methods used in managing other chronic illnesses has been an important step in depression care. Depression management systems have demonstrated improved short- and long-term outcomes of depression severity and persistence, employment retention, functional status and patient satisfaction (Katon et al. 2002; Rost et al. 2001).American Psychiatric Association (APA 2010): -Successful treatment of patients with major depressive disorder is promoted by a thorough assessment of the patient and close adherence to treatment plans. Treatment consists of an acute phase, during which remission is induced; a continuation phase, during which remission is preserved; and a maintenance phase, during which the susceptible patient is protected against the recurrence of a subsequent major depressive episode. - -Acute Phase: An antidepressant medication is recommended as an initial treatment choice for patients with mild to moderate major depressive disorder [I: Recommended with substantial clinical confidence] and definitely should be provided for those with severe major depressive disorder unless electroconvulsive therapy (ECT) is planned [I: Recommended with substantial clinical confidence]. For most patients, a selective serotonin reuptake inhibitor (SSRI), serotonin norepinephrine reuptake inhibitor (SNRI), mirtazapine, or bupropion is optimal [I: Recommended with substantial clinical confidence]. In general, the use of nonselective monoamine oxidase inhibitors (MAOIs) (eg, phenelzine, tranylcypromine, isocarboxazid) should be restricted to patients who do not respond to other treatments [I: Recommended with substantial clinical confidence], given the necessity for dietary restrictions with these medications and the potential for deleterious drug-drug interactions. - -During the acute phase of treatment, patients should be carefully and systematically monitored on a regular basis to assess their response to pharmacotherapy, identify the emergence of side effects (eg, gastrointestinal symptoms, sedation, insomnia, activation, changes in weight, and cardiovascular, neurological, anticholinergic, or sexual side effects), and assess patient safety [I: Recommended with substantial clinical confidence]. If antidepressant side effects do occur, an initial strategy is to lower the dose of the antidepressant or to change to an antidepressant that is not associated with that side effect [I: Recommended with substantial clinical confidence]. - -Continuation Phase: During the continuation phase of treatment, the patient should be carefully monitored for signs of possible relapse [I: Recommended with substantial clinical confidence]. Systematic assessment of symptoms, side effects, adherence, and functional status is essential [I: Recommended with substantial clinical confidence], and may be facilitated through the use of clinician- and/or patient-administered rating scales [II: Recommended with moderate clinical confidence]. To reduce the risk of relapse, patients who have been treated successfully with antidepressant medications in the acute phase should continue treatment with these agents for 4-9 months [I: Recommended with substantial clinical confidence]. In general, the dose used in the acute phase should be used in the continuation phase [II: Recommended with moderate clinical confidence]. To prevent a relapse of depression in the continuation phase, depression-focused psychotherapy is recommended [I: Recommended with substantial clinical confidence], with the best evidence available for cognitive-behavioral therapy. - -Maintenance Phase: During the maintenance phase, an antidepressant medication that produced symptom remission during the acute phase and maintained remission during the continuation phase should be continued at a full therapeutic dose [II: Recommended with moderate clinical confidence].Higher score indicates better quality.Charbonneau, A., W. Bruning, T. Titus-Howard, E. Ellerbeck, J. Whittle, S. Hall, J. Campbell, S. Crain, S. Munro. 2005. "The community initiative on depression: report from a multiphase work site depression intervention." J Occup Environ Med 47(1):60-7.Fournier, J.C., R.J. DeRubeis, S.D. Hollon, S. Dimidjian, J.D. Amsterdam, R.C. Shelton, J. Fawcett. "Antidepressant drug effects and depression severity: A patient-level meta-analysis." JAMA 303(1): 47-53.Katon, W., J. Russo, M. Von Korff, E. Lin, G. Simon, T. Bush, E. Ludman, E. Walker. 2002. "Long-term effects of a collaborative care intervention in persistently depressed primary care patients." J Gen Intern Med 17(10):741-748.Rost, K., P. Nutting, J. Smith, J. Werner, N. Duan. 2001. "Improving depression outcomes in the community primary care practice: a randomized trial of the QuEST intervention." J Gen Intern Med 16(3):143-149.Simon, G.E. 2002. "Evidence review: efficacy and effectiveness of antidepressant treatment in primary care." Gen Hosp Psychiatry 24(4):213-24.The National Alliance on Mental Illness. 2009. "Major Depression Fact Sheet." http://www.nami.org/Template.cfm?Section=Depression&Template=/ContentManagement/ContentDisplay.cfm&ContentID=88956 (October 27, 2011)American Psychiatric Association. 2010. Practice guideline for the treatment of patients with major depressive disorder, third edition. Arlington: American Psychiatric Association.Burcusa, S.L., and W.G. Iacono. 2007. "Risk for recurrence in depression." Clin Psychol Rev 27(8): 959-85.Centers for Disease Control and Prevention (CDC). 2011. "Mental Health: Mental Health Basics." http://www.cdc.gov/mentalhealth/basics.htm (July 27, 2011)Index Episode Start Date (IESD): The earliest diagnosis of major depression during the period beginning 180 days prior to the measurement period through 180 days after the start of the measurement period. -Index Prescription Start Date (IPSD): The earliest prescription dispensing event for an antidepressant medication during the period of 30 days prior to the IESD through 14 days after the IESD. -The "continuous treatment" described in this measure allows for gaps in medication treatment up to a total 30 days during the 114-day period (numerator 1) or 51 days during the 231-day period (numerator 2). Gaps can include either gaps used to change medication, or treatment gaps to refill the same medication.To identify new treatment episodes for major depression, there must be a 90-day negative medication history (a period during which the patient was not taking antidepressant medication) prior to the first dispensing event associated with the Index Episode Start Date (Index Prescription Start Date). - -CUMULATIVE MEDICATION DURATION is an individual's total number of medication days over a specific period; the period counts multiple prescriptions with gaps in between, but does not count the gaps during which a medication was not dispensed. - -To determine the cumulative medication duration, determine first the number of the Medication Days for each prescription in the period: the number of doses divided by the dose frequency per day. Then add the Medication Days for each prescription without counting any days between the prescriptions. - -For example, there is an original prescription for 30 days with 2 refills for thirty days each. After a gap of 3 months, the medication was prescribed again for 60 days with 1 refill for 60 days. The cumulative medication duration is (30 x 3) + (60 x 2) = 210 days over the 10 month period.TBDPatients 18 years of age and older with a diagnosis of major depression in the time within 270 days (9 months) prior to the measurement period through the first 90 days (3 months) of the measurement period, who were treated with antidepressant medication, and with a visit during the measurement periodEquals Initial PopulationPatients who were actively on an antidepressant medication in the 90 days prior to the Index Prescription Start DateNumerator 1: Patients who have received antidepressant medication for at least 84 days (12 weeks) of continuous treatment during the 114-day period following the Index Prescription Start Date - -Numerator 2: Patients who have received antidepressant medications for at least 180 days (6 months) of continuous treatment during the 231-day period following the Index Prescription Start DateNot ApplicableNoneNot ApplicableNot ApplicableNot ApplicableFor every patient evaluated by this measure also identify payer, race, ethnicity and sex.None - - \ No newline at end of file diff --git a/test/fixtures/hqmf/simplexml/CMS129v5_SimpleXML.xml b/test/fixtures/hqmf/simplexml/CMS129v5_SimpleXML.xml deleted file mode 100755 index 61f4e5c1..00000000 --- a/test/fixtures/hqmf/simplexml/CMS129v5_SimpleXML.xml +++ /dev/null @@ -1,19 +0,0 @@ -40280381-4be2-53b3-014b-e5e7f0db01ceProstate Cancer: Avoidance of Overuse of Bone Scan for Staging Low Risk Prostate Cancer PatientsProstate_Cancer1291635c14d-e612-4fa6-96cd-285361aa7f7b5.0.0000000010100001231American Medical Association-convened Physician Consortium for Performance Improvement(R) (AMA-PCPI)American Medical Association-convened Physician Consortium for Performance Improvement(R) (AMA-PCPI)National Quality ForumPercentage of patients, regardless of age, with a diagnosis of prostate cancer at low risk of recurrence receiving interstitial prostate brachytherapy, OR external beam radiotherapy to the prostate, OR radical prostatectomy, OR cryotherapy who did not have a bone scan performed at any time since diagnosis of prostate cancerCopyright 2014 American Medical Association. All Rights Reserved.Physician Performance Measures (Measures) and related data specifications have been developed by the American Medical Association (AMA) - convened Physician Consortium for Performance Improvement(R) (PCPI[R]). These Measures are not clinical guidelines and do not establish a standard of medical care, and have not been tested for all potential applications. The Measures, while copyrighted, can be reproduced and distributed, without modification, for noncommercial purposes, eg, use by health care providers in connection with their practices. Commercial use is defined as the sale, license, or distribution of the Measures for commercial gain, or incorporation of the Measures into a product or service that is sold, licensed or distributed for commercial gain. Commercial uses of the Measures require a license agreement between the user and the AMA, (on behalf of the PCPI). Neither the AMA, PCPI nor its members shall be responsible for any use of the Measures. - -THE MEASURES AND SPECIFICATIONS ARE PROVIDED "AS IS" WITHOUT WARRANTY OF ANY KIND. - -Limited proprietary coding is contained in the Measure specifications for convenience. Users of the proprietary code sets should obtain all necessary licenses from the owners of these code sets. The AMA, the PCPI and its members disclaim all liability for use or accuracy of any Current Procedural Terminology (CPT[R]) or other coding contained in the specifications. - -CPT(R) contained in the Measure specifications is copyright 2004-2014 American Medical Association. LOINC(R) copyright 2004-2014 Regenstrief Institute, Inc. This material contains SNOMED Clinical Terms(R) (SNOMED CT[R]) copyright 2004-2014 International Health Terminology Standards Development Organisation. ICD-10 copyright 2014 World Health Organization. All Rights Reserved. - -Due to technical limitations, registered trademarks are indicated by (R) or [R].ProportionProcessNoneNoneNoneA bone scan is generally not required for staging prostate cancer in men with a low risk of recurrence and receiving primary therapy. This measure is written as a negative measure so that the performance goal is 100%, consistent with the other measures for this condition.Routine use of a bone scan is not required for staging asymptomatic men with clinically localized prostate cancer when their PSA level is equal to or less than 20.0 ng/mL. (AUA, 2013) - -For symptomatic patients and/or those with a life expectancy of greater than 5 years, a bone scan is appropriate for patients with any of the following: 1) T1 disease with PSA over 20 ng/mL or T2 disease with PSA over 10 ng/mL; 2) a Gleason score of 8 or higher; 3) T3 to T4 tumors; or 4) symptomatic disease. (NCCN, 2015) (Category 2A)Higher score indicates better qualityAmerican Urological Association (AUA). Guideline for the Management of Clinically Localized Prostate Cancer: 2007 update. J Urol. 2007;177:2106-2131.American Urological Association Education and Research, Inc. PSA testing for the pretreatment staging and posttreatment management of prostate cancer: 2013 Revision of 2009 Best Practice Statement. Linthicum, MD: American Urological Association Education and Research, Inc. 2013. Available at: https://www.auanet.org/common/pdf/education/clinical-guidance/Prostate-Specific-Antigen.pdfNational Comprehensive Cancer Network (NCCN). Clinical Practice Guidelines in Oncology: Prostate Cancer. Version 4.2011. Available at www.nccn.orgNational Comprehensive Cancer Network (NCCN). Clinical Practice Guidelines in Oncology: Prostate Cancer. Version 1.2015. Available at www.nccn.orgRisk Strata Definitions: Low, Intermediate, or High - -Low Risk - PSA <= 10 ng/mL; AND Gleason score 6 or less; AND clinical stage T1c or T2a. (AUA, 2007) -Intermediate Risk - PSA > 10 to 20 ng/mL; OR Gleason score 7; OR clinical stage T2b, and not qualifying for high risk. (AUA, 2007) -High Risk - PSA > 20 ng/mL; OR Gleason score 8 to 10; OR clinically localized stage T3a. (NCCN, 2011) - -External beam radiotherapy - external beam radiotherapy refers to 3D conformal radiation therapy (3D-CRT), intensity modulated radiation therapy (IMRT), stereotactic body radiotherapy (SBRT), and proton beam therapy.A higher score indicates appropriate treatment of patients with prostate cancer at low risk of recurrence. -Only patients with prostate cancer with low risk of recurrence will be counted in the performance denominator of this measure.TBDAll patients, regardless of age, with a diagnosis of prostate cancerEquals Initial Population at low risk of recurrence receiving interstitial prostate brachytherapy, OR external beam radiotherapy to the prostate, OR radical prostatectomy, OR cryotherapyNonePatients who did not have a bone scan performed at any time since diagnosis of prostate cancerNot ApplicableDocumentation of reason(s) for performing a bone scan (including documented pain, salvage therapy, other medical reasons, bone scan ordered by someone other than reporting physician)Not ApplicableNot ApplicableNot ApplicableFor every patient evaluated by this measure also identify payer, race, ethnicity and sex.None - - \ No newline at end of file diff --git a/test/fixtures/hqmf/simplexml/CMS130v4_SimpleXML.xml b/test/fixtures/hqmf/simplexml/CMS130v4_SimpleXML.xml deleted file mode 100755 index 98c5b6bd..00000000 --- a/test/fixtures/hqmf/simplexml/CMS130v4_SimpleXML.xml +++ /dev/null @@ -1,44 +0,0 @@ -40280381-4b9a-3825-014b-e0bc5efd12f0Colorectal Cancer ScreeningColorectal_Cancer130aa2a4bbc-864f-45ee-b17a-7ebcc62e6aac4.0.0000000010100001231National Committee for Quality AssuranceNational Committee for Quality AssuranceNational Quality ForumPercentage of adults 50-75 years of age who had appropriate screening for colorectal cancer.Physician Performance Measure (Measures) and related data specifications were developed by the National Committee for Quality Assurance (NCQA). - -The Measures are copyrighted but can be reproduced and distributed, without modification, for noncommercial purposes (eg, use by healthcare providers in connection with their practices). Commercial use is defined as the sale, licensing, or distribution of the Measures for commercial gain, or incorporation of the Measures into a product or service that is sold, licensed or distributed for commercial gain. Commercial use of the Measures requires a license agreement between the user and NCQA. NCQA is not responsible for any use of the Measures. - -(C) 2008-2015 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 CPT or other codes contained in the specifications. - -CPT(R) contained in the Measure specifications is copyright 2004-2014 American Medical Association. LOINC(R) copyright 2004-2014 Regenstrief Institute, Inc. This material contains SNOMED Clinical Terms(R) (SNOMED CT[R]) copyright 2004-2014 International Health Terminology Standards Development Organisation. ICD-10 copyright 2014 World Health Organization. All Rights Reserved.These performance Measures are not clinical guidelines and do not establish a standard of medical care, and have not been tested for all potential applications. - -THE MEASURES 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].ProportionProcessNoneNoneNoneAn estimated 142,570 men and women were diagnosed with colon cancer in 2010. In the same year, 51,370 were estimated to have died from the disease, making colorectal cancer the third leading cause of cancer death in the United States (American Cancer Society 2010). - -Screening for colorectal cancer is extremely important as there are no signs or symptoms of the cancer in the early stages. If the disease is caught in its earliest stages, it has a five-year survival rate of 91%; however, the disease is often not caught this early. While screening is extremely effective in detecting colorectal cancer, it remains underutilized (American Cancer Society 2010). - -Fecal occult blood tests, colonoscopy, and flexible sigmoidoscopy are shown to be effective screening methods (United States Preventive Services Task Force, 2008). Colorectal screening of individuals with no symptoms can identify polyps whose removal can prevent more than 90% of colorectal cancers (Rozen 2004). - -Studies have shown that the cost-effectiveness of colorectal cancer screening is $40,000 per life year gained, which is similar to the cost-effectiveness of mammography for breast cancer screening (Hawk and Levin 2005).The United States Preventive Services Task Force (2008): - -[1] The USPSTF recommends screening for colorectal cancer using fecal occult blood testing, sigmoidoscopy, or colonoscopy in adults, beginning at age 50 years and continuing until age 75 years (A recommendation). -[2] The USPSTF concludes that the evidence is insufficient to assess the benefits and harms of computed tomographic (CT) colonography and fecal DNA testing as screening modalities for colorectal cancer (I statement). - -The American Cancer Society, The American College of Radiology, and the U.S. Multi-Society Task Force on Colorectal Cancer (Levin et al. 2008): - -Tests that Detect Adenomatous Polyps and Cancer -[1] Colonoscopy (every 10 years) -[2] Flexible sigmoidoscopy (every 5 years) -[3] Double contrast barium enema (DCBE) (every 5 years) -[4] Computed tomographic colonography (CTC) (every 5 years) - -Tests that Primarily Detect Cancer: -[1] Guaiac fecal occult blood test (gFOBT) with high sensitivity for cancer (annually) -[2] Fecal immunochemical test (FIT) with high sensitivity for cancer (annually) -[3] Stool DNA (sDNA) with high sensitivity for cancer (interval uncertain) - -Modalities not approved: -[1] Single digital rectal examination fecal occult blood test (FOBT) has a poor sensitivity for CRC and should not be performed as a primary screening method -[2] Studies evaluating virtual colonoscopy and fecal DNA testing for CRC screening have yielded conflicting results and therefore cannot be recommendedHigher score indicates better qualityLevin, B. D.A. Lieberman, B. McFarland, K.S. Andrews, D. Brooks, J. Bond, C. Dash, F.M. Giardiello, S. Glick, D. Johnson, C.D. Johnson, T.R. Levin, P.J. Pickhardt, D.K. Rex, R.A. Smith, A. Thorson, S.J. Winawer. 2008. "Screening and Surveillance for the Early Detection of Colorectal Cancer and Adenomatous Polyps, 2008: A Joint Guideline from the American Cancer Society, the US Multi-Society Task Force on Colorectal Cancer, and the American College of Radiology." CA Cancer J Clin 58(3):130-60. US Preventive Services Task Force (USPSTF). 2008. "Screening for colorectal cancer: U.S. Preventive Services Task Force recommendation statement." Ann Intern Med 149(9):627-37.American Cancer Society. 2010. Cancer Facts & Figures 2010. Atlanta: American Cancer Society.Hawk, E.T., and Levin, B. 2005. Colorectal cancer prevention. J Clin Oncol 23:378-388. Rozen, P. 2004. Cancer of the gastrointestinal tract: early detection or early prevention? Eur J Cancer Prev 13(1):71-5. NoneNoneTBDPatients 50-75 years of age with a visit during the measurement periodEquals Initial PopulationPatients with a diagnosis or past history of total colectomy or colorectal cancerPatients with one or more screenings for colorectal cancer. Appropriate screenings are defined by any one of the following criteria below: -- Fecal occult blood test (FOBT) during the measurement period -- Flexible sigmoidoscopy during the measurement period or the four years prior to the measurement period -- Colonoscopy during the measurement period or the nine years prior to the measurement periodNot ApplicableNoneNot ApplicableNot ApplicableNot ApplicableFor every patient evaluated by this measure also identify payer, race, ethnicity and sex.None - - \ No newline at end of file diff --git a/test/fixtures/hqmf/simplexml/CMS131v4_SimpleXML.xml b/test/fixtures/hqmf/simplexml/CMS131v4_SimpleXML.xml deleted file mode 100755 index a1e3ac0a..00000000 --- a/test/fixtures/hqmf/simplexml/CMS131v4_SimpleXML.xml +++ /dev/null @@ -1,28 +0,0 @@ -40280381-4b9a-3825-014b-e0a0ec991268Diabetes: Eye ExamDiab_Eye131d90bdab4-b9d2-4329-9993-5c34e2c0dc664.0.0000000010100001231National Committee for Quality AssuranceNational Committee for Quality AssuranceNational Quality ForumPercentage of patients 18-75 years of age with diabetes who had a retinal or dilated eye exam by an eye care professional during the measurement period or a negative retinal exam (no evidence of retinopathy) in the 12 months prior to the measurement periodPhysician Performance Measure (Measures) and related data specifications were developed by the National Committee for Quality Assurance (NCQA). - -The Measures are copyrighted but can be reproduced and distributed, without modification, for noncommercial purposes (eg, use by healthcare providers in connection with their practices). Commercial use is defined as the sale, licensing, or distribution of the Measures for commercial gain, or incorporation of the Measures into a product or service that is sold, licensed or distributed for commercial gain. Commercial use of the Measures requires a license agreement between the user and NCQA. NCQA is not responsible for any use of the Measures. - -(C) 2008-2015 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 CPT or other codes contained in the specifications. - -CPT(R) contained in the Measure specifications is copyright 2004-2014 American Medical Association. LOINC(R) copyright 2004-2014 Regenstrief Institute, Inc. This material contains SNOMED Clinical Terms(R) (SNOMED CT[R]) copyright 2004-2014 International Health Terminology Standards Development Organisation. ICD-10 copyright 2014 World Health Organization. All Rights Reserved.These performance Measures are not clinical guidelines and do not establish a standard of medical care, and have not been tested for all potential applications. - -THE MEASURES 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].ProportionProcessNoneNoneNoneDiabetes mellitus (diabetes) is a group of diseases characterized by high blood glucose levels caused by the body's inability to correctly produce or utilize the hormone insulin. It is recognized as a leading cause of death and disability in the U.S. and is highly underreported as a cause of death. Diabetes of either type may cause life-threatening, life-ending or life-altering complications, including glaucoma and blindness. Diabetic retinopathy is the most common diabetic eye disease and causes 21,000-24,000 new cases of blindness annually. The consensus among established clinical guidelines is that patients with both types of diabetes should have an initial dilated and comprehensive eye exam soon after diagnosis. Guidelines also recommend consultation with an ophthalmologist for treatment options if a patient has any level of macular edema or diabetic retinopathy (proliferative and nonproliferative) (American Diabetes Association 2009).American Diabetes Association (ADA) (2009): -* Adults and children aged 10 years or older with type 1 diabetes should have an initial dilated and comprehensive eye examination by an ophthalmologist or optometrist within 5 years after the onset of diabetes. (B recommendation) -* Patients with type 2 diabetes should have an initial dilated and comprehensive eye examination by an ophthalmologist or optometrist shortly after the diagnosis of diabetes. (B recommendation) -* Subsequent examinations for type 1 and type 2 diabetic patients should be repeated annually by an ophthalmologist or optometrist. Less frequent exams (every 2-3 years) may be considered following one or more normal eye exams. Examinations will be required more frequently if retinopathy is progressing. (B recommendation) -* Women with preexisting diabetes who are planning pregnancy or who have become pregnant should have a comprehensive eye examination and be counseled on the risk of development and/or progression of diabetic retinopathy. (B recommendation) -* Eye examination should occur in the first trimester with close follow-up throughout pregnancy and for 1 year postpartum. (B recommendation) -* Promptly refer patients with any level of macular edema, severe nonproliferative diabetic retinopathy (NPDR), or any proliferative diabetic retinopathy (PDR) to an ophthalmologist who is knowledgeable and experienced in the management and treatment of diabetic retinopathy. (A recommendation) -* Laser photocoagulation therapy is indicated to reduce the risk of vision loss in patients with high-risk PDR, clinically significant macular edema, and in some cases of severe NPDR. (A recommendation) -* The presence of retinopathy is not a contraindication to aspirin therapy for cardioprotection, as this therapy does not increase the risk of retinal hemorrhage. (A recommendation) - -American Geriatric Society (AGS) (Brown et al. 2003): The older adult who has new-onset DM should have an initial screening dilated-eye examination performed by an eye-care specialist with funduscopy training. (Level I, Grade B)Higher score indicates better qualityBrown, A.F., C.M. Mangione, D. Saliba, C.A. Sarkisian. California Healthcare Foundation/American Geriatrics Society Panel on Improving Care for Elders with Diabetes. 2003. "Guidelines for Improving the Care of the Older Person with Diabetes Mellitus." J Am Geriatr Soc 51(5 Suppl Guidelines):S265-80.American Diabetes Association. 2009. "Standards of Medical Care in Diabetes-2009." Diabetes Care 2009 32 (Suppl 1):S6-S12. doi:10.2337/dc09-S006.NoneOnly patients with a diagnosis of Type 1 or Type 2 diabetes should be included in the denominator of this measure; patients with a diagnosis of secondary diabetes due to another condition should not be included. - -The eye exam must be performed by an ophthalmologist or optometrist.TBDPatients 18-75 years of age with diabetes with a visit during the measurement periodEquals Initial PopulationNonePatients with an eye screening for diabetic retinal disease. This includes diabetics who had one of the following: -A retinal or dilated eye exam by an eye care professional in the measurement period or a negative retinal exam (no evidence of retinopathy) by an eye care professional in the year prior to the measurement periodNot ApplicableNoneNot ApplicableNot ApplicableNot ApplicableFor every patient evaluated by this measure also identify payer, race, ethnicity and sex.None - - \ No newline at end of file diff --git a/test/fixtures/hqmf/simplexml/CMS132v4_SimpleXML.xml b/test/fixtures/hqmf/simplexml/CMS132v4_SimpleXML.xml deleted file mode 100755 index 02c2c33e..00000000 --- a/test/fixtures/hqmf/simplexml/CMS132v4_SimpleXML.xml +++ /dev/null @@ -1,31 +0,0 @@ -40280381-4b9a-3825-014b-dbe6bbcd0f63Cataracts: Complications within 30 Days Following Cataract Surgery Requiring Additional Surgical ProceduresCataracts1329a0339c2-3d9b-11e1-8634-00237d5bf1744.0.0000000010100001231American Medical Association-convened Physician Consortium for Performance Improvement(R) (AMA-PCPI)American Medical Association-convened Physician Consortium for Performance Improvement(R) (AMA-PCPI)National Quality ForumPercentage of patients aged 18 years and older with a diagnosis of uncomplicated cataract who had cataract surgery and had any of a specified list of surgical procedures in the 30 days following cataract surgery which would indicate the occurrence of any of the following major complications: retained nuclear fragments, endophthalmitis, dislocated or wrong power IOL, retinal detachment, or wound dehiscenceCopyright 2014 American Medical Association. All Rights Reserved.Physician Performance Measures (Measures) and related data specifications have been developed by the American Medical Association (AMA) - convened Physician Consortium for Performance Improvement(R) (PCPI[R]). These Measures are not clinical guidelines and do not establish a standard of medical care, and have not been tested for all potential applications. The Measures, while copyrighted, can be reproduced and distributed, without modification, for noncommercial purposes, eg, use by health care providers in connection with their practices. Commercial use is defined as the sale, license, or distribution of the Measures for commercial gain, or incorporation of the Measures into a product or service that is sold, licensed or distributed for commercial gain. Commercial uses of the Measures require a license agreement between the user and the AMA (on behalf of the PCPI). Neither the AMA, PCPI, nor its members shall be responsible for any use of the Measures. - -The National Committee for Quality Assurance's significant past efforts and contributions to the development and updating of the Measures is acknowledged. - -THE MEASURES AND SPECIFICATIONS ARE PROVIDED "AS IS" WITHOUT WARRANTY OF ANY KIND. - -Limited proprietary coding is contained in the Measure specifications for convenience. Users of the proprietary code sets should obtain all necessary licenses from the owners of these code sets. The AMA, PCPI, and its members disclaim all liability for use or accuracy of any Current Procedural Terminology (CPT[R]) or other coding contained in the specifications. - -CPT(R) contained in the Measure specifications is copyright 2004-2014 American Medical Association. LOINC(R) copyright 2004-2014 Regenstrief Institute, Inc. This material contains SNOMED Clinical Terms(R) (SNOMED CT[R]) copyright 2004-2014 International Health Terminology Standards Development Organisation. ICD-10 copyright 2014 World Health Organization. All Rights Reserved. - -Due to technical limitations, registered trademarks are indicated by (R) or [R].ProportionOutcomeNoneNoneNone1. Scientific basis for assessing short-term complications following cataract surgery -Complications that may result in a permanent loss of vision following cataract surgery are uncommon. This short-term outcome of surgery indicator seeks to identify those complications from surgery that can reasonably be attributed to the surgery and surgeon and which reflect situations which - if untreated - generally result in significant avoidable vision loss that would negatively impact patient functioning. Further, it seeks to reduce surgeon burden and enhance accuracy in reporting by focusing on those significant complications that can be assessed from administrative data alone and which can be captured by the care of another physician or the provision of additional, separately coded, post-operative services. Finally, it focuses on patient safety and monitoring for events that, while hopefully uncommon, can signify important issues in the care being provided. For example, the need to reposition or exchange an intraocular lens (IOL) reflects in part "wrong power" IOL placement, a major patient safety issue. - -In order to achieve these ends, the indicator excludes patients with other known, pre-operative ocular conditions that could impact the likelihood of developing a complication. Based on the results of the Cataract Appropriateness Project at RAND, other published studies, and one analysis performed on a national MCO data base, the exclusion codes would preserve over 2/3 of all cataract surgery cases for analysis. Thus, this provides a "clean" indicator that captures care for the large majority of patients undergoing cataract surgery. - -2. Evidence for gap in care -The advances in technology and surgical skills over the last 30 years have made cataract surgery much safer and more effective. An analysis of a single company's database (commercial age MCO) demonstrated that the rate of complications found for this indicator was approximately 1 to 2%. Nevertheless, as noted above, the occurrence of one of these events is associated with a significant potential for vision loss that is otherwise avoidable. Furthermore, with an annual volume of 2.8 million cataract surgeries in the US, a 2% rate would mean that over 36,000 surgeries are accompanied by these complications (2/3 of 56,000 surgeries). - -A synthesis of the literature published prior to 1992 found weighted mean complication rates among all patients undergoing cataract surgery of 0.13% for endophthalmitis, 0.3% for bullous keratopathy, 1.4% clinically detectable CME, 3.5% for angiographically demonstrated CME, 0.7% for retinal detachment, and 1.1% for IOL dislocation. Bullous keratopathy and CME are not included in this indicator because they are conditions that are almost always temporary and resolve without additional intervention through additional procedures and associated care in this population of patients without prior known ocular conditions. - -Additional studies similarly demonstrate the low occurrence of complications, including many that are temporary in nature and without a significant impact on patient outcomes. A national survey of over 100 hospitals from 1997 to 1998 found the following results on 18,454 patients 50 years old or older. Seventy-seven percent of these patients had surgery performed by phacoemulsification. Rates for events that occurred during surgery were 4.4% for posterior capsule rupture and vitreous loss, 1.0% for incomplete cortical cleanup, 1.0% for anterior chamber hemorrhage and or collapse, and 0.77% for iris damage. Short-term (within 48 hours) perioperative complications included corneal edema (9.5%), increased IOP (7.9%), uveitis (5.6%), wound leak (1.2%), hyphema (1.1%), and retained lens material (1.1%). - -A retrospective study from New Zealand of 1,793 consecutive patients undergoing phacoemulsification reported a rate of 1.8% for posterior capsule rupture and a rate of 1.2% for rhegmatogenous retinal detachment. (AAO, 2006)This is an outcome measure. As such, there are no statements in the guideline specific to this measurement topic.Lower score indicates better qualityAmerican Academy of Ophthalmology. Preferred Practice Pattern: Cataract In the Adult Eye. 2006.Desai P, Minassian DC, Reidy A. National cataract surgery survey 1997-8: a report of the results of the clinical outcomes. Br J Ophthalmol 1999 Dec;83(12):1336-40.Powe NR, Schein OD, Gieser SC, Tielsch JM, Luthra R, Javitt J, Steinberg EP. Synthesis of the literature on visual acuity and complications following cataract extraction with intraocular lens implantation. Cataract Patient Outcome Research Team. Arch Ophthalmol 1994 Feb;112(2):239-52.Russell M, Gaskin B, Russell D, Polkinghorne PJ. Pseudophakic retinal detachment after phacoemulsification cataract surgery: Ten-year retrospective review. J Cataract Refract Surg 2006 Mar;32(3):442-5.NoneThis is an episode-based measure, meaning there may be more than one reportable event for a given patient during the measurement period. - -The level of analysis for this measure is each cataract surgery during the measurement period. Every cataract surgery during the measurement period should be counted as a measurable denominator event for the measure calculation. - -The measure, as written, does not specifically require documentation of laterality. Coding limitations in particular clinical terminologies do not currently allow for that level of specificity (ICD-10-CM includes laterality, but ICD-9-CM and SNOMED-CT do not uniformly include this distinction). Therefore, at this time, it is not a requirement of this measure to indicate laterality of the diagnoses, findings or procedures. Available coding to capture the data elements specified in this measure has been provided. It is assumed that the eligible professional will record laterality in the patient medical record, as quality care and clinical documentation should include laterality. - -This measure is to be reported by the clinician performing the cataract surgery procedure. Clinicians who provide only preoperative or postoperative management of cataract patients are not eligible for this measure.TBDAll patients aged 18 years and older who had cataract surgery and no significant ocular conditions impacting the surgical complication rateEquals Initial PopulationPatients with any one of a specified list of significant ocular conditions that impact the surgical complication ratePatients who had one or more specified operative procedures for any of the following major complications within 30 days following cataract surgery: retained nuclear fragments, endophthalmitis, dislocated or wrong power IOL, retinal detachment, or wound dehiscenceNot ApplicableNoneNot ApplicableNot ApplicableNot ApplicableFor every patient evaluated by this measure also identify payer, race, ethnicity and sex.None - - \ No newline at end of file diff --git a/test/fixtures/hqmf/simplexml/CMS133v4_SimpleXML.xml b/test/fixtures/hqmf/simplexml/CMS133v4_SimpleXML.xml deleted file mode 100755 index 5d7acd54..00000000 --- a/test/fixtures/hqmf/simplexml/CMS133v4_SimpleXML.xml +++ /dev/null @@ -1,33 +0,0 @@ -40280381-4c18-79df-014c-2091382800a9Cataracts: 20/40 or Better Visual Acuity within 90 Days Following Cataract SurgeryCataracts_20-4013339e0424a-1727-4629-89e2-c46c2fbb3f5f4.0.0000000010100001231American Medical Association-convened Physician Consortium for Performance Improvement(R) (AMA-PCPI)American Medical Association-convened Physician Consortium for Performance Improvement(R) (AMA-PCPI)National Quality ForumPercentage of patients aged 18 years and older with a diagnosis of uncomplicated cataract who had cataract surgery and no significant ocular conditions impacting the visual outcome of surgery and had best-corrected visual acuity of 20/40 or better (distance or near) achieved within 90 days following the cataract surgeryCopyright 2014 American Medical Association. All Rights Reserved.Physician Performance Measures (Measures) and related data specifications have been developed by the American Medical Association (AMA) - convened Physician Consortium for Performance Improvement(R) (PCPI[R]). These Measures are not clinical guidelines and do not establish a standard of medical care, and have not been tested for all potential applications. The Measures, while copyrighted, can be reproduced and distributed, without modification, for noncommercial purposes, eg, use by health care providers in connection with their practices. Commercial use is defined as the sale, license, or distribution of the Measures for commercial gain, or incorporation of the Measures into a product or service that is sold, licensed or distributed for commercial gain. Commercial uses of the Measures require a license agreement between the user and the AMA (on behalf of the PCPI). Neither the AMA, PCPI, nor its members shall be responsible for any use of the Measures. - -The National Committee for Quality Assurance's significant past efforts and contributions to the development and updating of the Measures is acknowledged. - -THE MEASURES AND SPECIFICATIONS ARE PROVIDED "AS IS" WITHOUT WARRANTY OF ANY KIND. - -Limited proprietary coding is contained in the Measure specifications for convenience. Users of the proprietary code sets should obtain all necessary licenses from the owners of these code sets. The AMA, PCPI, and its members disclaim all liability for use or accuracy of any Current Procedural Terminology (CPT[R]) or other coding contained in the specifications. - -CPT(R) contained in the Measure specifications is copyright 2004-2014 American Medical Association. LOINC(R) copyright 2004-2014 Regenstrief Institute, Inc. This material contains SNOMED Clinical Terms(R) (SNOMED CT[R]) copyright 2004-2014 International Health Terminology Standards Development Organisation. ICD-10 copyright 2014 World Health Organization. All Rights Reserved. - -Due to technical limitations, registered trademarks are indicated by (R) or [R].ProportionOutcomeNoneNoneNone1. Scientific basis for measuring visual acuity outcomes after cataract surgery -The only reason to perform cataract surgery (other than for a limited set of medical indications) is to improve a patient's vision and associated functioning. The use of a 20/40 visual acuity threshold is based on several considerations. First, it is the level for unrestricted operation of a motor vehicle in the US. Second, it has been consistently used by the FDA in its assessment for approval of intraocular lens (IOL) and other vision devices. Third, it is the literature standard to denote success in cataract surgery. Fourth, work by West et al in the Salisbury Eye Study suggests that 20/40 is a useful threshold for 50th percentile functioning for several vision-related tasks. - -Most patients achieve excellent visual acuity after cataract surgery (20/40 or better). This outcome is achieved consistently through careful attention through the accurate measurement of axial length and corneal power and the appropriate selection of an IOL power calculation formula. As such, it reflects the care and diligence with which the surgery is assessed, planned and executed. Failure to achieve this after surgery in eyes without comorbid ocular conditions that would impact the success of the surgery would reflect care that should be assessed for opportunities for improvement. - -The exclusion of patients with other ocular and systemic conditions known to increase the risk of an adverse outcome reflects the findings of the two published prediction rule papers for cataract surgery outcomes, by Mangione et al and Steinberg et al. In both papers, the presence of comorbid glaucoma and macular degeneration negatively impacted the likelihood of successful outcomes of surgery. Further, as noted in the prior indicator, exclusion of eyes with ocular conditions that could impact the success of the surgery would NOT eliminate the large majority of eyes undergoing surgery while also minimizing the potential adverse selection that might otherwise occur relative to those patients with the most complex situations who might benefit the most from having surgery to maximize their remaining vision. - -2. Evidence of a gap in care -This is an outcome of surgery indicator of direct relevance to patients and referring providers. The available evidence suggests that cataract surgery achieves this in between 86 and 98% of surgeries in eyes without comorbid ocular conditions (this indicator). While small, the volume of cataract surgery in the US of over 2.8 million surgeries suggests that the impact could affect more than 100,000 patients per year. Because of the exclusion of comorbid ocular conditions, one would expect performance on this indicator to be as high as possible, with significantly lower rates suggestive of opportunities for improvement. - -The ASCRS National Cataract Database reported that at 3 months postoperatively, 85.5% of all patients had a 20/40 or better best-corrected visual acuity, 57.2% of patients had 20/25 or better postoperative best-corrected visual acuity, and 74.6% of patients were within +/- 1.0 D of target spherical equivalent. Based on 5,788 responses, the mean visual function index score at 3 months postoperatively was 70.3% compared with 55.0% preoperatively. (The score is based on a scale of 0 to 100, with 0 indicating an inability to perform any of the activities.) The European Cataract Outcome Study reported for 1999 that 89% of patients achieved a postoperative visual acuity of 0.5 or more (20/40 or better), the average induced astigmatism was 0.59 D, and 86% of patients had an induced astigmatism within +/- 1.0 D. - -The AAO National Eyecare Outcomes Network (NEON) database also found similar rates of success, with an improvement in visual acuity in 92.2% of patients and improvement in VF-14 in over 90% of patients. Best-corrected visual acuity (BCVA) of 20/40 was achieved by 89% of all NEON patients and 96% of NEON patients without preoperative ocular comorbid conditions. Seventy-eight percent of patients were within +/-1.0 D of target spherical equivalent. Ninety-five percent of patients reported being satisfied with the results of their surgery. Patients who were dissatisfied with the results of their surgery were slightly older and more likely to have ocular comorbidity. - -In studies of phacoemulsification cataract surgery performed by ophthalmology residents, the reported range of patients with postoperative BCVA of 20/40 or better is 80% to 91%. If eyes with ocular comorbidities are excluded, the reported range of patients with postoperative BCVA of 20/40 or better is 86% to 98%. (AAO, 2011)This is an outcome measure. As such, there is no statement in the guideline specific to this measurement topic.Higher score indicates better quality.Albanis CV, Dwyer MA, Ernest JT. Outcomes of extracapsular cataract extraction and phacoemulsification performed in a university training program. Ophthalmic Surg Lasers 1998;29:643-8.Blomquist PH, Rugwani RM. Visual outcomes after vitreous loss during cataract surgery performed by residents. J Cataract Refract Surg 2002;28:847-52.Corey RP, Olson RJ. Surgical outcomes of cataract extractions performed by residents using phacoemulsification. J Cataract Refract Surg 1998;24:66-72.Karp KO, Albanis CV, Pearlman JB, Goins KM. Outcomes of temporal clear cornea versus superior scleral tunnel phacoemulsification incisions in a university training program. Ophthalmic Surg Lasers. 2001;32:228-232.Randleman JB, Srivastava SK, Aaron MM. Phacoemulsification with topical anesthesia performed by resident surgeons. J Cataract Refract Surg. 2004;30:149-154.Tarbet KJ, et al. Complications and results of phacoemulsification performed by residents. J Cataract Refract Surg. 1995;21:661-665.Quillen DA, Phipps SJ. Visual outcomes and incidence of vitreous loss for residents performing phacoemulsification without prior planned extracapsular cataract extraction experience. Am J Ophthalmol. 2003;135:732-733.American Academy of Ophthalmology. Preferred Practice Pattern: Cataract In the Adult Eye. 2011.NoneThis is an episode-based measure, meaning there may be more than one reportable event for a given patient during the measurement period. The level of analysis for this measure is each cataract surgery during the measurement period, including instances where more than one cataract procedure was performed during the measurement period. Every cataract surgery during the measurement period should be counted as a measurable denominator event for the measure calculation. - -Only procedures performed during January 1 - September 30 of the reporting period will be considered for this measure, in order to determine if 20/40 or better visual acuity has been achieved within the 90 days following the cataract procedure. Cataract procedures performed during October 1 - December 31 are excluded from the initial population. - -The measure, as written, does not specifically require documentation of laterality. Coding limitations in particular clinical terminologies do not currently allow for that level of specificity (ICD-10-CM includes laterality, but ICD-9-CM and SNOMED-CT do not uniformly include this distinction). Therefore, at this time, it is not a requirement of this measure to indicate laterality of the diagnoses, findings or procedures. Available coding to capture the data elements specified in this measure has been provided. It is assumed that the eligible professional will record laterality in the patient medical record, as quality care and clinical documentation should include laterality. - -This measure is to be reported by the clinician performing the cataract surgery procedure. Clinicians who provide only preoperative or postoperative management of cataract patients are not eligible for this measure.TBDAll patients aged 18 years and older who had cataract surgeryEquals Initial PopulationPatients with significant ocular conditions impacting the visual outcome of surgeryPatients who had best-corrected visual acuity of 20/40 or better (distance or near) achieved within 90 days following cataract surgeryNot ApplicableNoneNot ApplicableNot ApplicableNot ApplicableFor every patient evaluated by this measure also identify payer, race, ethnicity and sex.None - - \ No newline at end of file diff --git a/test/fixtures/hqmf/simplexml/CMS134v4_SimpleXML.xml b/test/fixtures/hqmf/simplexml/CMS134v4_SimpleXML.xml deleted file mode 100755 index 87ef88a2..00000000 --- a/test/fixtures/hqmf/simplexml/CMS134v4_SimpleXML.xml +++ /dev/null @@ -1,29 +0,0 @@ -40280381-4be2-53b3-014c-0a64db7e1750Diabetes: Urine Protein ScreeningDiab_Urine1347b2a9277-43da-4d99-9bee-6ac271a077474.0.0000000010100001231National Committee for Quality AssuranceNational Committee for Quality AssuranceNational Quality ForumThe percentage of patients 18-75 years of age with diabetes who had a nephropathy screening test or evidence of nephropathy during the measurement period.Physician Performance Measure (Measures) and related data specifications were developed by the National Committee for Quality Assurance (NCQA). - -The Measures are copyrighted but can be reproduced and distributed, without modification, for noncommercial purposes (eg, use by healthcare providers in connection with their practices). Commercial use is defined as the sale, licensing, or distribution of the Measures for commercial gain, or incorporation of the Measures into a product or service that is sold, licensed or distributed for commercial gain. Commercial use of the Measures requires a license agreement between the user and NCQA. NCQA is not responsible for any use of the Measures. - -(c) 2008-2015 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 CPT or other codes contained in the specifications. - -CPT(R) contained in the Measure specifications is copyright 2004-2014 American Medical Association. LOINC(R) copyright 2004-2014 Regenstrief Institute, Inc. This material contains SNOMED Clinical Terms(R) (SNOMED CT[R]) copyright 2004-2014 International Health Terminology Standards Development Organisation. ICD-10 copyright 2014 World Health Organization. All Rights Reserved.These performance Measures are not clinical guidelines and do not establish a standard of medical care, and have not been tested for all potential applications. - -THE MEASURES 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].ProportionProcessNoneNoneNoneDiabetes mellitus (diabetes) is a group of diseases characterized by high blood glucose levels caused by the body's inability to correctly produce or utilize the hormone insulin (National Institute of Diabetes and Digestive and Kidney Diseases 2011). It is recognized as a leading cause of death and disability in the U.S. and is highly underreported as a cause of death (National Institute of Diabetes and Digestive and Kidney Diseases 2011). Diabetes may cause life-threatening, life-ending or life-altering complications, including end-stage kidney disease. Diabetes is the primary cause of kidney failure, accounting for 44 percent of newly diagnosed cases in 2005 (National Institute of Diabetes and Digestive and Kidney Diseases 2011). Clinical guidelines recommend regular testing to evaluate urine albumin excretions and serum creatinine and the estimated glomerular filtration rate derived from serum creatinine, in addition to comparing measurements when screening for chronic kidney disease (American Diabetes Association 2009; American Association of Clinical Endocrinologists 2007).American Diabetes Association (2009): -- Perform an annual test to assess urine albumin excretion in type 1 diabetic patients with diabetes duration of >=5 years and in all type 2 diabetic patients, starting at diagnosis. (Level of Evidence E) -- Measure serum creatinine at least annually in all adults with diabetes regardless of the degree of urine albumin excretion. The serum creatinine should be used to estimate GFR and stage the level of chronic kidney disease (CKD), if present. (Level of Evidence E) -- In the treatment of the nonpregnant patient with micro- or macroalbuminuria, either ACE Inhibitors or ARBs should be used. (Level of Evidence A) - -American Association of Clinical Endocrinologists (2007): Screen all patients with diabetes mellitus for chronic kidney disease annually; screening should begin 5 years after diagnosis in patients with Type 1 diabetes mellitus (T1DM) and at the time of diagnosis in patients with Type 2 diabetes mellitus (T2DM). Testing includes: -- Measurement of albumin-to-creatinine ratio in a spot urine specimen and measurement of the estimated glomerular filtration rate derived from serum creatinine -- The following are diagnostic criteria for chronic kidney disease: -. Estimated glomerular filtration rate <60 mL/min/1.73 m2 or albumin-to-creatinine ratio >=30 mg albumin/g creatinine -. Microalbuminuria >=30 mg albumin/g creatinine -. Macroalbuminuria >=300 mg albumin/g creatinine (Grade A) -. Prescribe an angiotensin-converting enzyme inhibitor or an angiotensin receptor blocker in the antihypertensive regimen in the absence of contraindications. (Grade A) - -California Healthcare Foundation/American Geriatrics Society (2003): A test for the presence of microalbumin should be performed at diagnosis in patients with type 2 diabetes mellitus. After the initial screening and in the absence of previously demonstrated macro- or microalbuminuria, a test for the presence of microalbumin should be performed annually. (Level III, Grade A)Higher score indicates better qualityAmerican Association of Clinical Endocrinologists. 2007. "Medical Guidelines for Clinical Practice for the Management of Diabetes Mellitus." Endocr Pract 13(Suppl 1):4-68.American Diabetes Association. 2009. "Standards of Medical Care in Diabetes-2009." Diabetes Care 2009 32 (Suppl 1):S6-S12.California Healthcare Foundation/American Geriatrics Society Panel on Improving Care of Elders with Diabetes. 2003. "Guidelines for Improving the Care of the Older Person with Diabetes Mellitus." J Am Geriatr Soc 51:S265-S280. http://www.rand.org/content/dam/rand/www/external/labor/aging/rsi/rsi_papers/2004_mangione.pdNational Institute of Diabetes and Digestive and Kidney Diseases. 2011. "Causes of Diabetes." (September) -http://diabetes.niddk.nih.gov/dm/pubs/causes/index.aspxNoneOnly patients with a diagnosis of Type 1 or Type 2 diabetes should be included in the denominator of this measure; patients with a diagnosis of secondary diabetes due to another condition should not be included.TBDPatients 18-75 years of age with diabetes with a visit during the measurement periodEquals Initial PopulationNonePatients with a screening for nephropathy or evidence of nephropathy during the measurement periodNot ApplicableNoneNot ApplicableNot ApplicableNot ApplicableFor every patient evaluated by this measure also identify payer, race, ethnicity and sex.None - - \ No newline at end of file diff --git a/test/fixtures/hqmf/simplexml/CMS135v4_SimpleXML.xml b/test/fixtures/hqmf/simplexml/CMS135v4_SimpleXML.xml deleted file mode 100755 index decfaf5d..00000000 --- a/test/fixtures/hqmf/simplexml/CMS135v4_SimpleXML.xml +++ /dev/null @@ -1,50 +0,0 @@ -40280381-4b9a-3825-014b-e156e741144bHeart Failure (HF): Angiotensin-Converting Enzyme (ACE) Inhibitor or Angiotensin Receptor Blocker (ARB) Therapy for Left Ventricular Systolic Dysfunction (LVSD)HF_ACE_ARB_LVSD135430ffc53-4122-4421-88cc-2edd8117bb3c4.0.0000000010100001231American Medical Association-convened Physician Consortium for Performance Improvement(R) (AMA-PCPI)American Medical Association-convened Physician Consortium for Performance Improvement(R) (AMA-PCPI)National Quality ForumPercentage of patients aged 18 years and older with a diagnosis of heart failure (HF) with a current or prior left ventricular ejection fraction (LVEF) < 40% who were prescribed ACE inhibitor or ARB therapy either within a 12 month period when seen in the outpatient setting OR at each hospital dischargeCopyright 2014 American College of Cardiology, American Heart Association and American Medical Association. All Rights Reserved.Physician Performance Measures (Measures) and related data specifications have been developed by the American Medical Association (AMA) - convened Physician Consortium for Performance Improvement(R) (PCPI[R]), American College of Cardiology (ACC) and American Heart Association (AHA). These Measures are not clinical guidelines and do not establish a standard of medical care, and have not been tested for all potential applications. The Measures, while copyrighted, can be reproduced and distributed, without modification, for noncommercial purposes, eg, use by health care providers in connection with their practices. Commercial use is defined as the sale, license, or distribution of the Measures for commercial gain, or incorporation of the Measures into a product or service that is sold, licensed or distributed for commercial gain. Commercial uses of the Measures require a license agreement between the user and the AMA, (on behalf of the PCPI), ACC or AHA. Neither the AMA, ACC, AHA, PCPI nor its members shall be responsible for any use of the Measures. - -THE MEASURES AND SPECIFICATIONS ARE PROVIDED "AS IS" WITHOUT WARRANTY OF ANY KIND. - -Limited proprietary coding is contained in the Measure specifications for convenience. Users of the proprietary code sets should obtain all necessary licenses from the owners of these code sets. The AMA, ACC, AHA, the PCPI and its members disclaim all liability for use or accuracy of any Current Procedural Terminology (CPT[R]) or other coding contained in the specifications. - -CPT(R) contained in the Measure specifications is copyright 2004-2014 American Medical Association. LOINC(R) copyright 2004-2014 Regenstrief Institute, Inc. This material contains SNOMED Clinical Terms(R) (SNOMED CT[R]) copyright 2004-2014 International Health Terminology Standards Development Organisation. ICD-10 copyright 2014 World Health Organization. All Rights Reserved. - -Due to technical limitations, registered trademarks are indicated by (R) or [R].ProportionProcessNoneNoneNoneIn the absence of contraindications, ACE inhibitors or ARBs are recommended for all patients with symptoms of heart failure and reduced left ventricular systolic function. ACE inhibitors remain the first choice for inhibition of the renin-angiotensin system in chronic heart failure, but ARBs can now be considered a reasonable alternative. Both pharmacologic agents have been shown to decrease the risk of death and hospitalization. Additional benefits of ACE inhibitors include the alleviation of symptoms and the improvement of clinical status and overall sense of well-being of patients with heart failure.ACE inhibitors are recommended in patients with HFrEF [heart failure with reduced ejection fraction] and current or prior symptoms, unless contraindicated, to reduce morbidity and mortality. (Class I, Level of Evidence: A) (ACCF/AHA, 2013) - -Treatment with an ACE inhibitor should be initiated at low doses [see excerpt from guideline table below], followed by gradual dose increments if lower doses have been well tolerated... Clinicians should attempt to use doses that have been shown to reduce the risk of cardiovascular events in clinical trials. If these target doses of an ACE inhibitor cannot be used or are poorly tolerated, intermediate doses should be used with the expectation that there are likely to be only small differences in efficacy between low and high doses. Abrupt withdrawal of treatment with an ACE inhibitor can lead to clinical deterioration and should be avoided. (ACCF/AHA, 2013) - -Drugs Commonly Used for Stage C HFrEF (abbreviated to align with focus of measure to include only ACE inhibitors and ARB therapy) -Drug Initial Daily Dose(s) Maximum Doses(s) Mean Doses Achieved in - Clinical Trials -ACE Inhibitors - Captopril 6.25 mg 3 times 50 mg 3 times 122.7 mg/d - Enalapril 2.5 mg twice 10 to 20 mg twice 16.6 mg/d - Fosinopril 5 to 10 mg once 40 mg once N/A - Lisinopril 2.5 to 5 mg once 20 to 40 mg once 32.5 to 35.0 mg/d - Perindopril 2 mg once 8 to 16 mg once N/A - Quinapril 5 mg twice 20 mg twice N/A - Ramipril 1.25 to 2.5 mg once 10 mg once N/A - Trandolapril 1 mg once 4 mg once N/A -Angiotensin Receptor Blockers - Candesartan 4 to 8 mg once 32 mg once 24 mg/d - Losartan 25 to 50 mg once 50 to 150 mg once 129 mg/d - Valsartan 20 to 40 mg twice 160 mg twice 254 mg/d - -ARBs are recommended in patients with HFrEF with current or prior symptoms who are ACE inhibitor intolerant, unless contraindicated, to reduce morbidity and mortality. (Class I, Level of Evidence: A) (ACCF/AHA, 2013) - -ARBs are reasonable to reduce morbidity and mortality as alternatives to ACE inhibitors as first-line therapy for -patients with HFrEF, especially for patients already taking ARBs for other indications, unless contraindicated. (Class IIa, Level of Evidence: A) (ACCF/AHA, 2013) - -Addition of an ARB may be considered in persistently symptomatic patients with HFrEF who are already being -treated with an ACE inhibitor and a beta blocker in whom an aldosterone antagonist is not indicated or tolerated. (Class IIb, Level of Evidence: A) (ACCF/AHA, 2013) - -For the hospitalized patient: -In patients with HFrEF experiencing a symptomatic exacerbation of HF requiring hospitalization during chronic -maintenance treatment with GDMT[guideline-directed medical therapy; GDMT represents optimal medical therapy as defined by ACCF/AHA guideline-recommended therapies (primarily Class I)], it is recommended that GDMT be continued in the absence of hemodynamic instability or contraindications. (Class I, Level of Evidence: B) (ACCF/AHA, 2013)Higher score indicates better qualityYancy CW, Jessup M, Bozkurt B, Butler J, Casey DE Jr, Drazner MH, Fonarow GC, Geraci SA, Horwich T, Januzzi JL, Johnson MR, Kasper EK, Levy WC, Masoudi FA, McBride PE, McMurray JJV, Mitchell JE, Peterson PN, Riegel B, Sam F, Stevenson LW, Tang WHW, Tsai EJ, Wilkoff BL. 2013 ACCF/AHA guideline for the management of heart failure: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines. J Am Coll Cardiol 2013;62:e147-239. Prescribed-Outpatient setting: prescription given to the patient for ACE inhibitor or ARB therapy at one or more visits in the measurement period OR patient already taking ACE inhibitor or ARB therapy as documented in current medication list. - -Prescribed-Inpatient setting: prescription given to the patient for ACE inhibitor or ARB therapy at discharge OR ACE inhibitor or ARB therapy to be continued after discharge as documented in the discharge medication list. - -LVEF < 40% corresponds to qualitative documentation of moderate dysfunction or severe dysfunction.To satisfy this measure, it must be reported for all heart failure patients at least once during the measurement period if seen in the outpatient setting. If the patient has an eligible inpatient discharge during the measurement period, as defined in the measure logic, it is expected to be reported at each hospital discharge - -The requirement of "Count >=2 of Encounter, Performed" is to establish that the eligible professional has an existing relationship with the patient.TBDAll patients aged 18 years and older with a diagnosis of heart failureEquals Initial Population with a current or prior LVEF < 40%NonePatients who were prescribed ACE inhibitor or ARB therapy either within a 12 month period when seen in the outpatient setting OR at each hospital dischargeNot ApplicableDocumentation of medical reason(s) for not prescribing ACE inhibitor or ARB therapy (eg, hypotensive patients who are at immediate risk of cardiogenic shock, hospitalized patients who have experienced marked azotemia, allergy, intolerance, other medical reasons) -Documentation of patient reason(s) for not prescribing ACE inhibitor or ARB therapy (eg, patient declined, other patient reasons) -Documentation of system reason(s) for not prescribing ACE inhibitor or ARB therapy (eg, other system reasons)Not ApplicableNot ApplicableNot ApplicableFor every patient evaluated by this measure also identify payer, race, ethnicity and sex.None - - \ No newline at end of file diff --git a/test/fixtures/hqmf/simplexml/CMS136v5_SimpleXML.xml b/test/fixtures/hqmf/simplexml/CMS136v5_SimpleXML.xml deleted file mode 100755 index e6b30bc4..00000000 --- a/test/fixtures/hqmf/simplexml/CMS136v5_SimpleXML.xml +++ /dev/null @@ -1,55 +0,0 @@ -40280381-4de7-db4d-014d-e8910d540228ADHD: Follow-Up Care for Children Prescribed Attention-Deficit/Hyperactivity Disorder (ADHD) MedicationADHD_Follow-Up136703cc49b-b653-4885-80e8-245a057f5ae95.1.0000000010100001231National Committee for Quality AssuranceNational Committee for Quality AssuranceNational Quality ForumPercentage of children 6-12 years of age and newly dispensed a medication for attention-deficit/hyperactivity disorder (ADHD) who had appropriate follow-up care. Two rates are reported. -a. Percentage of children who had one follow-up visit with a practitioner with prescribing authority during the 30-Day Initiation Phase. -b. Percentage of children who remained on ADHD medication for at least 210 days and who, in addition to the visit in the Initiation Phase, had at least two additional follow-up visits with a practitioner within 270 days (9 months) after the Initiation Phase ended.Physician Performance Measure (Measures) and related data specifications were developed by the National Committee for Quality Assurance (NCQA). - -The Measures are copyrighted but can be reproduced and distributed, without modification, for noncommercial purposes (eg, use by healthcare providers in connection with their practices). Commercial use is defined as the sale, licensing, or distribution of the Measures for commercial gain, or incorporation of the Measures into a product or service that is sold, licensed or distributed for commercial gain. Commercial use of the Measures requires a license agreement between the user and NCQA. NCQA is not responsible for any use of the Measures. - -(c) 2008-2015 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 CPT or other codes contained in the specifications. - -CPT(R) contained in the Measure specifications is copyright 2004-2014 American Medical Association. LOINC(R) copyright 2004-2014 Regenstrief Institute, Inc. This material contains SNOMED Clinical Terms(R) (SNOMED CT[R]) copyright 2004-2014 International Health Terminology Standards Development Organisation. ICD-10 copyright 2014 World Health Organization. All Rights Reserved.These performance Measures are not clinical guidelines and do not establish a standard of medical care, and have not been tested for all potential applications. - -THE MEASURES 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].ProportionProcessNoneNoneNoneAttention-deficit/hyperactivity disorder (ADHD) is one of the more common chronic conditions of childhood. Children with ADHD may experience significant functional problems, such as school difficulties, academic underachievement, troublesome relationships with family members and peers and behavioral problems (American Academy of Pediatrics 2000). Given the high prevalence of ADHD among school-aged children (4 to 12 percent), primary care clinicians will encounter children with ADHD in their practices regularly and should have a strategy for diagnosis and long-term management of this condition (American Academy of Pediatrics 2001). - -The American Academy of Pediatrics (AAP) clinical practice guidelines provide evidence-based recommendations for the treatment of children diagnosed with ADHD. Two treatment approaches are recognized for efficacy: stimulant medication therapy or behavior therapy. Despite data showing that stimulant medications are safe, there are widespread misunderstandings about the safety and use of these drugs. Those used to treat ADHD have known side effects and, like all medications, need to be closely monitored (American Academy of Pediatrics 2001). - -Systematic monitoring of dosage and side-effects for children on stimulants is recommended in order to target any adverse effects (American Academy of Pediatrics 2001). Alternatively, a child may respond poorly to stimulant medication because of an undiagnosed co-morbid condition, the emergence of psychosocial stressors or noncompliance (Smucker and Hedayat 2001). The AAP clinical guideline recommends that clinicians evaluate the original diagnosis when a child does not meet target outcomes, in addition to treatment adherence. Assessment of target outcomes is based upon a systematic follow-up for the child with ADHD (American Academy of Pediatrics 2000).American Academy of Pediatrics (2001) - -Primary care clinicians should establish a management program that recognizes ADHD as a chronic condition (strength of evidence: good; strength of recommendation: strong). - -The treating clinician, parents, and the child, in collaboration with school personnel, should specify appropriate target outcomes to guide management (strength of evidence: good; strength of recommendation: strong). - -The clinician should recommend stimulant medication (strength of evidence: good) and/or behavior therapy (strength of evidence: fair), as appropriate, to improve target outcomes in children with ADHD (strength of recommendation: strong). - -When the selected management for a child with ADHD has not met target outcomes, clinicians should evaluate the original diagnosis, use of all appropriate treatments, adherence to the treatment plan, and presence of coexisting conditions (strength of evidence: weak; strength of recommendation: strong). - -The clinician should periodically provide a systematic follow-up for the child with ADHD. Monitoring should be directed to target outcomes and adverse effects by obtaining specific information from parents, teachers, and the child (strength of evidence: fair; strength of recommendation: strong).Higher score indicates better quality.American Academy of Pediatrics. 2000. "Clinical Practice Guideline: Diagnosis and Evaluation of the Child With Attention-Deficit/Hyperactivity Disorder." Pediatrics 105(5):1158-70.American Academy of Pediatrics. Subcommittee on Attention-Deficit/Hyperactivity Disorder and Committee on Quality Improvement. 2001. "Clinical Practice Guideline: Treatment of the School-Aged Child With Attention-Deficit/Hyperactivity Disorder." Pediatrics 108(4):1033-43.Smucker, W., and M. Hedayat. 2001. "Evaluation and Treatment of ADHD." Am Fam Physician 64(5):817-830.Intake Period: The five-month period starting 90 days prior to the start of the measurement period and ending 60 days after the start of the measurement period. - -Index Prescription Start Date (IPSD): The earliest prescription dispensing date for an ADHD medication where the date is in the Intake Period and an ADHD medication was not dispensed during the 120 days prior. - -Initiation Phase: The 30 days following the IPSD. - -Continuation and Maintenance Phase: The 31-300 days following the IPSD.CUMULATIVE MEDICATION DURATION is an individual's total number of medication days over a specific period; the period counts multiple prescriptions with gaps in between, but does not count the gaps during which a medication was not dispensed. - -To determine the cumulative medication duration, determine first the number of the medication Days for each prescription in the period: the number of doses divided by the dose frequency per day. Then add the Medication Days for each prescription without counting any days between the prescriptions. - -For example, there is an original prescription for 30 days with 2 refills for thirty days each. After a gap of 3 months, the medication was prescribed again for 60 days with 1 refill for 60 days. The cumulative medication duration is (30 x 3) + (60 x 2) = 210 days over the 10 month period.TBDInitial Population 1: Children 6-12 years of age who were dispensed an ADHD medication during the Intake Period and who had a visit during the measurement period - -Initial Population 2: Children 6-12 years of age who were dispensed an ADHD medication during the Intake Period and who remained on the medication for at least 210 days out of the 300 days following the IPSD, and who had a visit during the measurement period.Equals Initial PopulationDenominator Exclusion 1: Exclude patients diagnosed with narcolepsy at any point in their history or during the measurement period. - -Exclude patients who had an acute inpatient stay with a principal diagnosis of mental health or substance abuse during the 30 days after the IPSD. - -Exclude patients who were actively on an ADHD medication in the 120 days prior to the Index Prescription Start Date. - -Denominator Exclusion 2: Exclude patients diagnosed with narcolepsy at any point in their history or during the measurement period. - -Exclude patients who had an acute inpatient stay with a principal diagnosis of mental health or substance abuse during the 300 days after the IPSD. - -Exclude patients who were actively on an ADHD medication in the 120 days prior to the Index Prescription Start Date.Numerator 1: Patients who had at least one face-to-face visit with a practitioner with prescribing authority within 30 days after the IPSD - -Numerator 2: Patients who had at least one face-to-face visit with a practitioner with prescribing authority during the Initiation Phase, and at least two follow-up visits during the Continuation and Maintenance Phase. One of the two visits during the Continuation and Maintenance Phase may be a telephone visit with a practitioner.Not ApplicableNoneNot ApplicableNot ApplicableNot ApplicableFor every patient evaluated by this measure also identify payer, race, ethnicity and sex.None - - \ No newline at end of file diff --git a/test/fixtures/hqmf/simplexml/CMS137v4_SimpleXML.xml b/test/fixtures/hqmf/simplexml/CMS137v4_SimpleXML.xml deleted file mode 100755 index 57e8998f..00000000 --- a/test/fixtures/hqmf/simplexml/CMS137v4_SimpleXML.xml +++ /dev/null @@ -1,38 +0,0 @@ -40280381-4de7-db4d-014d-e88b64750209Initiation and Engagement of Alcohol and Other Drug Dependence TreatmentIni_Eng_Alc_Drug_Dep137c3657d72-21b4-4675-820a-86c7fe293bf54.1.0000000010100001231National Committee for Quality AssuranceNational Committee for Quality AssuranceNational Quality ForumPercentage of patients 13 years of age and older with a new episode of alcohol and other drug (AOD) dependence who received the following. Two rates are reported. -a. Percentage of patients who initiated treatment within 14 days of the diagnosis. -b. Percentage of patients who initiated treatment and who had two or more additional services with an AOD diagnosis within 30 days of the initiation visit.Physician Performance Measure (Measures) and related data specifications were developed by the National Committee for Quality Assurance (NCQA). - -The Measures are copyrighted but can be reproduced and distributed, without modification, for noncommercial purposes (eg, use by healthcare providers in connection with their practices). Commercial use is defined as the sale, licensing, or distribution of the Measures for commercial gain, or incorporation of the Measures into a product or service that is sold, licensed or distributed for commercial gain. Commercial use of the Measures requires a license agreement between the user and NCQA. NCQA is not responsible for any use of the Measures. - -(c) 2008-2015 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 CPT or other codes contained in the specifications. - -CPT(R) contained in the Measure specifications is copyright 2004-2014 American Medical Association. LOINC(R) copyright 2004-2014 Regenstrief Institute, Inc. This material contains SNOMED Clinical Terms(R) (SNOMED CT[R]) copyright 2004-2014 International Health Terminology Standards Development Organisation. ICD-10 copyright 2014 World Health Organization. All Rights Reserved.These performance Measures are not clinical guidelines and do not establish a standard of medical care, and have not been tested for all potential applications. - -THE MEASURES 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].ProportionProcessReport a total score, and each of the following strata: -Stratum 1: Patients age 13-17 -Stratum 2: Patients age >=18NoneNoneThere are more deaths, illnesses and disabilities from substance abuse than from any other preventable health condition. Treatment of medical problems caused by substance use and abuse places a huge burden on the health care system (Schneider Institute 2001). According to a report from the 2001 National Household Survey on Drug Abuse (NHSDA), an estimated 16.6 million Americans aged 12 or older in 2001 were classified with dependence on or abuse of either alcohol or illicit drugs (7.3 percent of the total population) (Substance Abuse and Mental Health Services Administration 2008). Of these, 2.4 million were classified with dependence on or abuse of both alcohol and illicit drugs, 3.2 million were dependent on or abused illicit drugs but not alcohol, and 11.0 million were dependent on or abused alcohol but not illicit drugs (Substance Abuse and Mental Health Services Administration 2008).American Psychiatric Association (2006) -* Because many substance use disorders are chronic, patients usually require long-term treatment, although the intensity and specific components of treatment may vary over time [I rating]. -* It is important to intensify the monitoring for substance use during periods when the patient is at a high risk of relapsing, including during the early stages of treatment, times of transition to less intensive levels of care, and the first year after active treatment has ceased [I rating]. -* Outpatient treatment of substance use disorders is appropriate for patients whose clinical condition or environmental circumstances do not require a more intensive level of care [I rating]. As in other treatment settings, a comprehensive approach is optimal, using, where indicated, a variety of psychotherapeutic and pharmacological interventions along with behavioral monitoring [I rating]. - -Michigan Quality Improvement Consortium (2009) -Patient Education and Brief Intervention by Primary Care Physician (PCP) or Trained Staff (eg, RN, MSW) [A rating] -* Assess patient's risk, understanding, and readiness to change. -* Discuss the relationship of substance use to presenting medical concerns or psychosocial problems. -* Negotiate goals and strategies for reducing consumption and other change. -* Involve family members as appropriate. - -Referral Considerations -* Consider referral to community-based services (eg, Alcoholics Anonymous, Narcotics Anonymous, Cocaine Anonymous) or Employee Assistance Program, or (especially if substance dependent) a substance abuse or behavioral health specialist. [D rating] -* Pharmacologic management should be conducted by or in collaboration with physicians who have expertise in the area of substance use disorders. [D rating] -* Schedule appropriate follow-up within 30 days to re-assess and support behavior change.Higher score indicates better qualitySchneider Institute for Health Policy, Brandeis University. 2001. Substance Abuse: The Nation's Number One Health Problem. Princeton: Robert Wood Johnson Foundation.Substance Abuse and Mental Health Services Administration, Office of Applied Studies. 2008. Results from the 2007 National Survey on Drug Use and Health: National Finding. NSDUH Series H-34, DHHS Publication No. SMA 08-4343. Rockville, MD. Work Group on Substance Use Disorders, Kleber H.D., R.D. Weiss, R.F. Anton, B.J. Rounsaville, T.P. George, E.C. Strain, S.F. Greenfield, D.M. Ziedonis, T.R. Kosten, G. Hennessy, C.P. O'Brien, H.S. Connery HS, American Psychiatric Association Steering Committee on Practice Guidelines, McIntyre J.S., S.C. Charles, D.J. Anzia, J.E. Nininger, I.A. Cook, P. Summergrad, M.T. Finnerty, S.M. Woods, B.R. Johnson, J. Yager, R. Pyles, L. Lurie, C.D. Cross, R.D. Walker, R. Peele, M.A. Barnovitz, S.H. Gray, J.P. Shemo, S. Saxena, T. Tonnu, R. Kunkle, A.B. Albert, L.J. Fochtmann, C. Hart, D. Regier. 2006. Treatment of patients with substance use disorders, second edition. American Psychiatic Association. Am J Psychiatry 163(8 Suppl):5-82.Michigan Quality Improvement Consortium. 2009. Screening, diagnosis and referral for substance use disorders. Southfield: Michigan Quality Improvement Consortium.The initiation visit is the first visit for alcohol or other drug dependence treatment within 14 days after a diagnosis of alcohol or other drug dependence. - -Treatment includes inpatient AOD admissions, outpatient visits, intensive outpatient encounters or partial hospitalization.The new episode of alcohol and other drug dependence should be the first episode of the measurement period that is not preceded in the 60 days prior by another episode of alcohol or other drug dependence.TBDPatients age 13 years of age and older who were diagnosed with a new episode of alcohol or drug dependency during a visit in the first 11 months of the measurement periodEquals Initial PopulationPatients with a previous active diagnosis of alcohol or drug dependence in the 60 days prior to the first episode of alcohol or drug dependenceNumerator 1: Patients who initiated treatment within 14 days of the diagnosis - -Numerator 2: Patients who initiated treatment and who had two or more additional services with an AOD diagnosis within 30 days of the initiation visitNot ApplicableNoneNot ApplicableNot ApplicableNot ApplicableFor every patient evaluated by this measure also identify payer, race, ethnicity and sex.None - - \ No newline at end of file diff --git a/test/fixtures/hqmf/simplexml/CMS138v4_SimpleXML.xml b/test/fixtures/hqmf/simplexml/CMS138v4_SimpleXML.xml deleted file mode 100755 index 044d34f7..00000000 --- a/test/fixtures/hqmf/simplexml/CMS138v4_SimpleXML.xml +++ /dev/null @@ -1,27 +0,0 @@ -40280381-4c18-79df-014c-2dfa25f60c0ePreventive Care and Screening: Tobacco Use: Screening and Cessation InterventionTobacco138e35791df-5b25-41bb-b260-673337bc44a84.0.0000000010100001231American Medical Association-convened Physician Consortium for Performance Improvement(R) (AMA-PCPI)American Medical Association-convened Physician Consortium for Performance Improvement(R) (AMA-PCPI)National Quality ForumPercentage of patients aged 18 years and older who were screened for tobacco use one or more times within 24 months AND who received cessation counseling intervention if identified as a tobacco userCopyright 2014 American Medical Association. All Rights Reserved.Physician Performance Measures (Measures) and related data specifications have been developed by the American Medical Association (AMA) - convened Physician Consortium for Performance Improvement(R) (PCPI[R]). These Measures are not clinical guidelines and do not establish a standard of medical care, and have not been tested for all potential applications. The Measures, while copyrighted, can be reproduced and distributed, without modification, for noncommercial purposes, eg, use by health care providers in connection with their practices. Commercial use is defined as the sale, license, or distribution of the Measures for commercial gain, or incorporation of the Measures into a product or service that is sold, licensed or distributed for commercial gain. Commercial uses of the Measures require a license agreement between the user and the AMA, (on behalf of the PCPI). Neither the AMA, PCPI nor its members shall be responsible for any use of the Measures. - -THE MEASURES AND SPECIFICATIONS ARE PROVIDED "AS IS" WITHOUT WARRANTY OF ANY KIND. - -Limited proprietary coding is contained in the Measure specifications for convenience. Users of the proprietary code sets should obtain all necessary licenses from the owners of these code sets. The AMA, the PCPI and its members disclaim all liability for use or accuracy of any Current Procedural Terminology (CPT[R]) or other coding contained in the specifications. - -CPT(R) contained in the Measure specifications is copyright 2004-2014 American Medical Association. LOINC(R) copyright 2004-2014 Regenstrief Institute, Inc. This material contains SNOMED Clinical Terms(R) (SNOMED CT[R]) copyright 2004-2014 International Health Terminology Standards Development Organisation. ICD-10 copyright 2014 World Health Organization. All Rights Reserved. - -Due to technical limitations, registered trademarks are indicated by (R) or [R].ProportionProcessNoneNoneNoneThis measure is intended to promote adult tobacco screening and tobacco cessation interventions for those who use tobacco products. There is good evidence that tobacco screening and brief cessation intervention (including counseling and/or pharmacotherapy) is successful in helping tobacco users quit. Tobacco users who are able to stop smoking lower their risk for heart disease, lung disease, and stroke.All patients should be asked if they use tobacco and should have their tobacco use status documented on a regular basis. Evidence has shown that clinic screening systems, such as expanding the vital signs to include tobacco use status or the use of other reminder systems such as chart stickers or computer prompts, significantly increase rates of clinician intervention. (Strength of Evidence = A) (U.S. Department of Health and Human Services. Public Health Service, 2008) - -All physicians should strongly advise every patient who smokes to quit because evidence shows that physician advice to quit smoking increases abstinence rates. (Strength of Evidence = A) (U.S. Department of Health and Human Services. Public Health Service, 2008) - -Minimal interventions lasting less than 3 minutes increase overall tobacco abstinence rates. Every tobacco user should be offered at least a minimal intervention, whether or not he or she is referred to an intensive intervention. (Strength of Evidence = A) (U.S. Department of Health and Human Services. Public Health Service, 2008) - -The combination of counseling and medication is more effective for smoking cessation than either medication or counseling alone. Therefore, whenever feasible and appropriate, both counseling and medication should be provided to patients trying to quit smoking. (Strength of Evidence = A) (U.S. Department of Health and Human Services. Public Health Service, 2008) - -Clinicians should encourage all patients attempting to quit to use effective medications for tobacco dependence treatment, except where contraindicated or for specific populations for which there is insufficient evidence of effectiveness (i.e., pregnant women, smokeless tobacco users, light smokers, and adolescents). (Strength of Evidence = A) (U.S. Department of Health and Human Services. Public Health Service, 2008) - -The USPSTF recommends that clinicians ask all adults about tobacco use and provide tobacco cessation interventions for those who use tobacco products. (A Recommendation) (U.S. Preventive Services Task Force, 2009)Higher score indicates better qualityFiore MC, Jaen CR, Baker TB, et al. Treating tobacco use and dependence: 2008 update. Clinical practice guideline. Rockville, MD: U.S. Department of Health and Human Services. Public Health Service. May 2008. -U.S. Preventive Services Task Force. Counseling and interventions to prevent tobacco use and tobacco-caused disease in adults and pregnant women: U.S. Preventive Services Task Force reaffirmation recommendation statement. Ann Intern Med 2009 Apr 21;150(8):551-5.Tobacco Use - Includes any type of tobacco -Tobacco Cessation Intervention - Includes brief counseling (3 minutes or less), and/or pharmacotherapyIf a patient uses any type of tobacco (ie, smokes or uses smokeless tobacco), the expectation is that they should receive tobacco cessation intervention: either counseling and/or pharmacotherapy. - -If tobacco use status of a patient is unknown, the patient does not meet the screening component required to be counted in the numerator and should be considered a measure failure. Instances where tobacco use status of "unknown" is recorded include: 1) the patient was not screened; or 2) the patient was screened and the patient (or caregiver) was unable to provide a definitive answer. If the patient does not meet the screening component of the numerator but has an allowable medical exception, then the patient should be removed from the denominator of the measure and reported as a valid exception. - -Exceptions only apply to the screening data element of the measure; once a patient has been screened, there are no allowable exceptions for not providing the intervention.TBDAll patients aged 18 years and older seen for at least two visits or at least one preventive visit during the measurement periodEquals Initial PopulationNonePatients who were screened for tobacco use at least once within 24 months AND who received tobacco cessation intervention if identified as a tobacco userNot ApplicableDocumentation of medical reason(s) for not screening for tobacco use (eg, limited life expectancy, other medical reason)Not ApplicableNot ApplicableNot ApplicableFor every patient evaluated by this measure also identify payer, race, ethnicity and sex.None - - \ No newline at end of file diff --git a/test/fixtures/hqmf/simplexml/CMS139v4_SimpleXML.xml b/test/fixtures/hqmf/simplexml/CMS139v4_SimpleXML.xml deleted file mode 100755 index 1362802f..00000000 --- a/test/fixtures/hqmf/simplexml/CMS139v4_SimpleXML.xml +++ /dev/null @@ -1,19 +0,0 @@ -40280381-4be2-53b3-014b-ebaf72d707c4Falls: Screening for Future Fall RiskFalls_Screening139bc5b4a57-b964-4399-9d40-667c896f31ea4.0.0000000010100001231National Committee for Quality AssuranceNational Committee for Quality AssuranceAmerican Medical Association-convened Physician Consortium for Performance Improvement(R) (AMA-PCPI)National Quality ForumPercentage of patients 65 years of age and older who were screened for future fall risk during the measurement period.Copyright 2014 National Committee for Quality Assurance (NCQA) and American Medical Association. All Rights Reserved.Physician Performance Measures (Measures) and related data specifications have been developed by the American Medical Association (AMA) - convened Physician Consortium for Performance Improvement(R) (PCPI[R]) and the National Committee for Quality Assurance (NCQA). These Measures are not clinical guidelines and do not establish a standard of medical care, and have not been tested for all potential applications. The Measures, while copyrighted, can be reproduced and distributed, without modification, for noncommercial purposes, eg, use by health care providers in connection with their practices. Commercial use is defined as the sale, license, or distribution of the Measures for commercial gain, or incorporation of the Measures into a product or service that is sold, licensed or distributed for commercial gain. Commercial uses of the Measures require a license agreement between the user and the AMA, (on behalf of the PCPI) or NCQA. Neither the AMA, PCPI, NCQA nor its members shall be responsible for any use of the Measures. - -THE MEASURES AND SPECIFICATIONS ARE PROVIDED "AS IS" WITHOUT WARRANTY OF ANY KIND. - -Limited proprietary coding is contained in the Measure specifications for convenience. Users of the proprietary code sets should obtain all necessary licenses from the owners of these code sets. The AMA, PCPI, NCQA and its members disclaim all liability for use or accuracy of any Current Procedural Terminology (CPT[R]) or other coding contained in the specifications. - -CPT(R) contained in the Measure specifications is copyright 2004-2014 American Medical Association. LOINC(R) copyright 2004-2014 Regenstrief Institute, Inc. This material contains SNOMED Clinical Terms(R) (SNOMED CT[R]) copyright 2004-2014 International Health Terminology Standards Development Organisation. ICD-10 copyright 2014 World Health Organization. All Rights Reserved. - -Due to technical limitations, registered trademarks are indicated by (R) or [R].ProportionProcessNoneNoneNoneAs the leading cause of both fatal and nonfatal injuries for older adults, falls are one of the most common and significant health issues facing people aged 65 years or older (Schneider, Shubert and Harmon 2010). Moreover, the rate of falls increases with age (Dykes et al. 2010). Older adults are five times more likely to be hospitalized for fall-related injuries than any other cause-related injury. It is estimated that one in every three adults over 65 will fall each year (Centers for Disease Control and Prevention 2012). In those over age 80, the rate of falls increases to fifty percent (Doherty et al. 2009). Falls are also associated with substantial cost and resource use, approaching $30,000 per fall hospitalization (Woolcott et al. 2011). Identifying at-risk patients is the most important part of management, as applying preventive measures in this vulnerable population can have a profound effect on public health (al-Aama 2011). Family physicians have a pivotal role in screening older patients for risk of falls, and applying preventive strategies for patients at risk (al-Aama 2011).All older persons who are under the care of a heath professional (or their caregivers) should be asked at least once a year about falls. (AGS/BGS/AAOS) - -Older persons who present for medical attention because of a fall, report recurrent falls in the past year, or demonstrate abnormalities of gait and/or balance should have a fall evaluation performed. This evaluation should be performed by a clinician with appropriate skills and experience, which may necessitate referral to a specialist (eg, geriatrician). (AGS/BGS/AAOS) - -Older people in contact with health care professionals should be asked routinely whether they have fallen in the past year and asked about the frequency, context, and characteristics of the falls. (NICE) (Grade C) - -Older people reporting a fall or considered at risk of falling should be observed for balance and gait deficits and considered for their ability to benefit from interventions to improve strength and balance. (NICE) (Grade C)A higher score indicates better quality.al-Aama, T. 2011. "Falls in the Elderly: Spectrum and Prevention." Can Fam Physician 57(7):771-6.Centers for Disease Control and Prevention. 2012. "Falls Among Older Adults: An Overview." (February 29) http://www.cdc.gov/HomeandRecreationalSafety/Falls/adultfalls.htmlDoherty, M., and J. Crossen-Sills. 2009. "Fall Risk: Keep your patients in balance." The Nurse Practitioner: The American Journal of Primary Health Care 34(12):46-51.American Geriatrics Society, British Geriatrics Society, and American Academy of Orthopaedic Surgeons Panel on Falls Prevention: Guideline for the prevention of falls in older persons. Journal of the American Geriatrics Society. 2001; 49: 664-672.National Institute for Clinical Excellence (NICE). Falls: the assessment and prevention of falls in older people. November 2004; clinical guideline 21. Available at: http://www.nice.org.uk/page.aspx?o=home.Dykes, P.C., D.L. Carroll DL, A. Hurley A, S. Lipsitz S, A. Benoit A, F. Chang F, S. Meltzer S, R. Tsurikova R, L. Zuyov L, B. Middleton B. 2010. "Fall Prevention in Acute Care Hospitals: A Randomized Trial." JAMA . 2010;304(17):1912-1918.Schneider, E.C., T.E. Shubert, and K.J. Harmon. 2010. "Addressing the Escalating Public Health Issue of Falls Among Older Adults." NC Med J 71(6):547-52.Woolcott, J.C., K.M. Khan, S. Mitrovic, A.H. Anis, C.A. Marra. 2011. "The Cost of Fall Related Presentations to the ED: A Prospective, In-Person, Patient-Tracking Analysis of Health Resource Utilization." Osteporos Int [Epub ahead of print].Future fall risk: Patients are considered at risk for future falls if they have had 2 or more falls in the past year or any fall with injury in the past year. - -Fall: A sudden, unintentional change in position causing an individual to land at a lower level, on an object, the floor, or the ground, other than as a consequence of sudden onset of paralysis, epileptic seizure, or overwhelming external force.NoneTBDPatients aged 65 years and older with a visit during the measurement periodEquals Initial PopulationNonePatients who were screened for future fall risk at least once within the measurement periodNot ApplicableDocumentation of medical reason(s) for not screening for fall risk (eg, patient is not ambulatory)Not ApplicableNot ApplicableNot ApplicableFor every patient evaluated by this measure also identify payer, race, ethnicity and sex.None - - \ No newline at end of file diff --git a/test/fixtures/hqmf/simplexml/CMS140v4_SimpleXML.xml b/test/fixtures/hqmf/simplexml/CMS140v4_SimpleXML.xml deleted file mode 100755 index e50596fe..00000000 --- a/test/fixtures/hqmf/simplexml/CMS140v4_SimpleXML.xml +++ /dev/null @@ -1,43 +0,0 @@ -40280381-4b9a-3825-014b-c16d387006eeBreast Cancer: Hormonal Therapy for Stage IC-IIIC Estrogen Receptor/Progesterone Receptor (ER/PR) Positive Breast CancerOnc_Breast_Cancer140ac639794-cb3f-4f4f-8fa6-680300d5ed4e4.0.0000000010100001231American Medical Association-convened Physician Consortium for Performance Improvement(R) (AMA-PCPI)American Medical Association-convened Physician Consortium for Performance Improvement(R) (AMA-PCPI)National Quality ForumPercentage of female patients aged 18 years and older with Stage IC through IIIC, ER or PR positive breast cancer who were prescribed tamoxifen or aromatase inhibitor (AI) during the 12-month reporting periodCopyright 2014 American Society of Clinical Oncology, National Comprehensive Cancer Network Association and American Medical Association. All Rights Reserved.Physician Performance Measures (Measures) and related data specifications have been developed by the American Medical Association (AMA) - convened Physician Consortium for Performance Improvement(R) (PCPI[R]), American Society of Clinical Oncology, and National Comprehensive Cancer Network. These Measures are not clinical guidelines and do not establish a standard of medical care, and have not been tested for all potential applications. The Measures, while copyrighted, can be reproduced and distributed, without modification, for noncommercial purposes, eg, use by health care providers in connection with their practices. Commercial use is defined as the sale, license, or distribution of the Measures for commercial gain, or incorporation of the Measures into a product or service that is sold, licensed or distributed for commercial gain. Commercial uses of the Measures require a license agreement between the user and the AMA, (on behalf of the PCPI). Neither the AMA, PCPI nor its members shall be responsible for any use of the Measures. - -THE MEASURES AND SPECIFICATIONS ARE PROVIDED "AS IS" WITHOUT WARRANTY OF ANY KIND. - -Limited proprietary coding is contained in the Measure specifications for convenience. Users of the proprietary code sets should obtain all necessary licenses from the owners of these code sets. The AMA, American Society of Clinical Oncology, National Comprehensive Cancer Network, the PCPI and its members disclaim all liability for use or accuracy of any Current Procedural Terminology (CPT[R]) or other coding contained in the specifications. - -CPT(R) contained in the Measure specifications is copyright 2004-2014 American Medical Association. LOINC(R) copyright 2004-2014 Regenstrief Institute, Inc. This material contains SNOMED Clinical Terms(R) (SNOMED CT[R]) copyright 2004-2014 International Health Terminology Standards Development Organisation. ICD-10 copyright 2014 World Health Organization. All Rights Reserved. - -Due to technical limitations, registered trademarks are indicated by (R) or [R].ProportionProcessNoneNoneNoneDespite evidence suggesting the role of adjuvant endocrine therapy in lowering the risk of tumor recurrence, many female patients who should be receiving this therapy are not. - -This measure assesses whether patients with a certain stage of breast cancer (IC through IIIC) and ER/PR+ are currently receiving the therapy. - -There are allowable medical, patient, and system reasons to document instances in which a woman with stage IC through IIIC, ER/PR+ may not be a candidate for the therapy.I. Women diagnosed with hormone receptor-positive breast cancer who are pre- or perimenopausal should be offered adjuvant endocrine therapy with: - a. Tamoxifen for an initial duration of 5 years. - b. After 5 years, women should receive additional therapy based on menopausal status. - i. If women are pre- or perimenopausal, or if menopausal status is unknown or cannot be determined, they should be offered continued tamoxifen for a total duration of 10 years. (Type: Evidence-Based, Evidence Quality: High, Strength of Recommendation: Strong) - ii. If women have become definitively postmenopausal, they should be offered continued tamoxifen for a total duration of 10 years or switching to up to 5 years of an aromatase inhibitor (AI), for a total duration of up to 10 years of adjuvant endocrine therapy. (Type: Evidence-Based, Evidence Quality for tamoxifen: High, Evidence Quality for AI: High, Strength of Recommendation: Strong) - -II. Women diagnosed with hormone receptor-positive breast cancer who are postmenopausal should be offered adjuvant endocrine therapy with one of the following options: - a. Tamoxifen for a duration of 10 years. (Type: Evidence-Based, Evidence Quality: High, Strength of Recommendation: Strong) Or - b. An AI for a duration of 5 years. There are insufficient data currently to recommend an AI for a duration of greater than 5 years. (Type: Evidence-Based, Evidence Quality: High, Strength of Recommendation: Strong) Or - c. Tamoxifen for an initial duration of 5 years, then switching to an AI for up to 5 years, for a total duration of up to 10 years of adjuvant endocrine therapy. (Type: Evidence-Based, Evidence Quality: High, Strength of Recommendation: Strong) Or - d. Tamoxifen for a duration of 2 to 3 years and switching to an AI for up to 5 years, for a total duration of up to 7 to 8 years of adjuvant endocrine therapy. (Type: Evidence-Based, Evidence Quality: High, Strength of Recommendation: Strong) - -III. Women who are postmenopausal and are intolerant of either tamoxifen or an AI should be offered the alternative type of adjuvant endocrine therapy. - a. If women have received an AI but discontinued treatment at less than 5 years, they may be offered tamoxifen for a total of 5 years. (Type: Informal consensus, Evidence Quality: Low, Strength of Recommendation: Weak) - b. If women have received tamoxifen for 2 to 3 years, they should be offered switching to an AI for up to 5 years, for a total duration of up to 7 to 8 years of adjuvant endocrine therapy. (Type: Evidence-Based, Evidence Quality: High, Strength of Recommendation: Strong) - -IV. Women who have received 5 years of tamoxifen as adjuvant endocrine therapy should be offered additional adjuvant endocrine treatment. - a. If women are postmenopausal, they should be offered continued tamoxifen for a total duration of 10 years or switching to up to 5 years AI, for a total duration of up to 10 years of adjuvant endocrine therapy. (Type: Evidence-Based, Evidence Quality: High, Strength of Recommendation: Strong) - b. If women are pre- or perimenopausal, or menopausal status cannot be ascertained, they should be offered 5 additional years of tamoxifen, for a total duration of 10 years of adjuvant endocrine therapy. (Type: Evidence-Based, Evidence Quality: High, Strength of Recommendation: Strong) (ASCO, 2014) - -Patients with invasive breast cancers that are ER- or PR-positive should be considered for adjuvant endocrine therapy regardless of patient age, lymph node status, or whether adjuvant chemotherapy is to be administered. (NCCN, 2014) - -The most firmly established adjuvant endocrine therapy is tamoxifen for both premenopausal and postmenopausal women. In women with ER-positive breast cancer, adjuvant tamoxifen decreases the annual odds of recurrence by 39% and the annual odds of death by 31% irrespective of the use of chemotherapy, patient age, menopausal status, or ALN status. In patients receiving both tamoxifen and chemotherapy, chemotherapy should be given first, followed by sequential tamoxifen. Prospective, randomized trials have demonstrated that 5 years of tamoxifen is more effective than 1 to 2 years of tamoxifen. (NCCN, 2014) - -Patients with lymph node involvement or with tumors greater than 1cm in diameter are appropriate candidates for adjuvant systemic therapy (category 1). For women with lymph node-negative, hormone receptor-negative tumors greater than 1 cm in diameter, chemotherapy is recommended (category 1). For those with lymph node-negative, hormone receptor-positive breast cancer tumors greater than 1 cm, endocrine therapy with chemotherapy is recommended (category 1). (NCCN, 2014)Higher score indicates better qualityBurstein HJ, Temin S, Anderson H, et al. Adjuvant endocrine therapy for women with hormone receptor-positive breast cancer: American Society of Clinical Oncology clinical practice guideline focused update. J Clin Oncol. 2014;32(21):2255-2269. doi:10.1200/JCO.2013.54.2258 National Comprehensive Cancer Network (NCCN). Clinical Practice Guidelines in Oncology: Breast Cancer. Version 3.2014. Available at http://www.nccn.org. NoneFor the eCQM version of this measure, the initial population for this measure has been limited to patients with a first recorded breast cancer diagnosis within the past 5 years, as opposed to accounting for that patient population through the use of an exception (as is the case for claims implementation). The numerator captures patients who are prescribed adjuvant tamoxifen or AI, or received adjuvant tamoxifen or AI during the 12 month period. Date of breast cancer diagnosis is defined as date of pathologic diagnosis. - -The requirement of "Count >=2 of Encounter, Performed" is to establish that the eligible professional has an existing relationship with the patient.TBDAll female patients aged 18 years and older with a diagnosis of breast cancerEquals Initial Population with stage IC through IIIC, estrogen receptor (ER) or progesterone receptor (PR) positive breast cancerNonePatients who were prescribed tamoxifen or aromatase inhibitor (AI) during the 12-month reporting periodNot Applicable- Documentation of medical reason(s) for not prescribing tamoxifen or aromatase inhibitor (eg, patient's disease has progressed to metastatic, patient is receiving a gonadotropin-releasing hormone analogue, patient has received oophorectomy, patient is receiving radiation or chemotherapy, patient's diagnosis date is within 120 days of the end of the 12 month reporting period, other medical reason) -- Documentation of patient reason(s) for not prescribing tamoxifen or aromatase inhibitor (eg, patient refusal, other patient reasons) -- Documentation of system reason(s) for not prescribing tamoxifen or aromatase inhibitor (eg, patient is currently enrolled in a clinical trial, other system reasons)Not ApplicableNot ApplicableNot ApplicableFor every patient evaluated by this measure also identify payer, race, ethnicity and sex.None - - \ No newline at end of file diff --git a/test/fixtures/hqmf/simplexml/CMS141v5_SimpleXML.xml b/test/fixtures/hqmf/simplexml/CMS141v5_SimpleXML.xml deleted file mode 100755 index e3cbe6db..00000000 --- a/test/fixtures/hqmf/simplexml/CMS141v5_SimpleXML.xml +++ /dev/null @@ -1,21 +0,0 @@ -40280381-4b9a-3825-014b-c184a62f0704Colon Cancer: Chemotherapy for AJCC Stage III Colon Cancer PatientsColon_Cancer1418479f6d6-4200-4fd0-9438-30048ebe3e295.0.0000000010100001231American Medical Association-convened Physician Consortium for Performance Improvement(R) (AMA-PCPI)American Medical Association-convened Physician Consortium for Performance Improvement(R) (AMA-PCPI)National Quality ForumPercentage of patients aged 18 through 80 years with AJCC Stage III colon cancer who are referred for adjuvant chemotherapy, prescribed adjuvant chemotherapy, or have previously received adjuvant chemotherapy within the 12-month reporting period.Copyright 2014 American Society of Clinical Oncology, National Comprehensive Cancer Network Association and American Medical Association. All Rights Reserved.Physician Performance Measures (Measures) and related data specifications have been developed by the American Medical Association (AMA) - convened Physician Consortium for Performance Improvement(R) (PCPI[R]), American Society of Clinical Oncology, and National Comprehensive Cancer Network. These Measures are not clinical guidelines and do not establish a standard of medical care, and have not been tested for all potential applications. The Measures, while copyrighted, can be reproduced and distributed, without modification, for noncommercial purposes, eg, use by health care providers in connection with their practices. Commercial use is defined as the sale, license, or distribution of the Measures for commercial gain, or incorporation of the Measures into a product or service that is sold, licensed or distributed for commercial gain. Commercial uses of the Measures require a license agreement between the user and the AMA, (on behalf of the PCPI). Neither the AMA, PCPI nor its members shall be responsible for any use of the Measures. - -THE MEASURES AND SPECIFICATIONS ARE PROVIDED "AS IS" WITHOUT WARRANTY OF ANY KIND. - -Limited proprietary coding is contained in the Measure specifications for convenience. Users of the proprietary code sets should obtain all necessary licenses from the owners of these code sets. The AMA, American Society of Clinical Oncology, National Comprehensive Cancer Network, the PCPI and its members disclaim all liability for use or accuracy of any Current Procedural Terminology (CPT(R)) or other coding contained in the specifications. - -CPT(R) contained in the Measure specifications is copyright 2004-2014 American Medical Association. LOINC(R) copyright 2004-2014 Regenstrief Institute, Inc. This material contains SNOMED Clinical Terms(R) (SNOMED CT[R]) copyright 2004-2014 International Health Terminology Standards Development Organisation. ICD-10 copyright 2014 World Health Organization. All Rights Reserved. - -Due to technical limitations, registered trademarks are indicated by (R) or [R].ProportionProcessNoneNoneNoneThe receipt of adjuvant chemotherapy in AJCC Stage III colon cancer patients following primary surgical treatment is associated with a significant survival benefit.For patients with stage III disease, the panel recommends 6 months of adjuvant chemotherapy after primary surgical treatment. The treatment options are: FOLFOX or CapeOx (both category 1 and preferred); FLOX (category 1); or single-agent capecitabine or 5-FU/LV in patients for whom oxaliplatin therapy is believed to be inappropriate. (NCCN, 2015) - -A shortage of LV recently existed in the United States. No specific data are available to guide management under these circumstances, and all proposed strategies are empiric. The panel recommends several possible options to help alleviate the problems associated with this shortage. One is the use of levoleucovorin, which is commonly used in Europe. A dose of 200 mg/m2 of leucovorin is equivalent to 400 mg/m2 of standard LV. Another option is for practices or institutions to use lower doses of LV for all doses in all patients, because the panel feels that lower doses are likely to be as efficacious as higher doses, based on several studies. Finally, if none of the above options is available, treatment without LV would be reasonable. For patients who tolerate this without grade II or higher toxicity, a modest increase in 5-FU dose (in the range of 10%) may be considered. (NCCN, 2015)Higher score indicates better qualityNational Comprehensive Cancer Network (NCCN). Clinical Practice Guidelines in Oncology: Colon Cancer. Version 2.2015. Available at: http://www.nccn.org.Adjuvant Chemotherapy - According to current NCCN guidelines, the following therapies are recommended: 5-FU/LV/oxaliplatin (FOLFOX) or capecitabine/oxaliplatin (CapeOx) (both category 1 and preferred); bolus 5-FU/LV/oxaliplatin (FLOX) (category 1); or single-agent capecitabine or 5-FU/LV in patients felt to be inappropriate for oxaliplatin therapy (NCCN). See clinical recommendation statement for cases where leucovorin is not available. - -Prescribed - May include prescription ordered for the patient for adjuvant chemotherapy at one or more visits in the 12-month period OR patient already receiving adjuvant chemotherapy as documented in the current medication list.The measure logic option that includes the combination of 5-FU/LV/oxaliplatin will capture either FOLFOX or FLOX. - -The denominator for this measure has been limited to patients with a first recorded colon cancer diagnosis during the 12 month reporting period. The numerator captures patients who are prescribed adjuvant chemotherapy or received adjuvant chemotherapy during the 12 month period. "Referred for Chemotherapy" is not separately specified, as this option can be captured either through the "Medication Order: Chemotherapy for Colon Cancer" numerator option or the patient reason exception: "Medication, Administered not done: Patient reason" for "Chemotherapy for Colon Cancer". Additional valid medical reason exceptions might include acute renal insufficiency, neutropenia, or leukopenia. Date of diagnosis is defined as the date of pathologic diagnosis. - -The requirement of "Count >=2 of Encounter, Performed" is to establish that the eligible professional has an existing relationship with the patient.TBDAll patients aged 18 through 80 years with colon cancerEquals Initial Population with AJCC Stage III colon cancerNonePatients who are referred for adjuvant chemotherapy, prescribed adjuvant chemotherapy, or who have previously received adjuvant chemotherapy within the 12 month reporting periodNot ApplicableDocumentation of medical reason(s) for not referring for or prescribing adjuvant chemotherapy (eg, medical co-morbidities, diagnosis date more than 5 years prior to the current visit date, patient's diagnosis date is within 120 days of the end of the 12 month reporting period, patient's cancer has metastasized, medical contraindication/allergy, poor performance status, other medical reasons) -Documentation of patient reason(s) for not referring for or prescribing adjuvant chemotherapy (eg, patient refusal, other patient reasons) -Documentation of system reason(s) for not referring for or prescribing adjuvant chemotherapy (eg, patient is currently enrolled in a clinical trial that precludes prescription of chemotherapy, other system reasons)Not ApplicableNot ApplicableNot ApplicableFor every patient evaluated by this measure also identify payer, race, ethnicity and sex.None - - \ No newline at end of file diff --git a/test/fixtures/hqmf/simplexml/CMS142v4_SimpleXML.xml b/test/fixtures/hqmf/simplexml/CMS142v4_SimpleXML.xml deleted file mode 100755 index f23efab2..00000000 --- a/test/fixtures/hqmf/simplexml/CMS142v4_SimpleXML.xml +++ /dev/null @@ -1,19 +0,0 @@ -40280381-4be2-53b3-014c-04948c45115eDiabetic Retinopathy: Communication with the Physician Managing Ongoing Diabetes CareDiab_Retin_Comm14253d6d7c3-43fb-4d24-8099-17e74c022c054.0.0000000010100001231American Medical Association-convened Physician Consortium for Performance Improvement(R) (AMA-PCPI)American Medical Association-convened Physician Consortium for Performance Improvement(R) (AMA-PCPI)National Quality ForumPercentage of patients aged 18 years and older with a diagnosis of diabetic retinopathy who had a dilated macular or fundus exam performed with documented communication to the physician who manages the ongoing care of the patient with diabetes mellitus regarding the findings of the macular or fundus exam at least once within 12 monthsCopyright 2014 American Medical Association. All Rights Reserved.Physician Performance Measures (Measures) and related data specifications have been developed by the American Medical Association (AMA) - convened Physician Consortium for Performance Improvement(R) (PCPI[R]). These Measures are not clinical guidelines and do not establish a standard of medical care, and have not been tested for all potential applications. The Measures, while copyrighted, can be reproduced and distributed, without modification, for noncommercial purposes, eg, use by health care providers in connection with their practices. Commercial use is defined as the sale, license, or distribution of the Measures for commercial gain, or incorporation of the Measures into a product or service that is sold, licensed or distributed for commercial gain. Commercial uses of the Measures require a license agreement between the user and the AMA (on behalf of the PCPI). Neither the AMA, PCPI, nor its members shall be responsible for any use of the Measures. - -The National Committee for Quality Assurance's significant past efforts and contributions to the development and updating of the Measures is acknowledged. - -THE MEASURES AND SPECIFICATIONS ARE PROVIDED "AS IS" WITHOUT WARRANTY OF ANY KIND. - -Limited proprietary coding is contained in the Measure specifications for convenience. Users of the proprietary code sets should obtain all necessary licenses from the owners of these code sets. The AMA, PCPI, and its members disclaim all liability for use or accuracy of any Current Procedural Terminology (CPT[R]) or other coding contained in the specifications. - -CPT(R) contained in the Measure specifications is copyright 2004-2014 American Medical Association. LOINC(R) copyright 2004-2014 Regenstrief Institute, Inc. This material contains SNOMED Clinical Terms(R) (SNOMED CT[R]) copyright 2004-2014 International Health Terminology Standards Development Organisation. ICD-10 copyright 2014 World Health Organization. All Rights Reserved. - -Due to technical limitations, registered trademarks are indicated by (R) or [R].ProportionProcessNoneNoneNoneThe primary care physician that manages the ongoing care of the patient with diabetes should be aware of the patient's dilated eye examination and severity of retinopathy to manage the ongoing diabetes care. Such communication is important in assisting the physician to better manage the diabetes. Several studies have shown that better management of diabetes is directly related to lower rates of development of diabetic eye disease (Diabetes Control and Complications Trial -DCCT, UK Prospective Diabetes Study - UKPDS).Ophthalmologists should communicate the ophthalmologic findings and level of retinopathy with the primary care physician as well as the need for optimizing metabolic control. (Good evidence; Strong recommendation) (AAO, 2014)Higher score indicates better qualityAmerican Academy of Ophthalmology Retina/Vitreous Panel. Preferred Practice Pattern Guidelines. Diabetic Retinopathy. San Francisco, CA: American Academy of Ophthalmology; 2014. Communication - May include documentation in the medical record indicating that the findings of the dilated macular or fundus exam were communicated (eg, verbally, by letter) with the clinician managing the patient's diabetic care OR a copy of a letter in the medical record to the clinician managing the patient's diabetic care outlining the findings of the dilated macular or fundus exam. - -Findings - Includes level of severity of retinopathy (eg, mild nonproliferative, moderate nonproliferative, severe nonproliferative, very severe nonproliferative, proliferative) AND the presence or absence of macular edema.The measure, as written, does not specifically require documentation of laterality. Coding limitations in particular clinical terminologies do not currently allow for that level of specificity (ICD-10-CM includes laterality, but ICD-9-CM and SNOMED-CT do not uniformly include this distinction). Therefore, at this time, it is not a requirement of this measure to indicate laterality of the diagnoses, findings or procedures. Available coding to capture the data elements specified in this measure has been provided. It is assumed that the eligible professional will record laterality in the patient medical record, as quality care and clinical documentation should include laterality. - -The communication of results to the primary care physician providing ongoing care of a patient's diabetes should be completed soon after the dilated exam is performed. Eligible professionals reporting on this measure should note that all data for the reporting year is to be submitted by the deadline established by CMS. Therefore, eligible professionals who see patients towards the end of the reporting period (ie, December in particular), should communicate the results of the dilated macular exam as soon as possible in order for those patients to be counted in the measure numerator. Communicating the results as soon as possible after the date of the exam will ensure the data are included in the submission to CMS.TBDAll patients aged 18 years and older with a diagnosis of diabetic retinopathyEquals Initial Population who had a dilated macular or fundus exam performedNonePatients with documentation, at least once within 12 months, of the findings of the dilated macular or fundus exam via communication to the physician who manages the patient's diabetic careNot ApplicableDocumentation of medical reason(s) for not communicating the findings of the dilated macular or fundus exam to the physician who manages the ongoing care of the patient with diabetes - -Documentation of patient reason(s) for not communicating the findings of the dilated macular or fundus exam to the physician who manages the ongoing care of the patient with diabetesNot ApplicableNot ApplicableNot ApplicableFor every patient evaluated by this measure also identify payer, race, ethnicity and sex.None - - \ No newline at end of file diff --git a/test/fixtures/hqmf/simplexml/CMS143v4_SimpleXML.xml b/test/fixtures/hqmf/simplexml/CMS143v4_SimpleXML.xml deleted file mode 100755 index 9ccde6d4..00000000 --- a/test/fixtures/hqmf/simplexml/CMS143v4_SimpleXML.xml +++ /dev/null @@ -1,25 +0,0 @@ -40280381-4b9a-3825-014b-cbaaf7620b3cPrimary Open-Angle Glaucoma (POAG): Optic Nerve EvaluationPOAG143db9d9f09-6b6a-4749-a8b2-8c1fdb0188234.0.0000000010100001231American Medical Association-convened Physician Consortium for Performance Improvement(R) (AMA-PCPI)American Medical Association-convened Physician Consortium for Performance Improvement(R) (AMA-PCPI)National Quality ForumPercentage of patients aged 18 years and older with a diagnosis of primary open-angle glaucoma (POAG) who have an optic nerve head evaluation during one or more office visits within 12 monthsCopyright 2014 American Medical Association. All Rights Reserved.Physician Performance Measures (Measures) and related data specifications have been developed by the American Medical Association (AMA) - convened Physician Consortium for Performance Improvement(R) (PCPI[R]). These Measures are not clinical guidelines and do not establish a standard of medical care, and have not been tested for all potential applications. The Measures, while copyrighted, can be reproduced and distributed, without modification, for noncommercial purposes, eg, use by health care providers in connection with their practices. Commercial use is defined as the sale, license, or distribution of the Measures for commercial gain, or incorporation of the Measures into a product or service that is sold, licensed or distributed for commercial gain. Commercial uses of the Measures require a license agreement between the user and the AMA (on behalf of the PCPI). Neither the AMA, PCPI, nor its members shall be responsible for any use of the Measures. - -The National Committee for Quality Assurance's significant past efforts and contributions to the development and updating of the Measures is acknowledged. - -THE MEASURES AND SPECIFICATIONS ARE PROVIDED "AS IS" WITHOUT WARRANTY OF ANY KIND. - -Limited proprietary coding is contained in the Measure specifications for convenience. Users of the proprietary code sets should obtain all necessary licenses from the owners of these code sets. The AMA, PCPI, and its members disclaim all liability for use or accuracy of any Current Procedural Terminology (CPT[R]) or other coding contained in the specifications. - -CPT(R) contained in the Measure specifications is copyright 2004-2014 American Medical Association. LOINC(R) copyright 2004-2014 Regenstrief Institute, Inc. This material contains SNOMED Clinical Terms(R) (SNOMED CT[R]) copyright 2004-2014 International Health Terminology Standards Development Organisation. ICD-10 copyright 2014 World Health Organization. All Rights Reserved. - -Due to technical limitations, registered trademarks are indicated by (R) or [R].ProportionProcessNoneNoneNoneChanges in the optic nerve are one of two characteristics which currently define progression and thus worsening of glaucoma disease status (the other characteristic is visual field). There is a significant gap in documentation patterns of the optic nerve for both initial and follow-up care (Fremont, 2003), even among specialists (Lee, 2006). Examination of the optic nerve head and retinal nerve fiber layer provides valuable structural information about glaucomatous optic nerve damage. Visible structural alterations of the optic nerve head or retinal nerve fiber layer and development of peripapillary choroidal atrophy frequently occur before visual field defects can be detected. Careful study of the optic disc neural rim for small hemorrhages is important, since these hemorrhages can precede visual field loss and further optic nerve damage.Ophthalmic Evaluation -In completing the elements in the comprehensive adult medical eye evaluation, the ophthalmic evaluation specifically focuses on the following elements: -History [A:III] -Visual acuity measurement [A:III] -Pupil examination [B:II] -Anterior segment examination [A:III] -Intraocular pressure measurement [A:I] -Gonioscopy [A:III] -Optic nerve head and retinal nerve fiber layer examination [A:III] -Fundus examination [A:III) -(AAO, 2010)Higher score indicates better qualityAmerican Academy of Ophthalmology. Preferred Practice Pattern: Primary Open-Angle Glaucoma. 2010.Fremont AM, et al. Patterns of Care for Open-angle Glaucoma in Managed Care. Arch Ophthalmol. 2003;121:777-783.Lee PP, et al. A Multicenter, Retrospective Pilot Study of Resource Use and Costs Associated With Severity of Disease in Glaucoma. Arch Ophthalmol. 2006;124:12-19.NoneOptic nerve head evaluation includes examination of the cup to disc ratio and identification of optic disc or retinal nerve abnormalities. Both of these components of the optic nerve head evaluation are examined using ophthalmoscopy. - -The measure, as written, does not specifically require documentation of laterality. Coding limitations in particular clinical terminologies do not currently allow for that level of specificity (ICD-10-CM includes laterality, but ICD-9-CM and SNOMED-CT do not uniformly include this distinction). Therefore, at this time, it is not a requirement of this measure to indicate laterality of the diagnoses, findings or procedures. Available coding to capture the data elements specified in this measure has been provided. It is assumed that the eligible professional will record laterality in the patient medical record, as quality care and clinical documentation should include laterality.TBDAll patients aged 18 years and older with a diagnosis of primary open-angle glaucomaEquals Initial PopulationNonePatients who have an optic nerve head evaluation during one or more office visits within 12 monthsNot ApplicableDocumentation of medical reason(s) for not performing an optic nerve head evaluationNot ApplicableNot ApplicableNot ApplicableFor every patient evaluated by this measure also identify payer, race, ethnicity and sex.None - - \ No newline at end of file diff --git a/test/fixtures/hqmf/simplexml/CMS144v4_SimpleXML.xml b/test/fixtures/hqmf/simplexml/CMS144v4_SimpleXML.xml deleted file mode 100755 index 69078929..00000000 --- a/test/fixtures/hqmf/simplexml/CMS144v4_SimpleXML.xml +++ /dev/null @@ -1,41 +0,0 @@ -40280381-4b9a-3825-014b-e0c7ac461325Heart Failure (HF): Beta-Blocker Therapy for Left Ventricular Systolic Dysfunction (LVSD)HF_Beta_LVSD1448439f671-2932-4d4c-88ca-ea5faeacc89a4.0.0000000010100001231American Medical Association-convened Physician Consortium for Performance Improvement(R) (AMA-PCPI)American Medical Association-convened Physician Consortium for Performance Improvement(R) (AMA-PCPI)National Quality ForumPercentage of patients aged 18 years and older with a diagnosis of heart failure (HF) with a current or prior left ventricular ejection fraction (LVEF) < 40% who were prescribed beta-blocker therapy either within a 12 month period when seen in the outpatient setting OR at each hospital dischargeCopyright 2014 American College of Cardiology, American Heart Association and American Medical Association. All Rights Reserved.Physician Performance Measures (Measures) and related data specifications have been developed by the American Medical Association (AMA) - convened Physician Consortium for Performance Improvement(R) (PCPI[R]), American College of Cardiology (ACC) and American Heart Association (AHA). These Measures are not clinical guidelines and do not establish a standard of medical care, and have not been tested for all potential applications. The Measures, while copyrighted, can be reproduced and distributed, without modification, for noncommercial purposes, eg, use by health care providers in connection with their practices. Commercial use is defined as the sale, license, or distribution of the Measures for commercial gain, or incorporation of the Measures into a product or service that is sold, licensed or distributed for commercial gain. Commercial uses of the Measures require a license agreement between the user and the AMA, (on behalf of the PCPI), ACC or AHA. Neither the AMA, ACC, AHA, PCPI nor its members shall be responsible for any use of the Measures. - -THE MEASURES AND SPECIFICATIONS ARE PROVIDED "AS IS" WITHOUT WARRANTY OF ANY KIND. - -Limited proprietary coding is contained in the Measure specifications for convenience. Users of the proprietary code sets should obtain all necessary licenses from the owners of these code sets. The AMA, ACC, AHA, the PCPI and its members disclaim all liability for use or accuracy of any Current Procedural Terminology (CPT[R]) or other coding contained in the specifications. - -CPT(R) contained in the Measure specifications is copyright 2004-2014 American Medical Association. LOINC(R) copyright 2004-2014 Regenstrief Institute, Inc. This material contains SNOMED Clinical Terms(R) (SNOMED CT[R]) copyright 2004-2014 International Health Terminology Standards Development Organisation. ICD-10 copyright 2014 World Health Organization. All Rights Reserved. - -Due to technical limitations, registered trademarks are indicated by (R) or [R].ProportionProcessNoneNoneNoneBeta-blockers are recommended for all patients with stable heart failure and left ventricular systolic dysfunction, unless contraindicated. Treatment should be initiated as soon as a patient is diagnosed with left ventricular systolic dysfunction and does not have low blood pressure, fluid overload, or recent treatment with an intravenous positive inotropic agent. Beta-blockers have been shown to lessen the symptoms of heart failure, improve the clinical status of patients, reduce future clinical deterioration, and decrease the risk of mortality and the combined risk of mortality and hospitalization.Use of 1 of the 3 beta blockers proven to reduce mortality (e.g., bisoprolol, carvedilol, and sustained-release metoprolol succinate) is recommended for all patients with current or prior symptoms of HFrEF [heart failure with reduced ejection fraction], unless contraindicated, to reduce morbidity and mortality. (Class I, Level of Evidence: A) (ACCF/AHA, 2013) - -Treatment with a beta blocker should be initiated at very low doses [see excerpt from guideline table below] followed by gradual increments in dose if lower doses have been well tolerated... Clinicians should make every effort to achieve the target doses of the beta blockers shown to be effective in major clinical trials. Even if symptoms do not improve, long-term treatment should be maintained to reduce the risk of major clinical events. Abrupt withdrawal of treatment with a beta blocker can lead to clinical deterioration and should be avoided. (ACCF/AHA, 2013) - -Drugs Commonly Used for Stage C HFrEF (abbreviated to align with focus of measure to include only Beta-blocker therapy) -Drug Initial Daily Dose(s) Maximum Doses(s) Mean Doses Achieved in Clinical - Trials -Beta Blockers -Bisoprolol 1.25 mg once 10 mg once 8.6 mg/d -Carvedilol 3.125 mg twice 50 mg twice 37 mg/d -Carvedilol CR 10 mg once 80 mg once N/A -Metoprolol succinate 12.5 to 25 mg once 200 mg once 159 mg/d -extended release -(metoprolol CR/XL) - -For the hospitalized patient: -In patients with HFrEF experiencing a symptomatic exacerbation of HF requiring hospitalization during chronic -maintenance treatment with GDMT[guideline-directed medical therapy; GDMT represents optimal medical therapy as defined by ACCF/AHA guideline-recommended therapies (primarily Class I)], it is recommended that GDMT be continued in the absence of hemodynamic instability or contraindications. (Class I, Level of Evidence: B) (ACCF/AHA, 2013) - -Initiation of beta-blocker therapy is recommended after optimization of volume status and successful discontinuation of intravenous diuretics, vasodilators, and inotropic agents. Beta-blocker therapy should be initiated at a low dose and only in stable patients. Caution should be used when initiating beta blockers in patients who have required inotropes during their hospital course. (Class I, Level of Evidence: B) (ACCF/AHA, 2013)Higher score indicates better qualityYancy CW, Jessup M, Bozkurt B, Butler J, Casey DE Jr, Drazner MH, Fonarow GC, Geraci SA, Horwich T, Januzzi JL, Johnson MR, Kasper EK, Levy WC, Masoudi FA, McBride PE, McMurray JJV, Mitchell JE, Peterson PN, Riegel B, Sam F, Stevenson LW, Tang WHW, Tsai EJ, Wilkoff BL. 2013 ACCF/AHA guideline for the management of heart failure: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines. J Am Coll Cardiol 2013;62:e147-239.Prescribed-Outpatient setting: prescription given to the patient for beta-blocker therapy at one or more visits in the measurement period OR patient already taking beta-blocker therapy as documented in current medication list - -Prescribed-Inpatient setting: prescription given to the patient for beta-blocker therapy at discharge OR beta-blocker therapy to be continued after discharge as documented in the discharge medication listLVEF < 40% corresponds to qualitative documentation of moderate dysfunction or severe dysfunction. - -To satisfy this measure, it must be reported for all heart failure patients at least once during the measurement period if seen in the outpatient setting. If the patient has an eligible inpatient discharge during the measurement period, as defined in the measure logic, it is expected to be reported at each hospital discharge. - -Beta-blocker therapy: --For patients with prior LVEF < 40%, beta-blocker therapy should include bisoprolol, carvedilol, or sustained release metoprolol succinate. - -The requirement of "Count >=2 of Encounter, Performed" is to establish that the eligible professional has an existing relationship with the patient.TBDAll patients aged 18 years and older with a diagnosis of heart failureEquals Initial Population with a current or prior LVEF < 40%NonePatients who were prescribed beta-blocker therapy either within a 12 month period when seen in the outpatient setting OR at each hospital dischargeNot ApplicableDocumentation of medical reason(s) for not prescribing beta-blocker therapy (eg, low blood pressure, fluid overload, asthma, patients recently treated with an intravenous positive inotropic agent, allergy, intolerance, other medical reasons) -Documentation of patient reason(s) for not prescribing beta-blocker therapy (eg, patient declined, other patient reasons) -Documentation of system reason(s) for not prescribing beta-blocker therapy (eg, other reasons attributable to the healthcare system)Not ApplicableNot ApplicableNot ApplicableFor every patient evaluated by this measure also identify payer, race, ethnicity and sex.None - - \ No newline at end of file diff --git a/test/fixtures/hqmf/simplexml/CMS145v4_SimpleXML.xml b/test/fixtures/hqmf/simplexml/CMS145v4_SimpleXML.xml deleted file mode 100755 index cefdc1be..00000000 --- a/test/fixtures/hqmf/simplexml/CMS145v4_SimpleXML.xml +++ /dev/null @@ -1,24 +0,0 @@ -40280381-4de7-db4d-014d-e8833c8401f7Coronary Artery Disease (CAD): Beta-Blocker Therapy-Prior Myocardial Infarction (MI) or Left Ventricular Systolic Dysfunction (LVEF <40%)BB_MI_LVEF14580744ae2-de81-4b16-a71d-69522eb865c54.1.0000000010100001231American Medical Association-convened Physician Consortium for Performance Improvement(R) (AMA-PCPI)American Medical Association-convened Physician Consortium for Performance Improvement(R) (AMA-PCPI)National Quality ForumPercentage of patients aged 18 years and older with a diagnosis of coronary artery disease seen within a 12 month period who also have a prior MI or a current or prior LVEF <40% who were prescribed beta-blocker therapyCopyright 2014 American College of Cardiology, American Heart Association and American Medical Association. All Rights Reserved.Physician Performance Measures (Measures) and related data specifications have been developed by the American Medical Association (AMA) - convened Physician Consortium for Performance Improvement(R) (PCPI[R]), American College of Cardiology (ACC) and American Heart Association (AHA). These Measures are not clinical guidelines and do not establish a standard of medical care, and have not been tested for all potential applications. The Measures, while copyrighted, can be reproduced and distributed, without modification, for noncommercial purposes, eg, use by health care providers in connection with their practices. Commercial use is defined as the sale, license, or distribution of the Measures for commercial gain, or incorporation of the Measures into a product or service that is sold, licensed or distributed for commercial gain. Commercial uses of the Measures require a license agreement between the user and the AMA, (on behalf of the PCPI), ACC or AHA. Neither the AMA, ACC, AHA, PCPI nor its members shall be responsible for any use of the Measures. - -THE MEASURES AND SPECIFICATIONS ARE PROVIDED "AS IS" WITHOUT WARRANTY OF ANY KIND. - -Limited proprietary coding is contained in the Measure specifications for convenience. Users of the proprietary code sets should obtain all necessary licenses from the owners of these code sets. The AMA, ACC, AHA, the PCPI and its members disclaim all liability for use or accuracy of any Current Procedural Terminology (CPT[R]) or other coding contained in the specifications. - -CPT(R) contained in the Measure specifications is copyright 2004-2014 American Medical Association. LOINC(R) copyright 2004-2014 Regenstrief Institute, Inc. This material contains SNOMED Clinical Terms(R) (SNOMED CT[R]) copyright 2004-2014 International Health Terminology Standards Development Organisation. ICD-10 copyright 2014 World Health Organization. All Rights Reserved. - -Due to technical limitations, registered trademarks are indicated by (R) or [R].ProportionProcessNoneNoneDenominator 1: Patients with left ventricular systolic dysfunction (LVEF <40%) -Denominator 2: Patients with a prior (resolved) (within the past 3 years) myocardial infarctionNonadherence to cardioprotective medications is prevalent among outpatients with coronary artery disease and can be associated with a broad range of adverse outcomes, including all-cause and cardiovascular mortality, cardiovascular hospitalizations, and the need for revascularization procedures. - -A patient with a diagnosis of coronary artery disease seen within a 12 month period and LVEF <40% should be taking either bisoprolol, carvedilol, or sustained release metoprolol succinate. While all beta-blockers appear to be of equal efficacy in patients with chronic stable coronary artery disease, these three medications have specifically shown to reduce mortality in patients with reduced LVEF.Beta-blocker therapy should be started and continued for 3 years in all patients with normal LV function after MI or ACS. (Class I, Level of Evidence: B) (ACCF/AHA/ACP/AATS/PCNA/SCAI/STS, 2012) - -Beta-blocker therapy should be used in all patients with LV systolic dysfunction (EF <= 40%) with heart failure or prior MI, unless contraindicated. (Use should be limited to carvedilol, metoprolol succinate, or bisoprolol, which have been shown to reduce risk of death.) (Class I, Level of Evidence: A) (ACCF/AHA/ACP/AATS/PCNA/SCAI/STS, 2012)Higher score indicates better qualityFihn SD, Gardin JM, Abrams J, Berra K, Blankenship JC, Dallas AP, Douglas PS, Foody JM, Gerber TC, Hinderliter AL, King SB III, Kligfield PD, Krumholz HM, Kwong RYK, Lim MJ, Linderbaum JA, Mack MJ, Munger MA, Prager RL, Sabik JF, Shaw LJ, Sikkema JD, Smith CR Jr, Smith SC Jr, Spertus JA, Williams SV. 2012 ACCF/AHA/ACP/AATS/PCNA/SCAI/STS guideline for the diagnosis and management of patients with stable ischemic heart disease: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines, American Association for Thoracic Surgery, Preventive Cardiovascular Nurses Association, Society for Cardiovascular Angiography and Interventions, and Society of Thoracic Surgeons. J Am Coll Cardiol 2012;60:e44-164.Prescribed may include prescription given to the patient for beta-blocker therapy at one or more visits in the measurement period OR patient already taking beta-blocker therapy as documented in current medication list. - -Prior Myocardial Infarction (MI) for denominator 2 is limited to those occurring within the past 3 years.Beta-blocker therapy: -- For patients with prior MI, beta-blocker therapy includes any agent within the beta-blocker drug class. As of 2014, no recommendations or evidence are cited in current stable ischemic heart disease guidelines for preferential use of specific agents -- For patients with prior LVEF <40%, beta-blocker therapy includes the following: bisoprolol, carvedilol, or sustained release metoprolol succinate - -The requirement of "Count >=2 of Encounter, Performed" is to establish that the eligible professional has an existing relationship with the patient.TBDAll patients aged 18 years and older with a diagnosis of coronary artery disease seen within a 12 month periodEquals Initial Population who also have prior (within the past 3 years) MI or a current or prior LVEF <40%NonePatients who were prescribed beta-blocker therapyNot ApplicableDocumentation of medical reason(s) for not prescribing beta-blocker therapy (eg, allergy, intolerance, other medical reasons) -Documentation of patient reason(s) for not prescribing beta-blocker therapy (eg, patient declined, other patient reasons) -Documentation of system reason(s) for not prescribing beta-blocker therapy (eg, other reasons attributable to the health care system)Not ApplicableNot ApplicableNot ApplicableFor every patient evaluated by this measure also identify payer, race, ethnicity and sex.None - - \ No newline at end of file diff --git a/test/fixtures/hqmf/simplexml/CMS146v4_SimpleXML.xml b/test/fixtures/hqmf/simplexml/CMS146v4_SimpleXML.xml deleted file mode 100755 index e552ded0..00000000 --- a/test/fixtures/hqmf/simplexml/CMS146v4_SimpleXML.xml +++ /dev/null @@ -1,27 +0,0 @@ -40280381-4b9a-3825-014b-e0999f911223Appropriate Testing for Children with PharyngitisPharyngitis146beb1c33c-2549-4e7f-9567-05ed384484644.0.0000000010100001231National Committee for Quality AssuranceNational Committee for Quality AssuranceNational Quality ForumPercentage of children 2-18 years of age who were diagnosed with pharyngitis, ordered an antibiotic and received a group A streptococcus (strep) test for the episode.Physician Performance Measure (Measures) and related data specifications were developed by the National Committee for Quality Assurance (NCQA). - -The Measures are copyrighted but can be reproduced and distributed, without modification, for noncommercial purposes (eg, use by healthcare providers in connection with their practices). Commercial use is defined as the sale, licensing, or distribution of the Measures for commercial gain, or incorporation of the Measures into a product or service that is sold, licensed or distributed for commercial gain. Commercial use of the Measures requires a license agreement between the user and NCQA. NCQA is not responsible for any use of the Measures. - -(c) 2008-2015 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 CPT or other codes contained in the specifications. - -CPT(R) contained in the Measure specifications is copyright 2004-2014 American Medical Association. LOINC(R) copyright 2004-2014 Regenstrief Institute, Inc. This material contains SNOMED Clinical Terms(R) (SNOMED CT[R]) copyright 2004-2014 International Health Terminology Standards Development Organisation. ICD-10 copyright 2014 World Health Organization. All Rights Reserved.These performance Measures are not clinical guidelines and do not establish a standard of medical care, and have not been tested for all potential applications. - -THE MEASURES 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].ProportionProcessNoneNoneNoneGroup A streptococcal bacterial infections and other infections that cause pharyngitis (which are most often viral) often produce the same signs and symptoms (IDSA 2002). The American Academy of Pediatrics, the Centers for Disease Control and Prevention, and the Infectious Diseases Society of America all recommend a diagnostic test for Strep A to improve diagnostic accuracy and avoid unnecessary antibiotic treatment (Linder et al. 2005). A study on antibiotic treatment of children with sore throat found that although only 15 to 36 percent of children with sore throat have Strep A pharyngitis, physicians prescribed antibiotics to 53 percent of children with a chief complaint of sore throat between 1995 and 2003 (Linder et al. 2005).Institute for Clinical Systems Improvement (ICSI) (2007) - -Reduce unnecessary use of antibiotics. Antibiotic treatment should be reserved for a bacterial illness. Diagnosis of group A beta streptococcal Pharyngitis should be made by laboratory testing rather than clinically. - -Infectious Disease Society of America (Bisno et al. 2002) - -The signs and symptoms of group A streptococcal and other (most frequently viral) pharyngitides overlap broadly. Therefore, unless the physician is able with confidence to exclude the diagnosis of streptococcal pharyngitis on epidemiological and clinical grounds alone, a laboratory test should be done to determine whether group A streptococci are present in the pharynx. - -With the exception of very rare infections by certain other pharyngeal bacterial pathogens (eg, Corynebacterium diphtheriae and Neisseria gonorrhoeae), antimicrobial therapy is of no proven benefit as treatment for acute pharyngitis due to bacteria other than group A streptococci. Therefore, it is extremely important that physicians exclude the diagnosis of group A streptococcal pharyngitis to prevent inappropriate administration of antimicrobials to large numbers of patients with pharyngitis. - -Michigan Quality Improvement Consortium (2007) - -Probability of group A beta hemolytic streptococci (GABHS): Low; Testing: None; Treatment: Symptomatic treatment only. Avoid antibiotics. Probability of GABHS: Intermediate or High; Testing: Throat Culture (TC) OR Rapid Screen; Treatment: If TC is positive, use antibiotics. If TC is negative, use symptomatic treatment only. Avoid antibiotics. If treatment is started and culture result is negative, stop antibiotics. If Rapid Screen is positive, use antibiotics. If Rapid Screen is negative, culture (Culture is optional for age 16 and over) and only use antibiotics if throat culture is positive. (Michigan, 2007)Higher score indicates better qualityLinder, J.A., D.W. Bates, G.M. Lee, J.A. Finkelstein. 2005. "Antibiotic treatment of children with sore throat." JAMA 294(18):2315-2322. Bisno, A.L., M.A. Gerber, J.M. Gwaltney Jr., E.L. Kaplan, R.H. Schwartz, Infectious Diseases Society of America. 2002. "Practice guidelines for the diagnosis and management of group A streptococcal pharyngitis. Infectious Diseases Society of America." Clin Infect Dis 35(2):113-25.Institute for Clinical Systems Improvement (ICSI). 2008. "Diagnosis and treatment of respiratory illness in children and adults." Bloomington: Institute for Clinical Systems Improvement (ICSI).Michigan Quality Improvement Consortium. 2007. Acute pharyngitis in children. Southfield: Michigan Quality Improvement Consortium.NoneThis is an episode of care measure that examines all eligible episodes for the patient during the measurement period. If the patient has more than one episode, include all episodes in the measure.TBDChildren 2-18 years of age who had an outpatient or emergency department (ED) visit with a diagnosis of pharyngitis during the measurement period and an antibiotic ordered on or three days after the visitEquals Initial PopulationChildren who are taking antibiotics in the 30 days prior to the diagnosis of pharyngitisChildren with a group A streptococcus test in the 7-day period from 3 days prior through 3 days after the diagnosis of pharyngitisNot ApplicableNoneNot ApplicableNot ApplicableNot ApplicableFor every patient evaluated by this measure also identify payer, race, ethnicity and sex.None - - \ No newline at end of file diff --git a/test/fixtures/hqmf/simplexml/CMS147v5_SimpleXML.xml b/test/fixtures/hqmf/simplexml/CMS147v5_SimpleXML.xml deleted file mode 100755 index c3d3aed5..00000000 --- a/test/fixtures/hqmf/simplexml/CMS147v5_SimpleXML.xml +++ /dev/null @@ -1,18 +0,0 @@ -40280381-4be2-53b3-014c-13f567921f71Preventive Care and Screening: Influenza ImmunizationFlu_Imm147a244aa29-7d11-4616-888a-86e376bfcc6f5.0.0000000010100001231American Medical Association-convened Physician Consortium for Performance Improvement(R) (AMA-PCPI)American Medical Association-convened Physician Consortium for Performance Improvement(R) (AMA-PCPI)National Quality ForumPercentage of patients aged 6 months and older seen for a visit between October 1 and March 31 who received an influenza immunization OR who reported previous receipt of an influenza immunizationCopyright 2014 American Medical Association. All Rights Reserved.Physician Performance Measures (Measures) and related data specifications have been developed by the American Medical Association (AMA) - convened Physician Consortium for Performance Improvement(R) (PCPI[R]). These Measures are not clinical guidelines and do not establish a standard of medical care, and have not been tested for all potential applications. The Measures, while copyrighted, can be reproduced and distributed, without modification, for noncommercial purposes, eg, use by health care providers in connection with their practices. Commercial use is defined as the sale, license, or distribution of the Measures for commercial gain, or incorporation of the Measures into a product or service that is sold, licensed or distributed for commercial gain. Commercial uses of the Measures require a license agreement between the user and the AMA, (on behalf of the PCPI). Neither the AMA, PCPI nor its members shall be responsible for any use of the Measures. - -THE MEASURES AND SPECIFICATIONS ARE PROVIDED "AS IS" WITHOUT WARRANTY OF ANY KIND. - -Limited proprietary coding is contained in the Measure specifications for convenience. Users of the proprietary code sets should obtain all necessary licenses from the owners of these code sets. The AMA, the PCPI and its members disclaim all liability for use or accuracy of any Current Procedural Terminology (CPT[R]) or other coding contained in the specifications. - -CPT(R) contained in the Measure specifications is copyright 2004-2014 American Medical Association. LOINC(R) copyright 2004-2014 Regenstrief Institute, Inc. This material contains SNOMED Clinical Terms(R) (SNOMED CT[R]) copyright 2004-2014 International Health Terminology Standards Development Organisation. ICD-10 copyright 2014 World Health Organization. All Rights Reserved. - -Due to technical limitations, registered trademarks are indicated by (R) or [R].ProportionProcessNoneNoneNoneAnnual influenza vaccination is the most effective method for preventing influenza virus infection and its complications. Influenza vaccine is recommended for all persons aged >=6 months who do not have contraindications to vaccination.Routine annual influenza vaccination is recommended for all persons aged >=6 months who do not have contraindications. Vaccination optimally should occur before onset of influenza activity in the community. Health care providers should offer vaccination soon after vaccine becomes available (by October, if possible). Vaccination should be offered as long as influenza viruses are circulating. (CDC/ACIP, 2014)Higher score indicates better qualityCenters for Disease Control and Prevention (CDC). Prevention and Control of Seasonal Influenza with Vaccines: Recommendations of the Advisory Committee on Immunization Practices (ACIP) - United States, 2014-2015. MMWR, August 15, 2014; 63(327):691-697. Available at: http://www.cdc.gov/mmwr/preview/mmwrhtml/mm6332a3.htm. Accessed November 26, 2014. Previous Receipt - receipt of the current season's influenza immunization from another provider OR from same provider prior to the visit to which the measure is applied (typically, prior vaccination would include influenza vaccine given since August 1st)The timeframe for the visit during the "Encounter, Performed: Encounter-Influenza" or "Procedure, Performed: Peritoneal Dialysis" or "Procedure, Performed: Hemodialysis" in the Population Criteria-Denominator, refers to the influenza season defined by the measure: October through March (October 1 for the year prior to the start of the reporting period through March 31 during the reporting period). The "Encounter-Influenza" Grouping OID detailed in the data criteria section below is comprised of several individual OIDs of different encounter types. The individual OIDs are included in the value set and should be reviewed to determine that an applicable visit occurred during the timeframe for "Encounter, Performed: Encounter-Influenza" as specified in the denominator. -To enable reporting of this measure at the close of the reporting period, this measure will only assess the influenza season that ends in March of the reporting period. The subsequent influenza season (ending March of the following year) will be measured and reported in the following year. - -To account for the majority of reporting years' appropriate flu season duration, the measure logic will look at the first 89 days of the measurement period for the appropriate criteria and actions to be present/performed (January 1 through March 31). The measure developer believes it is best to keep the logic as static as possible from one reporting year to the next. Therefore, during leap years, only encounters that occur through March 30 will be counted in the denominator.TBDAll patients aged 6 months and older seen for at least two visits or at least one preventive visit during the measurement periodEquals Initial Population and seen for a visit between October 1 and March 31NonePatients who received an influenza immunization OR who reported previous receipt of an influenza immunizationNot ApplicableDocumentation of medical reason(s) for not receiving influenza immunization (eg, patient allergy, other medical reasons) - -Documentation of patient reason(s) for not receiving influenza immunization (eg, patient declined, other patient reasons) - -Documentation of system reason(s) for not receiving influenza immunization (eg, vaccine not available, other system reasons)Not ApplicableNot ApplicableNot ApplicableFor every patient evaluated by this measure also identify payer, race, ethnicity and sex.None - - \ No newline at end of file diff --git a/test/fixtures/hqmf/simplexml/CMS148v4_SimpleXML.xml b/test/fixtures/hqmf/simplexml/CMS148v4_SimpleXML.xml deleted file mode 100755 index e4f49801..00000000 --- a/test/fixtures/hqmf/simplexml/CMS148v4_SimpleXML.xml +++ /dev/null @@ -1,21 +0,0 @@ -40280381-4b9a-3825-014b-e0b49cd612d2Hemoglobin A1c Test for Pediatric PatientsHA1c_Ped14895fb767e-0cb2-4778-b5ff-6ba9a53fa28e4.0.0000000010100001231National Committee for Quality AssuranceNational Committee for Quality AssuranceNational Quality ForumPercentage of patients 5-17 years of age with diabetes with an HbA1c test during the measurement periodPhysician Performance Measure (Measures) and related data specifications were developed by the National Committee for Quality Assurance (NCQA). - -The Measures are copyrighted but can be reproduced and distributed, without modification, for noncommercial purposes (eg, use by healthcare providers in connection with their practices). Commercial use is defined as the sale, licensing, or distribution of the Measures for commercial gain, or incorporation of the Measures into a product or service that is sold, licensed or distributed for commercial gain. Commercial use of the Measures requires a license agreement between the user and NCQA. NCQA is not responsible for any use of the Measures. - -(C) 2008-2015 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 CPT or other codes contained in the specifications. - -CPT(R) contained in the Measure specifications is copyright 2004-2014 American Medical Association. LOINC(R) copyright 2004-2014 Regenstrief Institute, Inc. This material contains SNOMED Clinical Terms(R) (SNOMED CT[R]) copyright 2004-2014 International Health Terminology Standards Development Organisation. ICD-10 copyright 2014 World Health Organization. All Rights Reserved.These performance Measures are not clinical guidelines and do not establish a standard of medical care, and have not been tested for all potential applications. - -THE MEASURES 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].ProportionProcessNoneNoneNoneDiabetes mellitus (diabetes) is a group of diseases characterized by high blood glucose levels caused by the body's inability to correctly produce or utilize the hormone insulin. It is recognized as a leading cause of death and disability in the U.S. and is highly underreported as a cause of death. Diabetes may cause life-threatening, life-ending or life-altering complications, including poor circulation, nerve damage or neuropathy in the feet and eventual amputation. Nearly 60-70 percent of diabetics suffer from mild or severe nervous system damage (American Diabetes Association 2009). - -Even though most target recommendations for glycemic control have been based on data obtained from studies of adult patients with diabetes, the ideal goal of near-normalization of blood glucose levels in children and adolescents is generally the same as that for adults. However, special consideration must be given to the unique risks of hypoglycemia in young children (Silverstein et al. 2005).1. American Association of Clinical Endocrinologists (2002): -Recommends that a glycosylated hemoglobin be performed during an initial assessment and during follow-up assessments, which should occur at no longer than three-month intervals. - -2. American Diabetes Association (2006): -Recommends obtaining a glycosylated hemoglobin during an initial assessment and then routinely as part of continuing care. In the absence of well-controlled studies that suggest a definite testing protocol, expert opinion recommends glycosylated hemoglobin be obtained at least twice a year in patients who are meeting treatment goals and who have stable glycemic control and more frequently (quarterly assessment) in patients whose therapy was changed or who are not meeting glycemic goals.Higher scores indicate better qualityAmerican Diabetes Association. 2009. "Standards of Medical Care in Diabetes-2009." Diabetes Care 2009 32(Suppl 1):S6-S12.American Diabetes Association. 2006. "Standards of medical care in Diabetes-2006." Diabetes Care 29(suppl1):S4-42.American Association of Clinical Endocrinologists. 2002. "Medical Guidelines for the Management of Diabetes Mellitus: The AACE System of Intensive Diabetes Self-Management-2002 Update." Endocr Pract 8(suppl 1):40-82.Silverstein, J., G. Klingensmith, K. Copeland, L. Plotnick, F. Kaufman, L. Laffel, L. Deeb, M. Grey, B. Anderson, L. Holzmeister, N. Clark, 2005. "Care of Children and Adolescents With Type 1 Diabetes. A statement of the American Diabetes Association." Diabetes Care, 28(1), 186-212. http://care.diabetesjournals.org/content/28/1/186.longNoneOnly patients with a diagnosis of Type 1 or Type 2 diabetes should be included in the denominator of this measure; patients with a diagnosis of secondary diabetes due to another condition should not be included.TBDPatients 5 to 17 years of age with a diagnosis of diabetes and a face-to-face visit between the physician and the patient that predates the most recent visit by at least 12 monthsEquals Initial PopulationNonePatients with documentation of date and result for a HbA1c test during the measurement periodNot ApplicableNoneNot ApplicableNot ApplicableNot ApplicableFor every patient evaluated by this measure also identify payer, race, ethnicity and sex.None - - \ No newline at end of file diff --git a/test/fixtures/hqmf/simplexml/CMS149v4_SimpleXML.xml b/test/fixtures/hqmf/simplexml/CMS149v4_SimpleXML.xml deleted file mode 100755 index 0f427eff..00000000 --- a/test/fixtures/hqmf/simplexml/CMS149v4_SimpleXML.xml +++ /dev/null @@ -1,25 +0,0 @@ -40280381-4b9a-3825-014b-dbd811090f3dDementia: Cognitive AssessmentDementia_Cognitive1497c443b9b-1ad1-4467-b527-defc445701ff4.0.0000000010100001231American Medical Association-convened Physician Consortium for Performance Improvement(R) (AMA-PCPI)American Medical Association-convened Physician Consortium for Performance Improvement(R) (AMA-PCPI)Percentage of patients, regardless of age, with a diagnosis of dementia for whom an assessment of cognition is performed and the results reviewed at least once within a 12 month periodCopyright 2014 American Medical Association. All Rights Reserved.Physician Performance Measures (Measures) and related data specifications have been developed by the American Medical Association (AMA) - convened Physician Consortium for Performance Improvement(R) (PCPI[R]). These Measures are not clinical guidelines and do not establish a standard of medical care, and have not been tested for all potential applications. The Measures, while copyrighted, can be reproduced and distributed, without modification, for noncommercial purposes, eg, use by health care providers in connection with their practices. Commercial use is defined as the sale, license, or distribution of the Measures for commercial gain, or incorporation of the Measures into a product or service that is sold, licensed or distributed for commercial gain. Commercial uses of the Measures require a license agreement between the user and the AMA, (on behalf of the PCPI). Neither the AMA, PCPI nor its members shall be responsible for any use of the Measures. - -THE MEASURES AND SPECIFICATIONS ARE PROVIDED "AS IS" WITHOUT WARRANTY OF ANY KIND. - -Limited proprietary coding is contained in the Measure specifications for convenience. Users of the proprietary code sets should obtain all necessary licenses from the owners of these code sets. The AMA, the PCPI and its members disclaim all liability for use or accuracy of any Current Procedural Terminology (CPT[R]) or other coding contained in the specifications. - -CPT(R) contained in the Measure specifications is copyright 2004-2014 American Medical Association. LOINC(R) copyright 2004-2014 Regenstrief Institute, Inc. This material contains SNOMED Clinical Terms(R) (SNOMED CT[R]) copyright 2004-2014 International Health Terminology Standards Development Organisation. ICD-10 copyright 2014 World Health Organization. All Rights Reserved. - -Due to technical limitations, registered trademarks are indicated by (R) or [R].ProportionProcessNoneNoneNoneDementia is often characterized by the gradual onset and continuing cognitive decline in one or more domains including memory, executive function, language, judgment, and spatial abilities. (APA, 2007) Cognitive deterioration represents a major source of morbidity and mortality and poses a significant burden on affected individuals and their caregivers. (NIH, 2010) Although cognitive deterioration follows a different course depending on the type of dementia, significant rates of decline have been reported. For example, one study found that the annual rate of decline for Alzheimer's disease patients was more than four times that of older adults with no cognitive impairment. (Wilson et al., 2010) Nevertheless, measurable cognitive abilities remain throughout the course of dementia. (APA, 2007) Initial and ongoing assessments of cognition are fundamental to the proper management of patients with dementia. These assessments serve as the basis for identifying treatment goals, developing a treatment plan, monitoring the effects of treatment, and modifying treatment as appropriate.Ongoing assessment includes periodic monitoring of the development and evolution of cognitive and noncognitive psychiatric symptoms and their response to intervention (Category I). Both cognitive and noncognitive neuropsychiatric and behavioral symptoms of dementia tend to evolve over time, so regular monitoring allows detection of new symptoms and adaptation of treatment strategies to current needs... Cognitive symptoms that almost always require assessment include impairments in memory, executive function, language, judgment, and spatial abilities. It is often helpful to track cognitive status with a structured simple examination. (APA, 2007) - -Conduct and document an assessment and monitor changes in cognitive status using a reliable and valid instrument. Cognitive status should be reassessed periodically to identify sudden changes, as well as to monitor the potential beneficial or harmful effects of environmental changes, specific medications, or other interventions. Proper assessment requires the use of a standardized, objective instrument that is relatively easy to use, reliable (with less variability between different assessors), and valid (results that would be similar to gold-standard evaluations). (California Workgroup on Guidelines for Alzheimer's Disease Management, 2008)Higher score indicates better qualityAmerican Psychiatric Association (APA). Practice guideline for the treatment of patients with Alzheimer's disease and other dementias. Arlington (VA): American Psychiatric Association (APA); 2007 Oct.California Workgroup on Guidelines for Alzheimer's Disease Management. Guidelines for Alzheimer's disease management. Los Angeles, CA: Alzheimer's Disease and Related Disorders Association, Inc., Los Angeles Chapter. 2008.National Institutes of Health (NIH). NIH State-of-the-Science Conference: Preventing Alzheimer's Disease and Cognitive Decline. April 26-28, 2010. http://consensus.nih.gov/2010/docs/alz/alz_stmt.pdf. Accessed June 9, 2010.Wilson RS, Aggarwal NT, Barnes LL, Mendes de Leon CF, Hebert LE, Evans DA. Cognitive decline in incident Alzheimer disease in a community population. Neurology. 2010 Mar 23;74(12):951-5.Cognition can be assessed by the clinician during the patient's clinical history. -Cognition can also be assessed by direct examination of the patient using one of a number of instruments, including several originally developed and validated for screening purposes. This can also include, where appropriate, administration to a knowledgeable informant. Examples include, but are not limited to: --Blessed Orientation-Memory-Concentration Test (BOMC) --Montreal Cognitive Assessment (MoCA) --St. Louis University Mental Status Examination (SLUMS) --Mini-Mental State Examination (MMSE) [Note: The MMSE has not been well validated for non-Alzheimer's dementias] --Short Informant Questionnaire on Cognitive Decline in the Elderly (IQCODE) --Ascertain Dementia 8 (AD8) Questionnaire --Minimum Data Set (MDS) Brief Interview of Mental Status (BIMS) [Note: Validated for use with nursing home patients only] --Formal neuropsychological evaluationUse of a standardized tool or instrument to assess cognition other than those listed will meet numerator performance. Standardized tools can be mapped to the concept "Intervention, Performed: Cognitive Assessment" included in the numerator logic below. - -The requirement of "Count >=2 of Encounter, Performed" is to establish that the eligible professional has an existing relationship with the patient.TBDAll patients, regardless of age, with a diagnosis of dementiaEquals Initial PopulationNonePatients for whom an assessment of cognition is performed and the results reviewed at least once within a 12 month periodNot ApplicableDocumentation of medical reason(s) for not assessing cognition (eg, patient with very advanced stage dementia, other medical reason) -Documentation of patient reason(s) for not assessing cognitionNot ApplicableNot ApplicableNot ApplicableFor every patient evaluated by this measure also identify payer, race, ethnicity and sex.None - - \ No newline at end of file diff --git a/test/fixtures/hqmf/simplexml/CMS153v4_SimpleXML.xml b/test/fixtures/hqmf/simplexml/CMS153v4_SimpleXML.xml deleted file mode 100755 index c083b57b..00000000 --- a/test/fixtures/hqmf/simplexml/CMS153v4_SimpleXML.xml +++ /dev/null @@ -1,35 +0,0 @@ -40280381-4b9a-3825-014b-dc0a24b30faaChlamydia Screening for WomenChlamydia153c9930664-be3d-4ffe-ae4a-5cf4933ecb894.0.0000000010100001231National Committee for Quality AssuranceNational Committee for Quality AssuranceNational Quality ForumPercentage of women 16-24 years of age who were identified as sexually active and who had at least one test for chlamydia during the measurement period.Physician Performance Measure (Measures) and related data specifications were developed by the National Committee for Quality Assurance (NCQA). - -The Measures are copyrighted but can be reproduced and distributed, without modification, for noncommercial purposes (eg, use by healthcare providers in connection with their practices). Commercial use is defined as the sale, licensing, or distribution of the Measures for commercial gain, or incorporation of the Measures into a product or service that is sold, licensed or distributed for commercial gain. Commercial use of the Measures requires a license agreement between the user and NCQA. NCQA is not responsible for any use of the Measures. - -(c) 2008-2015 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 CPT or other codes contained in the specifications. - -CPT(R) contained in the Measure specifications is copyright 2004-2014 American Medical Association. LOINC(R) copyright 2004-2014 Regenstrief Institute, Inc. This material contains SNOMED Clinical Terms(R) (SNOMED CT[R]) copyright 2004-2014 International Health Terminology Standards Development Organisation. ICD-10 copyright 2014 World Health Organization. All Rights Reserved.These performance Measures are not clinical guidelines and do not establish a standard of medical care, and have not been tested for all potential applications. - -THE MEASURES 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].ProportionProcessReport a total score, and each of the following strata: -Stratum 1: Patients age 16-20 -Stratum 2: Patients age 21-24NoneNoneChlamydia trachomatis is the most common sexually transmitted bacterial infection in the U.S., resulting in over 2.8 million new cases each year (Centers for Disease Control and Prevention 2011 - Chlamydia). It is often known as a "silent" disease because most infected people have no symptoms and therefore are unaware they have an infection (United States Preventive Services Task Force, 2007; Centers for Disease Control and Prevention 2011- Chlamydia). Although chlamydia symptoms are usually mild or nonexistent, untreated infections can lead to serious and irreversible complications (United States Preventive Services Task Force 2007). - -Women are particularly vulnerable when infected with chlamydia. Left untreated, chlamydia can cause pelvic inflammatory disease (PID), permanent damage to a woman's fallopian tubes, uterus and surrounding tissue, or Reiter Syndrome, which includes pink eye (conjunctivitis) and skin lesions affecting the lower extremities. Between 10 and 15 percent of untreated chlamydia infections result in PID, which can lead to ectopic pregnancy and infertility (Centers for Disease Control and Prevention 2011 - Chlamydia). As many as 15 percent of women with PID will become infertile (Centers for Disease Control and Prevention 2011 - Pelvic Inflammatory Disease). Additionally, pregnant women might experience premature delivery, miscarriage, low birth weight, infant mortality, or they may pass conjunctivitis or chlamydia pneumonia to their infants (United States Preventive Services Task Force, 2007; Centers for Disease Control and Prevention 2011-Chlamydia). Chlamydia is the leading cause of preventable infertility and, among other adverse pregnancy related problems, can cause preterm birth, miscarriages, infant mortality, and neonatal chlamydia infections (United States Preventive Services Task Force 2007). - -Over 900,000 chlamydia infections were reported to the Centers for Disease Control and Prevention (CDC) from 50 states and the District of Columbia in 2004. Since many cases are not reported or even diagnosed, it is estimated that there are actually 2.8 million new cases of chlamydia each year (Centers for Disease Control and Prevention 2010). From 1987 through 2004, the reported rate of chlamydia infection in women increased from 78.5 cases to 485 cases per 100,000 people, though a portion of the increase in prevalence is attributed to continued expansion of chlamydia screening programs (Centers for Disease Control and Prevention 2005). - -A significant proportion of sexually active individuals, both male and female, continue to go undiagnosed due to the disease's asymptomatic nature (Wilson et al. 2009). Approximately 75 percent of chlamydia infections in women and 95 percent in men are asymptomatic, resulting in delayed medical care and treatment (Centers for Disease Control and Prevention 2011 - Pelvic Inflammatory Disease). Women whose sexual partners are not screened and appropriately treated are at high risk for re-infection. Multiple chlamydia infections increase a woman's risk of serious reproductive health complications (Centers for Disease Control and Prevention 2010).U.S. Preventive Services Task Force (2007): -All sexually active nonpregnant young women age 24 years or younger and older women (pregnant or not) who are at increased risk should be screened for a chlamydial infection. - -The USPSTF found fair evidence that nucleic acid amplification tests (NAATs) can identify chlamydial infection in asymptomatic men and women, including asymptomatic pregnant women, with high test specificity. - -If clinicians have not concurrently screened for chlamydial infection, the CDC recommends presumptive treatment for chlamydia at the time of treatment for gonorrhea. In order to prevent recurrent transmission, partners of infected individuals should be tested and treated if infected, or treated presumptively. - -American Academy of Family Physicians (2009): -The AAFP strongly recommends screening for chlamydia infection for all sexually active non-pregnant young women aged 24 and younger and for older non-pregnant women who are at increased risk. - -The AAFP recommends screening for chlamydia infection for all pregnant women aged 24 younger and for older pregnant women who are at increased risk.Higher score indicates better qualityCenters for Disease Control and Prevention. 2011. "Chlamydia - CDC Fact Sheet." http://www.cdc.gov/std/Chlamydia/STDFact-Chlamydia.htmUnited States Preventive Services Task Force. 2007. Screening for chlamydia infection: U.S. Preventive Services Task Force recommendation statement. Ann Intern Med 147(2):128-34. Wilson, T.E., M. Hogben, E.S. Malka, N. Liddon, W.M. McCormack, S.R. Rubin, M.A. Augenbraun. 2009. "A Randomized Controlled Trial for Reducing Risks for Sexually Transmitted Infections Through Enhanced Patient-Based Partner Notification." Am J Public Health 99(S1):S104-10.Centers for Disease Control and Prevention. 2011. "Pelvic Inflammatory Disease (PID) - CDC Fact Sheet" http://www.cdc.gov/std/PID/STDFact-PID.htm Centers for Disease Control and Prevention. 2010. "Sexually Transmitted Diseases (STDs): Chlamydia Treatment." http://www.cdc.gov/std/chlamydia/treatment.htm (June 6, 2011).Centers for Disease Control and Prevention. 2005. Sexually Transmitted Disease Surveillance 2004 Supplement, Chlamydia Prevalence Monitoring Project. Atlanta: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention.American Academy of Family Physicians (AAFP). 2009. Summary of recommendations for clinical preventive services. Revision 6.8. Leawood: American Academy of Family Physicians (AAFP).NoneCodes to identify sexually active women include codes for: pregnancy, sexually transmitted infections, contraceptives or contraceptive devices, and infertility treatments. - -The denominator exclusion does not apply to patients who qualify for the initial population (IP) based on services other than the pregnancy test alone. For example, a patient who has both a pregnancy test and a chlamydia diagnosis, either of which would qualify them for the IP, would not be eligible for this denominator exclusion.TBDWomen 16 to 24 years of age who are sexually active and who had a visit in the measurement periodEquals Initial PopulationWomen who received a pregnancy test solely as a safety precaution before ordering an x-ray or specified medicationsWomen with at least one chlamydia test during the measurement periodNot ApplicableNoneNot applicableNot applicableNot applicableFor every patient evaluated by this measure also identify payer, race, ethnicity and sex.None - - \ No newline at end of file diff --git a/test/fixtures/hqmf/simplexml/CMS154v4_SimpleXML.xml b/test/fixtures/hqmf/simplexml/CMS154v4_SimpleXML.xml deleted file mode 100755 index fe497abe..00000000 --- a/test/fixtures/hqmf/simplexml/CMS154v4_SimpleXML.xml +++ /dev/null @@ -1,25 +0,0 @@ -40280381-4b9a-3825-014b-c27ee384089eAppropriate Treatment for Children with Upper Respiratory Infection (URI)URI154e455fac0-f2cb-4074-a351-1e68a90fb7cf4.0.0000000010100001231National Committee for Quality AssuranceNational Committee for Quality AssuranceNational Quality ForumPercentage of children 3 months-18 years of age who were diagnosed with upper respiratory infection (URI) and were not dispensed an antibiotic prescription on or three days after the episode.Physician Performance Measure (Measures) and related data specifications were developed by the National Committee for Quality Assurance (NCQA). - -The Measures are copyrighted but can be reproduced and distributed, without modification, for noncommercial purposes (eg, use by healthcare providers in connection with their practices). Commercial use is defined as the sale, licensing, or distribution of the Measures for commercial gain, or incorporation of the Measures into a product or service that is sold, licensed or distributed for commercial gain. Commercial use of the Measures requires a license agreement between the user and NCQA. NCQA is not responsible for any use of the Measures. - -(C) 2008-2015 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 CPT or other codes contained in the specifications. - -CPT(R) contained in the Measure specifications is copyright 2004-2014 American Medical Association. LOINC(R) copyright 2004-2014 Regenstrief Institute, Inc. This material contains SNOMED Clinical Terms(R) (SNOMED CT[R]) copyright 2004-2014 International Health Terminology Standards Development Organisation. ICD-10 copyright 2014 World Health Organization. All Rights Reserved.These performance Measures are not clinical guidelines and do not establish a standard of medical care, and have not been tested for all potential applications. - -THE MEASURES 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].ProportionProcessNoneNoneNoneIn 1998, 25 million patients (adults and children) sought care for non-specific upper respiratory infections (URI, also known as the common cold) and 30 percent received antibiotics (Gonzales 2001). - -Inappropriate antibiotic prescriptions for URI, pharyngitis and bronchitis are estimated to amount to 55 percent (22.6 million) of all antibiotics prescribed for acute respiratory infections, costing $726 million in 1998 (Gonzales 2001). - -Using antibiotics inappropriately can lead to antibiotic resistance, which can result in increased morbidity and mortality (Feikin 2000). The resulting increased effort to treat drug-resistant pathogens can also lead to more repeated health care visits, greater risk of disease complications and increased health care costs (Feikin 2000; Dagan 2000; Watanabe 2000).American Family Physician (Wong, Blumberg, and Lowe 2006) - -- A diagnosis of acute bacterial rhinosinusitis should be considered in patients with symptoms of a viral upper respiratory infection that have not improved after 10 days or that worsen after five to seven days. (C) - -- Treatment of sinus infection with antibiotics in the first week of symptoms is not recommended. (C) - -- Telling patients not to fill an antibiotic prescription unless symptoms worsen or fail to improve after several days can reduce the inappropriate use of antibiotics. (B)Higher scores indicates better qualityWong, D.M., D.A. Blumberg, and L.G. Lowe. 2006. "Guidelines for the use of antibiotics in acute upper respiratory tract infections." Am Fam Physician 74(6):956-966.Dagan, R. 2000. "Clinical significance of resistant organisms in otitis media." Pediatr Infect Dis J 19(4):378-382.Feikin, D.R., A. Schuchat, M. Kolczak, N.L. Barrett, L.H. Harrison, L. Lefkowitz, A. McGeer, M.M. Farley, D.J. Vugia, C. Lexau, K.R. Stefonek, J.E. Patterson, J.H. Jorgensen. 2000. "Mortality from invasive pneumococcal pneumonia in the era of antibiotic resistance, 1995-1997." Am J Public Health 90(2):223-229.Gonzales, R., D.C. Malone, J.H. Maselli, M.A. Sande. 2001. "Excessive antibiotic use for acute respiratory infections in the United States." Clin Infect Dis 33(6):757-762.Watanabe, H., S. Sato, K. Kawakami, K. Watanabe, K. Oishi, N. Rikitomi, T. li, H. Ikeda, A. Sato, T. Nagatake. 2000. "A comparative clinical study of pneumonia by penicillin-resistant and sensitive Streptococcus pneumoniae in a community hospital." Respirology 5(1):59-64.NoneThis is an episode of care measure that examines all eligible episodes for the patient during the measurement period. If the patient has more than one episode, include all episodes in the measure.TBDChildren age 3 months to 18 years who had an outpatient or emergency department (ED) visit with a diagnosis of upper respiratory infection (URI) during the measurement periodEquals Initial PopulationExclude children who are taking antibiotics in the 30 days prior to the date of the encounter during which the diagnosis was established. Exclude children who had an encounter with a competing diagnosis within three days after the initial diagnosis of URI.Children without a prescription for antibiotic medication on or 3 days after the outpatient or ED visit for an upper respiratory infectionNot ApplicableNoneNot ApplicableNot ApplicableNot ApplicableFor every patient evaluated by this measure also identify payer, race, ethnicity and sex.None - - \ No newline at end of file diff --git a/test/fixtures/hqmf/simplexml/CMS155v4_SimpleXML.xml b/test/fixtures/hqmf/simplexml/CMS155v4_SimpleXML.xml deleted file mode 100755 index d80627d6..00000000 --- a/test/fixtures/hqmf/simplexml/CMS155v4_SimpleXML.xml +++ /dev/null @@ -1,38 +0,0 @@ -40280381-4de7-db4d-014d-e877328b01ddWeight Assessment and Counseling for Nutrition and Physical Activity for Children and AdolescentsWght_Assess_Counseling1550b63f730-25d6-4248-b11f-8c09c66a04eb4.1.0000000010100001231National Committee for Quality AssuranceNational Committee for Quality AssuranceNational Quality ForumPercentage of patients 3-17 years of age who had an outpatient visit with a Primary Care Physician (PCP) or Obstetrician/Gynecologist (OB/GYN) and who had evidence of the following during the measurement period. Three rates are reported. - - - Percentage of patients with height, weight, and body mass index (BMI) percentile documentation - - Percentage of patients with counseling for nutrition - - Percentage of patients with counseling for physical activityPhysician Performance Measure (Measures) and related data specifications were developed by the National Committee for Quality Assurance (NCQA). - -The Measures are copyrighted but can be reproduced and distributed, without modification, for noncommercial purposes (eg, use by healthcare providers in connection with their practices). Commercial use is defined as the sale, licensing, or distribution of the Measures for commercial gain, or incorporation of the Measures into a product or service that is sold, licensed or distributed for commercial gain. Commercial use of the Measures requires a license agreement between the user and NCQA. NCQA is not responsible for any use of the Measures. - -(C) 2008-2015 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 CPT or other codes contained in the specifications. - -CPT(R) contained in the Measure specifications is copyright 2004-2014 American Medical Association. LOINC(R) copyright 2004-2014 Regenstrief Institute, Inc. This material contains SNOMED Clinical Terms(R) (SNOMED CT[R]) copyright 2004-2014 International Health Terminology Standards Development Organisation. ICD-10 copyright 2014 World Health Organization. All Rights Reserved.These performance Measures are not clinical guidelines and do not establish a standard of medical care, and have not been tested for all potential applications. - -THE MEASURES 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].ProportionProcessReport a total score, and each of the following strata: -Stratum 1 - Patients age 3-11 -Stratum 2 - Patients age 12-17NoneNoneOne of the most important developments in pediatrics in the past two decades has been the emergence of a new chronic disease: obesity in childhood and adolescence. The rapidly increasing prevalence of obesity among children is one of the most challenging dilemmas currently facing pediatricians. National Health and Nutrition Examination Survey (NHANES) data from Cycle II (1976-1980) compared with data from Cycle III (1988-1994) documents an increase in the prevalence of obesity in all age, ethnic, and gender groups. NHANES data collected from 1999-2000 revealed a continued increase in the number of obese children. In that data collection, the prevalence of obesity (body mass index (BMI) > 95th percentile) was 10 percent among children 2-5 years of age and 15 percent among children 6-19 years of age. When children at risk for obesity (BMI of 85th-94th percentile) were included, the prevalence increased to 20 percent and 30 percent, respectively. Therefore, >1 of every 4 patients examined by pediatricians either is obese or is considered to be at high risk for developing this challenging health problem (O'Brien et al. 2004). - -In addition to the growing prevalence of obesity in children and adolescents, the number of overweight children at risk of becoming obese is also of great concern. Evidence suggests that overweight children and adolescents are more likely to become obese as adults. For example, one study found that approximately 80 percent of children who were overweight at age 10-15 years were obese adults at age 25 years (Whitaker et al. 1997). Another study found that 25 percent of obese adults were overweight as children. The latter study also found that if overweight begins before 8 years of age, obesity in adulthood is likely to be more severe (Freedman et al. 2001).U.S. Preventive Services Task Force (2005) - Evidence is insufficient to recommend for or against routine screening for overweight in children and adolescents as a means to prevent adverse health outcomes (I rating). - -American Academy of Pediatrics (2004) - BMI should be calculated from the height and weight, and the BMI percentile should be calculated. - -American Medical Association (AMA), Centers for Disease Control and Prevention (CDC), Health Resources and Services Administration (HRSA) (2007) - At minimum, a yearly assessment of weight status in all children. - -Include calculation of height, weight (measured appropriately), and body mass index (BMI) for age and plotting of those measures on standard growth charts. - -The AAP and the American College of Clinical Endocrinology (ACCE) (Dorsey 2005) - Screen children for obesity using BMI and examine overweight children for obesity-related diseases. - -CDC (Baker 2005) - Using the percentile BMI for age and sex as the most appropriate and easily available method to screen for childhood overweight or at risk for overweight. - -Bright Futures (AAP) (Hagan 2008) - Calculate BMI at every visit.Higher score indicates better qualityO'Brien, S.H., R. Holubkov, E.C Reis. 2004. "Identification, evaluation, and management of obesity in an academic primary care center." Pediatrics 11:154-159.Whitaker, R.C., J.A. Wright, M.S. Pepe, K.D. Seidel, W.H. Dietz. 1997. "Predicting obesity in young adulthood from childhood and parental obesity." N Engl J Med 37(13):869-873.Freedman, D.S., L.K. Khan, W.H. Dietz, S.R. Srinivasan, G.S. Berenson. 2001. "Relationship of childhood overweight to coronary heart disease risk factors in adulthood: The Bogalusa Heart Study." Pediatrics 108:712-718.U.S. Preventive Services Task Force (USPSTF). 2005. Screening and interventions for overweight in children and adolescents: recommendation statement. Rockville: Agency for Healthcare Research and Quality (AHRQ).[AAP] National High Blood Pressure Education Program Working Group on High Blood Pressure in Children. 2004. "The fourth report on the diagnosis, evaluation, and treatment of high blood pressure in children and adolescents." Pediatrics 114(2 Suppl):555-76.AMA/HRSA/CDC Expert Committee on the Assessment, Prevention and Treatment of Child and Adolescent Overweight and Obesity. 2007. Recommendations on the assessment, prevention and treatment of child and adolescent overweight and obesity. Chicago: AMA. Dorsey, K.B., C. Wells, H.M. Krumholz, J.C. Concato. 2005. "Diagnosis, evaluation, and treatment of childhood obesity in pediatric practice." Arch Pediatr Adolesc Med 159:632-638.Baker, S., S. Barlow, W. Cochran, G. Fuchs, W. Klish, N. Krebs, R. Strauss, A. Tershakovec, J. Udall. 2005. "Overweight children and adolescents: a clinical report of the North American Society for Pediatric Gastroenterology, Hepatology and Nutrition." J Pediatr Gastroenterol Nutr 40(5):533-43.Hagan, J.F., Shaw J.S., Duncan P.M. eds. 2008. Bright Futures: Guidelines for Health Supervision of Infants, Children, and Adolescents, Third Edition. Elk Grove: American Academy of Pediatrics.NoneThe visit must be performed by a PCP or OB/GYN. -Because BMI norms for youth vary with age and sex, this measure evaluates whether BMI percentile is assessed rather than an absolute BMI value.TBDPatients 3-17 years of age with at least one outpatient visit with a primary care physician (PCP) or an obstetrician/gynecologist (OB/GYN) during the measurement periodEquals Initial PopulationPatients who have a diagnosis of pregnancy during the measurement periodNumerator 1: Patients who had a height, weight and body mass index (BMI) percentile recorded during the measurement period -Numerator 2: Patients who had counseling for nutrition during a visit that occurs during the measurement period -Numerator 3: Patients who had counseling for physical activity during a visit that occurs during the measurement periodNot ApplicableNoneNot ApplicableNot ApplicableNot ApplicableFor every patient evaluated by this measure also identify payer, race, ethnicity and sexNone - - \ No newline at end of file diff --git a/test/fixtures/hqmf/simplexml/CMS156v4_SimpleXML.xml b/test/fixtures/hqmf/simplexml/CMS156v4_SimpleXML.xml deleted file mode 100755 index 6e975d04..00000000 --- a/test/fixtures/hqmf/simplexml/CMS156v4_SimpleXML.xml +++ /dev/null @@ -1,31 +0,0 @@ -40280381-4de7-db4d-014d-e86c831201c7Use of High-Risk Medications in the ElderlyHigh-Risk_Med_Elderly156a3837ff8-1abc-4ba9-800e-fd4e7953adbd4.1.0000000010100001231National Committee for Quality AssuranceNational Committee for Quality AssuranceNational Quality ForumPercentage of patients 66 years of age and older who were ordered high-risk medications. Two rates are reported. -a. Percentage of patients who were ordered at least one high-risk medication. -b. Percentage of patients who were ordered at least two different high-risk medications.Physician Performance Measure (Measures) and related data specifications were developed by the National Committee for Quality Assurance (NCQA). - -The Measures are copyrighted but can be reproduced and distributed, without modification, for noncommercial purposes (eg, use by healthcare providers in connection with their practices). Commercial use is defined as the sale, licensing, or distribution of the Measures for commercial gain, or incorporation of the Measures into a product or service that is sold, licensed or distributed for commercial gain. Commercial use of the Measures requires a license agreement between the user and NCQA. NCQA is not responsible for any use of the Measures. - -(C) 2008-2015 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 CPT or other codes contained in the specifications. - -CPT(R) contained in the Measure specifications is copyright 2004-2014 American Medical Association. LOINC(R) copyright 2004-2014 Regenstrief Institute, Inc. This material contains SNOMED Clinical Terms(R) (SNOMED CT[R]) copyright 2004-2014 International Health Terminology Standards Development Organisation. ICD-10 copyright 2014 World Health Organization. All Rights Reserved.These performance Measures are not clinical guidelines and do not establish a standard of medical care, and have not been tested for all potential applications. - -THE MEASURES 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].ProportionProcessNoneNoneNoneSeniors receiving inappropriate medications are more likely to report poorer health status at follow-up, compared to seniors who receive appropriate medications (Fu, Liu, and Christensen 2004). In 2005, rates of potentially inappropriate medication use in the elderly were as large or larger than in a 1996 national sample, highlighting the need for progress in this area (Simon et al. 2005). While some adverse drug events are not preventable, studies estimate that between 30 and 80 percent of adverse drug events in the elderly are preventable (MacKinnon and Hepler 2003). - -Reducing the number of inappropriate prescriptions can lead to improved patient safety and significant cost savings. Conservative estimates of extra costs due to potentially inappropriate medications in the elderly average $7.2 billion a year (Fu, Liu, and Christensen 2004). Medication use by older adults will likely increase further as the U.S. population ages, new drugs are developed, and new therapeutic and preventive uses for medications are discovered (Rothberg et al. 2008). By the year 2030, nearly one in five U.S. residents is expected to be aged 65 years or older; this age group is projected to more than double in number from 38.7 million in 2008 to more than 88.5 million in 2050. Likewise, the population aged 85 years or older is expected to increase almost four-fold, from 5.4 million to 19 million between 2008 and 2050. As the elderly population continues to grow, the number of older adults who present with multiple medical conditions for which several medications are prescribed continues to increase, resulting in polypharmacy (Gray and Gardner 2009).The measure is based on the literature and key clinical expert consensus processes by Beers in 1997, Zahn in 2001 and an updated process by Fick in 2003, which identified drugs of concern in the elderly based on various high-risk criteria. NCQA's Medication Management expert panel selected a subset of drugs that should be used with caution in the elderly for inclusion in the proposed measure based upon these two lists. NCQA analyzed the prevalence of drugs prescribed according to the Beers and Zhan classifications and determined that drugs identified by Zhan that are classified as never or rarely appropriate would form the basis for the list (Fick 2003). - - -Certain medications (MacKinnon 2003) are associated with increased risk of harms from drug side-effects and drug toxicity and pose a concern for patient safety. There is clinical consensus that these drugs pose increased risks in the elderly (Kaufman 2005). Studies link prescription drug use by the elderly with adverse drug events that contribute to hospitalization, increased length of hospital stay, increased duration of illness, nursing home placement and falls and fractures that are further associated with physical, functional and social decline in the elderly (AHRQ 2009).Lower score indicates better qualityZhan, C, et al. Potentially inappropriate medication use in the community-dwelling elderly. JAMA 2001; 286(22):2823-2868.Beers, M.H. Explicit criteria for determining potentially inappropriate medication use by the elderly. Arch Intern Med 1997; 157:1531-1536.Fick, DM, et al. Updating the Beers criteria for potentially inappropriate medication use in older adults. Arch Intern Med 2003; 163:2716-2724.Fu, A.Z., G.G. Liu, and D.B. Christensen. 2004. "Inappropriate Medication Use and Health Outcomes in the Elderly." J Am Geriatr Soc 52(11): 1934-9.Gray, C.L, and C. Gardner. 2009. "Adverse Drug Events in the Elderly: An Ongoing Problem." J Manag Care Pharm 15(7):568-71.AHRQ, National Quality Measures Clearinghouse. www.qualitymeasures.ahrq.gov (Accessed Web page: October 12, 2009).MacKinnon, N.J. and C.D. Hepler. 2003. "Indicators of Preventable Drug-related Morbidity in Older Adults: Use Within a Managed Care Organization." J Managed Care Pharm 9:134-41.Simon, S.R., K.A. Chan, S.B. Soumerai, A.K. Wagner, S.E. Andrade, A.C. Feldstein, J.E. Lafata, R.L. Davis, J.H. Gurwitz. 2005 "Potentially Inappropriate Medication Use by Elderly Persons in U.S. Health Maintenance Organizations, 2000-2001." J Am Geriatr Soc 53(2): 227-232.Kaufman MB, et al. Effect of Prescriber Education on the Use of Medications Contraindicated in Older Adults in a Managed Medicare Population. J Manag Care Pharm 2005 April/May; 11(3):211-219.Rothberg, M.B., P.S. Perkow, F. Liu, B. Korc-Grodzicki, M.J. Brennan, S. Bellantonio, M. Heelon, P.K. Lindenauer. 2008. "Potentially Inappropriate Medication Use in Hospitalized Elders." J Hosp Med 3:91-102.A high-risk medication is identified by either of the following: - a. A prescription for medications classified as high risk at any dose and for any duration - b. Prescriptions for medications classified as high risk at any dose with greater than a 90 day supplyThe intent of Numerator 1 of the measure is to assess if the patient has been prescribed at least one high-risk medication. The intent of Numerator 2 of the measure is to assess if the patient has been prescribed at least two different high-risk medications. - -CUMULATIVE MEDICATION DURATION is an individual's total number of medication days over a specific period; the period counts multiple prescriptions with gaps in between, but does not count the gaps during which a medication was not dispensed. - -To determine the cumulative medication duration, determine first the number of the Medication Days for each prescription in the period: the number of doses divided by the dose frequency per day. Then add the Medication Days for each prescription without counting any days between the prescriptions. - -For example, there is an original prescription for 30 days with 2 refills for thirty days each. After a gap of 3 months, the medication was prescribed again for 60 days with 1 refill for 60 days. The cumulative medication duration is (30 x 3) + (60 x 2) = 210 days over the 10 month period.TBDPatients 66 years and older who had a visit during the measurement periodEquals Initial PopulationNoneNumerator 1: Patients with an order for at least one high-risk medication during the measurement period. -Numerator 2: Patients with an order for at least two different high-risk medications during the measurement period.Not ApplicableNoneNot ApplicableNot ApplicableNot ApplicableFor every patient evaluated by this measure also identify payer, race, ethnicity and sex.None - - \ No newline at end of file diff --git a/test/fixtures/hqmf/simplexml/CMS157v4_SimpleXML.xml b/test/fixtures/hqmf/simplexml/CMS157v4_SimpleXML.xml deleted file mode 100755 index 439aa231..00000000 --- a/test/fixtures/hqmf/simplexml/CMS157v4_SimpleXML.xml +++ /dev/null @@ -1,17 +0,0 @@ -40280381-4b9a-3825-014b-bd61148f05c9Oncology: Medical and Radiation - Pain Intensity QuantifiedOnc_Pain-Int-Quant1579a0330d0-3d9b-11e1-8634-00237d5bf1744.0.0000000010100001231American Medical Association-convened Physician Consortium for Performance Improvement(R) (AMA-PCPI)American Medical Association-convened Physician Consortium for Performance Improvement(R) (AMA-PCPI)National Quality ForumPercentage of patient visits, regardless of patient age, with a diagnosis of cancer currently receiving chemotherapy or radiation therapy in which pain intensity is quantifiedCopyright 2014 American Medical Association. All Rights Reserved.Physician Performance Measures (Measures) and related data specifications have been developed by the American Medical Association (AMA) - convened Physician Consortium for Performance Improvement(R) (PCPI[R]). These Measures are not clinical guidelines and do not establish a standard of medical care, and have not been tested for all potential applications. The Measures, while copyrighted, can be reproduced and distributed, without modification, for noncommercial purposes, eg, use by health care providers in connection with their practices. Commercial use is defined as the sale, license, or distribution of the Measures for commercial gain, or incorporation of the Measures into a product or service that is sold, licensed or distributed for commercial gain. Commercial uses of the Measures require a license agreement between the user and the AMA, (on behalf of the PCPI). Neither the AMA, PCPI nor its members shall be responsible for any use of the Measures. - -THE MEASURES AND SPECIFICATIONS ARE PROVIDED "AS IS" WITHOUT WARRANTY OF ANY KIND. - -Limited proprietary coding is contained in the Measure specifications for convenience. Users of the proprietary code sets should obtain all necessary licenses from the owners of these code sets. The AMA, the PCPI and its members disclaim all liability for use or accuracy of any Current Procedural Terminology (CPT[R]) or other coding contained in the specifications. - -CPT(R) contained in the Measure specifications is copyright 2004-2014 American Medical Association. LOINC(R) copyright 2004-2014 Regenstrief Institute, Inc. This material contains SNOMED Clinical Terms(R) (SNOMED CT[R]) copyright 2004-2014 International Health Terminology Standards Development Organisation. ICD-10 copyright 2014 World Health Organization. All Rights Reserved. - -Due to technical limitations, registered trademarks are indicated by (R) or [R].ProportionProcessNoneNoneNoneInadequate cancer pain management is widely prevalent, harmful to the patient and costly.This algorithm begins with the premise that all patients with cancer should be screened for pain during the initial evaluation, follow-up intervals, and whenever new therapy is initiated. If pain is present on a screening evaluation, the pain intensity must be quantified by the patient (whenever possible). Since pain is inherently subjective, patients' self-reporting of pain is the current standard of care for assessment. (NCCN, 2014) - -Intensity of pain should be quantified using a numerical rating scale (ie, 0-10), visual analog scale, categorical scale, or pictorial scale (eg, The Faces Pain Rating Scale). Although pain is commonly assessed using numerical or categorical ratings, some patients may experience difficulty with these scales. The Faces Pain Rating Scale may be successful with patients who have difficulty with other scales, for example, children, the elderly, and patients with language or cultural differences or other communication barriers. (NCCN, 2014) - -All patients should be routinely screened for pain, and when it is present, pain intensity should be recorded in highly visible ways that facilitate regular review by health care providers. A standard for pain assessment and documentation should be established in each setting to ensure that pain is recognized, documented, and treated promptly. (APS, 2005)Higher score indicates better qualityNational Comprehensive Cancer Network (NCCN). Clinical Practice Guidelines in Oncology: Adult Cancer Pain. Version 2.2014. Available at: http://www.nccn.org.Gordon DB; Dahl JL, Miaskowski C, et al. American Pain Society Recommendations for Improving the Quality of Acute and Cancer Pain Management: American Pain Society Quality of Care Task Force. Arch Intern Med. 2005;165:1574-1580.NoneThis measure is an episode-of-care measure; the level of analysis for this measure is every visit for patients with a diagnosis of cancer who are also receiving chemotherapy or radiation therapy during the measurement period. For patients receiving radiation therapy, pain intensity should be quantified at each radiation treatment management encounter. For patients receiving chemotherapy, pain intensity should be quantified at each face-to-face encounter with the physician while the patient is receiving treatment. For purposes of calculating this measure, eligible encounters for patients receiving chemotherapy will include those encounters where the patient has been administered chemotherapy within 30 days prior to the encounter and also been administered chemotherapy within 30 days after the date of the encounter. For example, at every visit for patients with a diagnosis of cancer who are also receiving chemotherapy or radiation therapy, the patient should have pain intensity quantified. - -Pain intensity should be quantified using a standard instrument, such as a 0-10 numeric rating scale, visual analog scale, a categorical scale, or the pictorial scale.TBDAll patient visits, regardless of patient age, with a diagnosis of cancer currently receiving chemotherapy or radiation therapyEquals Initial PopulationNonePatient visits in which pain intensity is quantifiedNot ApplicableNoneNot ApplicableNot ApplicableNot ApplicableFor every patient evaluated by this measure also identify payer, race, ethnicity and sex.None - - \ No newline at end of file diff --git a/test/fixtures/hqmf/simplexml/CMS158v4_SimpleXML.xml b/test/fixtures/hqmf/simplexml/CMS158v4_SimpleXML.xml deleted file mode 100755 index adeefbbb..00000000 --- a/test/fixtures/hqmf/simplexml/CMS158v4_SimpleXML.xml +++ /dev/null @@ -1,7 +0,0 @@ -40280381-4b9a-3825-014b-cbf6b87d0bb6Pregnant women that had HBsAg testingPreg_HBsAg1583bbfc929-50c8-44b8-8d34-82be75c08a704.0.0000000010100001231OptumOptumThis measure identifies pregnant women who had a HBsAg (hepatitis B) test during their pregnancy.(C) 2015 Optum, Inc. All rights reserved.The information in this document is subject to change without notice. This documentation contains proprietary information, and is protected by U.S. and international copyright. All rights reserved. No part of this documentation may be reproduced or transmitted in any form or by any means, electronic or mechanical, including photocopying, modifying, or recording, without the prior written permission of Optum, Inc. No part of this documentation may be translated to another program language without the prior written consent of Optum, Inc. - -Optum(R), Symmetry(R), EBM Connect(R), service marks and logos are registered and unregistered trademarks of Optum and its affiliates in the United States and other countries. - -EBM Connect(R), Release 9.0, 2015ProportionProcessNoneNoneNoneThe USPSTF found good evidence that universal prenatal screening for HBV infection using HBsAg substantially reduces prenatal transmission of HBV and the subsequent development of chronic HBV infection (USPSTF 2004). The current practice of vaccinating all infants against HBV infection and post-exposure prophylaxis with hepatitis B immune globulin administered at birth to infants of HBV-infected mothers substantially reduces the risk for acquiring HBV infection.The U.S. Preventive Services Task Force (USPSTF) strongly recommends screening for hepatitis B virus (HBV) infection in pregnant women at their first prenatal visit (USPSTF 2004). This is a grade A* recommendation from the USPSTF. In addition, the American College of Obstetricians and Gynecologists (ACOG) recommend screening all pregnant women for HBV infection (ACOG 2002).Higher score indicates better qualityU.S. Preventive Services Task Force. Screening for Hepatitis B Virus Infection in Pregnancy: U.S.Preventive Services Task Force Reaffirmation Recommendation Statement. Ann Int Med 2009;150:869-73.American College of Obstetricians and Gynecologists. ACOG Practice Bulletin No. 86: Viral hepatitis in pregnancy. Obstet Gynecol 2007;110:941-56.[PMID: 17906043]NoneNoneTBDAll female patients aged 12 and older who had a live birth or delivery during the measurement period.Equals Initial Population.NonePatients who were tested for Hepatitis B surface antigen (HBsAg) during pregnancy within 280 days prior to delivery.Not ApplicablePatients with current or past Hepatitis B infection.Not ApplicableNot ApplicableNot ApplicableFor every patient evaluated by this measure also identify payer, race, ethnicity and sex.None - - \ No newline at end of file diff --git a/test/fixtures/hqmf/simplexml/CMS159v4_SimpleXML.xml b/test/fixtures/hqmf/simplexml/CMS159v4_SimpleXML.xml deleted file mode 100755 index e59b731f..00000000 --- a/test/fixtures/hqmf/simplexml/CMS159v4_SimpleXML.xml +++ /dev/null @@ -1,18 +0,0 @@ -40280381-4b9a-3825-014b-c1a59e160733Depression Remission at Twelve MonthsDep_Rem_121598455cd3e-dbb9-4e0c-8084-3ece4068fe944.0.0000000010100001231MN Community MeasurementMN Community MeasurementNational Quality ForumAdult patients age 18 and older with major depression or dysthymia and an initial PHQ-9 score > 9 who demonstrate remission at twelve months defined as PHQ-9 score less than 5. This measure applies to both patients with newly diagnosed and existing depression whose current PHQ-9 score indicates a need for treatmentCopyright MN Community Measurement, 2015. All rights reserved.This measure is "re-tooled" from the existing NQF # 710 measure. eMeasure development was a collaboration between MN Community Measurement and Telligen with technical assistance provided by Telligen.ProportionOutcomeNoneNoneNoneThe Centers for Disease Control and Prevention states that nationally 15.7% of people report being told by a health care professional that they had depression at some point in their lifetime. Persons with a current diagnosis of depression and a lifetime diagnosis of depression or anxiety were significantly more likely than persons without these conditions to have cardiovascular disease, diabetes, asthma and obesity and to be a current smoker, to be physically inactive and to drink heavily. According to National Institute of Mental Health (NIMH), 6.7 percent of the U.S. population ages 18 and older (14.8 million people) in any given year have a diagnosis of a major depressive disorder. Major depression is the leading cause of disability in the U.S. for ages 15 - 44. Additionally, dysthymia accounts for an additional 3.3 million Americans.Improvement in the symptoms of depression and an ongoing assessment of the current treatment plan is crucial to the reduction of symptoms and psychosocial well being of patients with major depression. Most people treated for initial depression need to be on medication at least six to twelve months after adequate response to symptoms, patients with recurrent depression need to be treated for three years or more and response with psychotherapy can take eight to twelve weeks of regular and frequent therapy to show improvement. Remission is defined as a PHQ-9 score of less than five at twelve months. The Patient Health Questionnaire (PHQ-9) tool is a widely accepted, standardized tool [Developed by Drs. Robert L. Spitzer, Janet B.W. Williams, Kurt Kroenke and colleagues, with an educational grant from Pfizer Inc. No permission required to reproduce, translate, display or distribute.] that is completed by the patient, ideally at each visit, and utilized by the provider to monitor treatment progress. This tool was selected for measuring outcomes for this population because it is 1) validated with a sensitivity of .080 and a specificity of 0.92 with substantial heterogeneity I2 = 82%, 2) widely accepted and utilized in Minnesota, 3) available for clinical use, 4) translated into many languages and 5) easy for the patient to complete and the provider to score. Available at www.phqscreeners.com. This nine question tool contains the following questions which are scored on a scale of 0 to 27 based on the scale of Not at All (0), Several Days (1), More Than Half the Days (2), or Nearly Every Day (3) for responses to the questions over the last 2 weeks. - -* Little interest or pleasure in doing things -* Feeling down, depressed, or hopeless -* Feeling tired or having little energy -* Poor appetite or overeating -* Feeling bad about yourself - or that you are a failure or have let yourself or your family down -* Trouble concentrating on things, such as reading the newspaper or watching television -* Moving or speaking so slowly that other people could have noticed? Or the opposite - being so fidgety or restless that you have been moving around a lot more than usual -* Thoughts that you would be better off dead or of hurting yourself in some wayHigher score indicates better qualityInstitute for Clinical Systems Improvement (ICSI) Major Depression in Adults in Primary Care 16th edition September 2013 www.icsi.orgScreening for Depression in Medical Settings with the Patient Health Questionnaire (PHQ) A Diagnostic Meta Analysis. Gilbody, Simon et al Journal of General Internal Medicine Sept 2007The PHQ-9: Validity of a Brief Depression Severity Measure Kurt Kroenke, MD, Robert Spitzer, MD J Gen Intern Med 2001 16:606-613Collaborative Care for Depression: a Cumulative Meta-analysis and Review of Longer-term Outcomes. Gilbody, Simon et al Archives Internal Medicine Dec 2006Remission is defined as a PHQ-9 score of less than five - -Twelve Months is defined as the point in time from the date in the measurement period that a patient meets the inclusion criteria (diagnosis and elevated PHQ-9 > 9) extending out twelve months and then allowing a grace period of thirty days prior to and thirty days after this date. Any PHQ-9 less than five obtained during this period is deemed as remission at twelve months, values obtained prior to or after this period are not counted as numerator compliant (remission)NoneTBDAdults age 18 and older with a diagnosis of major depression or dysthymia and an initial PHQ-9 score greater than nine during an outpatient encounter.Equals the Initial Patient Population1: Patients who died -2: Patients who received hospice or palliative care services -3: Patients who were permanent nursing home residents -4: Patients with a diagnosis of bipolar disorder -5: Patients with a diagnosis of personality disorderAdults who achieved remission at twelve months as demonstrated by a twelve month (+/- 30 days) PHQ-9 score of less than five.NoneNoneNot ApplicableNot ApplicableNot ApplicableFor every patient evaluated by this measure also identify payer, race, ethnicity and sex.None - - \ No newline at end of file diff --git a/test/fixtures/hqmf/simplexml/CMS160v4_SimpleXML.xml b/test/fixtures/hqmf/simplexml/CMS160v4_SimpleXML.xml deleted file mode 100755 index c92bcf2d..00000000 --- a/test/fixtures/hqmf/simplexml/CMS160v4_SimpleXML.xml +++ /dev/null @@ -1,15 +0,0 @@ -40280381-4de7-db4d-014d-e932bb6c02d0Depression Utilization of the PHQ-9 ToolDep_PHQ-9160a4b9763c-847e-4e02-bb7e-acc596e90e2c4.2.0000000010100001231MN Community MeasurementMN Community MeasurementNational Quality ForumAdult patients age 18 and older with the diagnosis of major depression or dysthymia who have a PHQ-9 tool administered at least once during a 4-month period in which there was a qualifying visit.Copyright MN Community Measurement, 2015. All rights reservedThis measure is "re-tooled" from the existing NQF # 712 measure. eMeasure development was a collaboration between MN Community Measurement and Telligen with technical assistance provided by Telligen.ProportionProcessNoneNoneNoneThe Centers for Disease Control and Prevention states that nationally 15.7% of people report being told by a health care professional that they had depression at some point in their lifetime. Persons with a current diagnosis of depression and a lifetime diagnosis of depression or anxiety were significantly more likely than persons without these conditions to have cardiovascular disease, diabetes, asthma and obesity and to be a current smoker, to be physically inactive and to drink heavily. According to National Institute of Mental Health (NIMH), 6.7 percent of the U.S. population ages 18 and older (14.8 million people) in any given year have a diagnosis of a major depressive disorder. Major depression is the leading cause of disability in the U.S. for ages 15 - 44. Additionally, dysthymia accounts for an additional 3.3 million Americans.This process measure for using the PHQ-9 tool is directly related to the desired outcomes of demonstrating improvement in symptoms of depression (remission). Improvement in the symptoms of depression and an ongoing assessment of the current treatment plan is crucial to the reduction of symptoms and psychosocial well being of patients with major depression. Most people treated for initial depression need to be on medication at least six to twelve months after adequate response to symptoms, patients with recurrent depression need to be treated for three years or more and response with psychotherapy can take eight to twelve weeks of regular and frequent therapy to show improvement. Remission is defined as a PHQ-9 score of less than five at twelve months. The Patient Health Questionnaire (PHQ-9) tool is a widely accepted, standardized tool [Developed by Drs. Robert L. Spitzer, Janet B.W. Williams, Kurt Kroenke and colleagues, with an educational grant from Pfizer Inc. No permission required to reproduce, translate, display or distribute.] that is completed by the patient, ideally at each visit, and utilized by the provider to monitor treatment progress. This tool was selected for measuring outcomes for this population because it is 1) validated with a sensitivity of .080 and a specificity of 0.92 with substantial heterogeneity I2 = 82%, 2) widely accepted and utilized in Minnesota, 3) available for clinical use, 4) translated into many languages and 5) easy for the patient to complete and the provider to score. Available at www.phqscreeners.com. This nine question tool contains the following questions which are scored on a scale of 0 to 27 based on the scale of Not at All (0), Several Days (1), More Than Half the Days (2), or Nearly Every Day (3) for responses to the questions over the last 2 weeks. -* Little interest or pleasure in doing things -* Feeling down, depressed, or hopeless -* Feeling tired or having little energy -* Poor appetite or overeating -* Feeling bad about yourself - or that you are a failure or have let yourself or your family down -* Trouble concentrating on things, such as reading the newspaper or watching television -* Moving or speaking so slowly that other people could have noticed? Or the opposite - being so fidgety or restless that you have been moving around a lot more than usual -* Thoughts that you would be better off dead or of hurting yourself in some wayHigher scores indicate better qualityInstitute for Clinical Systems Improvement (ICSI) Major Depression in Adults in Primary Care 16th edition September 2013 www.icsi.orgScreening for Depression in Medical Settings with the Patient Health Questionnaire (PHQ) A Diagnostic Meta Analysis. Gilbody, Simon et al Journal of General Internal Medicine Sept 2007The PHQ-9: Validity of a Brief Depression Severity Measure Kurt Kroenke, MD, Robert Spitzer, MD J Gen Intern Med 2001 16:606-613Collaborative Care for Depression: a Cumulative Meta-analysis and Review of Longer-term Outcomes. Gilbody, Simon et al Archives Internal Medicine Dec 2006NoneNoneTBDAdult patients age 18 and older with an office visit and the diagnosis of major depression or dysthymia during each four month periodEquals the Initial Population1: Patients who died -2: Patients who received hospice or palliative care services -3: Patients who were permanent nursing home residents -4: Patients with a diagnosis of bipolar disorder -5: Patients with a diagnosis of personality disorderAdult patients who have a PHQ-9 tool administered at least once during the four-month period.Not applicableNoneNot applicableNot applicableNot applicableFor every patient evaluated by this measure also identify payer, race, ethnicity and sex.None - - \ No newline at end of file diff --git a/test/fixtures/hqmf/simplexml/CMS161v4_SimpleXML.xml b/test/fixtures/hqmf/simplexml/CMS161v4_SimpleXML.xml deleted file mode 100755 index 248f510d..00000000 --- a/test/fixtures/hqmf/simplexml/CMS161v4_SimpleXML.xml +++ /dev/null @@ -1,72 +0,0 @@ -40280381-4b9a-3825-014b-c1fde24a07d4Adult Major Depressive Disorder (MDD): Suicide Risk AssessmentMDD_Suicide16160176fbf-bfdc-4892-9c9e-604f206553c84.0.0000000010100001231American Medical Association-convened Physician Consortium for Performance Improvement(R) (AMA-PCPI)American Medical Association-convened Physician Consortium for Performance Improvement(R) (AMA-PCPI)National Quality ForumPercentage of patients aged 18 years and older with a diagnosis of major depressive disorder (MDD) with a suicide risk assessment completed during the visit in which a new diagnosis or recurrent episode was identifiedCopyright 2014 American Medical Association. All Rights Reserved.Physician Performance Measures (Measures) and related data specifications have been developed by the American Medical Association (AMA) - convened Physician Consortium for Performance Improvement(R) (PCPI[R]). These Measures are not clinical guidelines and do not establish a standard of medical care, and have not been tested for all potential applications. The Measures, while copyrighted, can be reproduced and distributed, without modification, for noncommercial purposes, eg, use by health care providers in connection with their practices. Commercial use is defined as the sale, license, or distribution of the Measures for commercial gain, or incorporation of the Measures into a product or service that is sold, licensed or distributed for commercial gain. Commercial uses of the Measures require a license agreement between the user and the AMA, (on behalf of the PCPI). Neither the AMA, PCPI nor its members shall be responsible for any use of the Measures. - -THE MEASURES AND SPECIFICATIONS ARE PROVIDED "AS IS" WITHOUT WARRANTY OF ANY KIND. - -Limited proprietary coding is contained in the Measure specifications for convenience. Users of the proprietary code sets should obtain all necessary licenses from the owners of these code sets. The AMA, the PCPI and its members disclaim all liability for use or accuracy of any Current Procedural Terminology (CPT[R]) or other coding contained in the specifications. - -CPT(R) contained in the Measure specifications is copyright 2004-2014 American Medical Association. LOINC(R) copyright 2004-2014 Regenstrief Institute, Inc. This material contains SNOMED Clinical Terms(R) (SNOMED CT[R]) copyright 2004-2014 International Health Terminology Standards Development Organisation. ICD-10 copyright 2014 World Health Organization. All Rights Reserved. - -Due to technical limitations, registered trademarks are indicated by (R) or [R].ProportionProcessNoneNoneNoneResearch has shown that more than 90% of people who kill themselves have depression or another diagnosable mental or substance abuse disorder. Depression is the cause of over two-thirds of the reported suicides in the U.S. each year. The intent of this measure is for a clinician to assess suicide risk at initial intake or at the visit in which depression was diagnosed. As the guidelines state, it is important to assess for additional factors which may increase or decrease suicide risk, such as presence of additional symptoms (eg, psychosis, severe anxiety, hopelessness, severe chronic pain); presence of substance abuse, history and seriousness of previous attempts, particularly, recent suicidal behavior, current stressors and potential protective factors (eg, positive reasons for living, strong social support), family history of suicide or mental illness or recent exposure to suicide, impulsivity and potential for risk to others, including history of violence or violent or homicidal ideas, plans, or intentions, and putting one's affairs in order (eg, giving away possessions, writing a will). In addition, although the measure focuses on the initial visit, it is critical that suicide risk be monitored especially for the 90 days following the initial visit and throughout MDD treatment.A careful and ongoing evaluation of suicide risk is necessary for all patients with major depressive disorder [I]. (APA, 2010) - -Such an assessment includes specific inquiry about suicidal thoughts, intent, plans, means, and behaviors; identification of specific psychiatric symptoms (eg, psychosis, severe anxiety, substance use) or general medical conditions that may increase the likelihood of acting on suicidal ideas; assessment of past and, particularly, recent suicidal behavior; delineation of current stressors and potential protective factors (eg, positive reasons for living, strong social support); and identification of any family history of suicide or mental illness [I]. (APA, 2010) - -As part of the assessment process, impulsivity and potential for risk to others should also be evaluated, including any history of violence or violent or homicidal ideas, plans, or intentions [I]. (APA, 2010) - -The patient's risk of harm to him- or herself and to others should also be monitored as treatment proceeds [I]. (APA, 2010) - -Guidelines for Selecting a Treatment Setting for Patients at Risk for Suicide or Suicidal Behaviors (from APA's Practice Guideline for Assessment and Treatment of Patients With Suicidal Behaviors-2010, Downloaded from http://psychiatryonline.org/ on 6/25/12): -Admission generally indicated -After a suicide attempt or aborted suicide attempt if: -* Patient is psychotic -* Attempt was violent, near-lethal, or premeditated -* Precautions were taken to avoid rescue or discovery -* Persistent plan and/or intent is present -* Distress is increased or patient regrets surviving -* Patient is male, older than age 45 years, especially with new onset of psychiatric illness or suicidal thinking -* Patient has limited family and/or social support, including lack of stable living situation -* Current impulsive behavior, severe agitation, poor judgment, or refusal of help is evident -* Patient has change in mental status with a metabolic, toxic, infectious, or other etiology requiring further workup in a structured setting - -In the presence of suicidal ideation with: -* Specific plan with high lethality -* High suicidal intent - -Admission may be necessary -After a suicide attempt or aborted suicide attempt, except in circumstances for which admission is generally indicated - -In the presence of suicidal ideation with: -* Psychosis -* Major psychiatric disorder -* Past attempts, particularly if medically serious -* Possibly contributing medical condition (eg, acute neurological disorder, cancer, infection) -* Lack of response to or inability to cooperate with partial hospital or outpatient treatment -* Need for supervised setting for medication trial or ECT -* Need for skilled observation, clinical tests, or diagnostic assessments that require a structured setting -* Limited family and/or social support, including lack of stable living situation -* Lack of an ongoing clinician-patient relationship or lack of access to timely outpatient follow-up -* [Evidence of putting one's affairs in order (eg, giving away possessions, writing a will)] - -In the absence of suicide attempts or reported suicidal ideation/plan/intent but evidence from the psychiatric evaluation and/or history from others suggests a high level of suicide risk and a recent acute increase in risk - -Release from emergency department with follow-up recommendations may be possible -After a suicide attempt or in the presence of suicidal ideation/plan when: -* Suicidality is a reaction to precipitating events (eg, exam failure, relationship difficulties), particularly if the patient's view of situation has changed since coming to emergency department -* Plan/method and intent have low lethality -* Patient has stable and supportive living situation -* Patient is able to cooperate with recommendations for follow-up, with treater contacted, if possible, if patient is currently in treatment - -Outpatient treatment may be more beneficial than hospitalization -Patient has chronic suicidal ideation and/or self-injury without prior medically serious attempts, if a safe and supportive living situation is available and outpatient psychiatric care is ongoing.Higher score indicates better qualityAmerican Psychiatric Association (APA). Practice Guideline for the Treatment of Patients With Major Depressive Disorder, Third Edition--2010. This practice guideline was approved in May 2010 and published in October 2010. A guideline watch, summarizing significant developments in the scientific literature since publication of this guideline, may be available at -http://www.psychiatryonline.com/pracGuide/pracGuideTopic_7.aspx.Conwell Y, Brent D. Suicide and aging I: patterns of psychiatric diagnosis. International Psychogeriatrics, 1995; 7(2): 149-64.Statistics on Depression. Depression and Bipolar Support Alliance. -<http://www.dbsalliance.org/site/PageServer?pagename=press_facts_depression>. Accessed February 17, 2015.Suicide risk assessment - Must include questions about the following: -1) Suicidal ideation -2) Patient's intent of initiating a suicide attempt -AND, if either is present, -3) Patient plans for a suicide attempt -4) Whether the patient has means for completing suicideIt is expected that a suicide risk assessment will be completed at the visit during which a new diagnosis is made or at the visit during which a recurrent episode is first identified (ie, at the initial evaluation). This measure is an episode-of-care measure and should be reported for each instance of a new or recurrent episode of MDD; every new or recurrent episode will count separately in the Initial Population. - -Use of a standardized tool or instrument to assess suicide risk will meet numerator performance. Standardized tools can be mapped to the concept "Intervention, Performed: Suicide Risk Assessment" included in the numerator logic below. - -The measure description outlined in the header for this measure states, 'patients aged 18 years and older' while the logic statement states, '>= 17 year(s) at: "Measurement Period"'. The logic statement, as written, captures patients who turn 18 years old during the measurement period so that these patients are included in the measure. To ensure all patients with major depressive disorder (MDD) are assessed for suicide risk, there are two clinical quality measures addressing suicide risk assessment; CMS 177 covers children and adolescents aged 6 through 17, and CMS 161 covers the adult population aged 18 years and older.TBDAll patients aged 18 years and older with a diagnosis of major depressive disorder (MDD)Equals Initial PopulationNonePatients with a suicide risk assessment completed during the visit in which a new diagnosis or recurrent episode was identifiedNot ApplicableNoneNot ApplicableNot ApplicableNot ApplicableFor every patient evaluated by this measure also identify payer, race, ethnicity and sex.None - - \ No newline at end of file diff --git a/test/fixtures/hqmf/simplexml/CMS163v4_SimpleXML.xml b/test/fixtures/hqmf/simplexml/CMS163v4_SimpleXML.xml deleted file mode 100755 index e3a87e35..00000000 --- a/test/fixtures/hqmf/simplexml/CMS163v4_SimpleXML.xml +++ /dev/null @@ -1,19 +0,0 @@ -40280381-4cc2-8ffd-014c-d8450c9a0848Diabetes: Low Density Lipoprotein (LDL) ManagementDiab_LDL1630dac1dec-e011-493b-a281-7c28964872dd4.1.0000000010100001231National Committee for Quality AssuranceNational Committee for Quality AssurancePercentage of patients 18-75 years of age with diabetes whose LDL-C was adequately controlled (<100 mg/dL) during the measurement period.Physician Performance Measure (Measures) and related data specifications were developed by the National Committee for Quality Assurance (NCQA). - -The Measures are copyrighted but can be reproduced and distributed, without modification, for noncommercial purposes (eg, use by healthcare providers in connection with their practices). Commercial use is defined as the sale, licensing, or distribution of the Measures for commercial gain, or incorporation of the Measures into a product or service that is sold, licensed or distributed for commercial gain. Commercial use of the Measures requires a license agreement between the user and NCQA. NCQA is not responsible for any use of the Measures. - -(C) 2008-2015 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 CPT or other codes contained in the specifications. - -CPT(R) contained in the Measure specifications is copyright 2004-2014 American Medical Association. LOINC(R) copyright 2004-2014 Regenstrief Institute, Inc. This material contains SNOMED Clinical Terms(R) (SNOMED CT[R]) copyright 2004-2014 International Health Terminology Standards Development Organisation. ICD-10 copyright 2014 World Health Organization. All Rights Reserved.These performance Measures are not clinical guidelines and do not establish a standard of medical care, and have not been tested for all potential applications. - -THE MEASURES 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].ProportionOutcomeNoneNoneNoneDiabetes mellitus (diabetes) is a group of diseases characterized by high blood glucose levels caused by the body's inability to correctly produce or utilize the hormone insulin. It is recognized as a leading cause of death and disability in the U.S. and is highly underreported as a cause of death. Diabetes may cause life-threatening, life-ending or life-altering complications, including poor cholesterol, specifically lipoprotein (LDL). Clinical guidelines recommend lifestyle modifications that include reducing intake of saturated fat, trans fat and cholesterol; weight loss; and increased physical activity (American Diabetes Association 2009). Statin therapy is suggested for eligible patients whose levels are consistently and significantly higher (American Diabetes Association 2009).American Diabetes Association (2009): In most adult patients, measure fasting lipid profile at least annually. In adults with low-risk lipid values (LDL cholesterol < 100 mg/dl, HDL cholesterol > 50 mg/dl, and triglycerides < 150 mg/dl), lipid assessments may be repeated every 2 years. - -American Association of Clinical Endocrinologists (2007): Aggressive management of dyslipidemia in patients with diabetes mellitus is critical; treat patients to achieve the following goal: LDL-C < 100 mg/dL (< 70 mg/dL is recommended for patients with diabetes mellitus and coronary artery disease).Higher score indicates better qualityAmerican Diabetes Association. 2009. "Standards of Medical Care in Diabetes-2009." Diabetes Care 2009 32 (Suppl 1):S6-S12.American Association of Clinical Endocrinologists. 2007. "Medical Guidelines for Clinical Practice for the Management of Diabetes Mellitus." Endocr Pract 13(Suppl 1):4-68.NoneThe patient is not numerator compliant if the result for the most recent LDL-C test during the measurement period is >= 100 mg/dL, or is missing, or if an LDL-C test was not performed during the measurement period. - -Only patients with a diagnosis of Type 1 or Type 2 diabetes should be included in the denominator of this measure; patients with a diagnosis of secondary diabetes due to another condition should not be included.TBDPatients 18-75 years of age with diabetes with a visit during the measurement periodEquals Initial PopulationNonePatients whose most recent LDL-C level performed during the measurement period is <100 mg/dLNot ApplicableNoneNot ApplicableNot ApplicableNot ApplicableFor every patient evaluated by this measure also identify payer, race, ethnicity and sex.None - - \ No newline at end of file diff --git a/test/fixtures/hqmf/simplexml/CMS164v4_SimpleXML.xml b/test/fixtures/hqmf/simplexml/CMS164v4_SimpleXML.xml deleted file mode 100755 index 33999277..00000000 --- a/test/fixtures/hqmf/simplexml/CMS164v4_SimpleXML.xml +++ /dev/null @@ -1,31 +0,0 @@ -40280381-4b9a-3825-014b-c2899fcf08b9Ischemic Vascular Disease (IVD): Use of Aspirin or Another AntithromboticIVD_Aspirin1640713ea8f-0e5b-4099-8c7c-dd677280398f4.0.0000000010100001231National Committee for Quality AssuranceNational Committee for Quality AssuranceNational Quality ForumPercentage of patients 18 years of age and older who were discharged alive for acute myocardial infarction (AMI), coronary artery bypass graft (CABG) or percutaneous coronary interventions (PCI) in the 12 months prior to the measurement period, or who had an active diagnosis of ischemic vascular disease (IVD) during the measurement period, and who had documentation of use of aspirin or another antithrombotic during the measurement period.Physician Performance Measure (Measures) and related data specifications were developed by the National Committee for Quality Assurance (NCQA). - -The Measures are copyrighted but can be reproduced and distributed, without modification, for noncommercial purposes (eg, use by healthcare providers in connection with their practices). Commercial use is defined as the sale, licensing, or distribution of the Measures for commercial gain, or incorporation of the Measures into a product or service that is sold, licensed or distributed for commercial gain. Commercial use of the Measures requires a license agreement between the user and NCQA. NCQA is not responsible for any use of the Measures. - -(C) 2008-2015 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 CPT or other codes contained in the specifications. - -CPT(R) contained in the Measure specifications is copyright 2004-2014 American Medical Association. LOINC(R) copyright 2004-2014 Regenstrief Institute, Inc. This material contains SNOMED Clinical Terms(R) (SNOMED CT[R]) copyright 2004-2014 International Health Terminology Standards Development Organisation. ICD-10 copyright 2014 World Health Organization. All Rights Reserved.These performance Measures are not clinical guidelines and do not establish a standard of medical care, and have not been tested for all potential applications. - -THE MEASURES 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].ProportionProcessNoneNoneNoneCoronary heart disease (CHD) is a major cause of death in the United States - in 2004, it was an underlying or contributing cause of death for 451,300 people (1 of every 5 deaths). Acute myocardial infarction (AMI) was an underlying or contributing cause of death for 156,000 people (American Heart Association 2008). In addition, nearly 16 million people (or 7.3 percent of the American population) had CHD in 2005 (American Heart Association 2008). The cost of cardiovascular diseases and stroke in the United States for 2008 was estimated at $448.5 billion (American Heart Association 2008). This figure includes health expenditures (direct costs such as the cost of physicians and healthcare practitioners, hospital and nursing home services, medications, home health care and other medical durables) and lost productivity resulting from morbidity and mortality (indirect costs). AMI accounts for 18 percent of hospital discharges and 28 percent of deaths due to heart disease (National Heart, Lung, and Blood Institute 2000). Research has shown that costs associated with cardiovascular disease for hospitals are easily $156 billion (American Heart Association 2008). - -Aspirin treatments reduce MI in men (127 events per 100,000 person-years) and women (17 events per 100,000 person-years) (Grieving et al. 2008). While studies have shown warfarin to be more effective, aspirin is a safer, more convenient, and less expensive form of therapy (Patrono et al. 2004). Aspirin therapy has been shown to directly reduce the odds of cardiovascular events among men by 14 percent and among women by 12 percent (Berger et al. 2006). Aspirin use has been shown to reduce the number of strokes by 20 percent, MI by 30 percent, and other vascular events by 30 percent (Weisman and Graham 2002).U.S. Preventive Services Task Force (2009): -The U.S. Preventive Services Task Force (USPSTF) strongly recommends that clinicians discuss aspirin chemoprevention with adults who are at increased risk (5-year risk of greater than or equal to 3 percent) for coronary heart disease (CHD). Discussions with patients should address both the potential benefits and harms of aspirin therapy. - -The USPSTF found good evidence that aspirin decreases the incidence of coronary heart disease in adults who are at increased risk for heart disease. They also found good evidence that aspirin increases the incidence of gastrointestinal bleeding and fair evidence that aspirin increases the incidence of hemorrhagic strokes. The USPSTF concluded that the balance of benefits and harms is most favorable in patients at high risk of CHD (5-year risk of greater than or equal to 3 percent) but is also influenced by patient preferences. - -USPSTF encourages men age 45 to 79 years to use aspirin when the potential benefit of a reduction in myocardial infarctions outweighs the potential harm of an increase in gastrointestinal hemorrhage. They encourage women age 55 to 79 years to use aspirin when the potential benefit of a reduction in ischemic strokes outweighs the potential harm of an increase in gastrointestinal hemorrhage. - -American Diabetes Association (2008): -Use aspirin therapy (75-162 mg/day) as a primary prevention strategy in those with type 1 or 2 diabetes at increased cardiovascular risk, including those who are 40 years of age or who have additional risk factors (family history of CVD, hypertension, smoking, dyslipidemia, or albuminuria). - -American Heart Association/American Stroke Association (2008): -AHA/ASA: The use of aspirin is recommended for cardiovascular (including but not specific to stroke) prophylaxis among persons whose risk is sufficiently high for the benefits to outweigh the risks associated with treatment (a 10-year risk of cardiovascular events of 6% to 10%). - -American College of Clinical Pharmacy (2004): -For long-term treatment after PCI, the guideline developers recommend aspirin, 75 to 162 mg/day. For long-term treatment after PCI in patients who receive antithrombotic agents such as clopidogrel or warfarin, the guideline developers recommend lower-dose aspirin, 75 to 100 mg/day. For patients with ischemic stroke who are not receiving thrombolysis, the guideline developers recommend early aspirin therapy, 160 to 325 mg/day.Higher score indicates better qualityAmerican Diabetes Association. 2008. "Standards of Medical Care in Diabetes - 2008." Diabetes Care 31:S12-S54.U.S. Preventive Services Task Force. 2009. "Aspirin for the Prevention of Cardiovascular Disease." (December). http://www.ahrq.gov/clinic/uspstf/uspsasmi.htmNational Institutes of Health, National Heart, Lung, and Blood Institute. 2000. Morbidity and Mortality: 2000 Chart Book on Cardiovascular, Lung, and Blood Diseases. http://www.fda.gov/ohrms/dockets/dockets/01q0313/01q-0313-hcn0001-64-reference-50-vol3.pdfGrieving, J.P., E. Buskens, H. Koffijberg, A. Algra. 2008. "Cost-effectiveness of aspirin treatment in the primary prevention of cardiovascular disease events in subgroups based on age, sex, and varying cardiovascular risk." Circulation 117:2875-2883.Patrono, C., B. Coller, G.A. FitzGerald, J. Hirsh, G. Roth. 2004. "Platelet-Active Drugs: The relationships among dose, effectiveness, and side effects: the seventh ACCP Conference on antithrombotic and thrombolytic therapy." Chest 126:234-264.Berger, J.S., M.C. Roncaglioni, F. Avanzini, I. Pangrazzi, G. Tognoni, D.L. Brown. 2006. "Aspirin for the primary prevention of cardiovascular events in women and men: a sex-specific meta-analysis of randomized controlled trials." JAMA 296(4):306-314.Weisman, S.M., and D.Y. Graham. 2002. "Evaluation of the benefits and risks of low-dose aspirin in the secondary prevention of cardiovascular and cerebrovascular events." Arch Intern Med 162(19):2197-2202.American Heart Association. 2008. Heart Disease and Stroke Statistics - 2008 Update. Circulation 117:25-146. http://circ.ahajournals.org/content/117/4/e25.fullNoneOnly patients who were discharged alive for acute myocardial infarction (AMI), coronary artery bypass graft (CABG) or percutaneous coronary interventions (PCI) should be included in the measure.TBDPatients 18 years of age and older with a visit during the measurement period, and an active diagnosis of ischemic vascular disease (IVD) or who were discharged alive for acute myocardial infarction (AMI), coronary artery bypass graft (CABG) or percutaneous coronary interventions (PCI) in the 12 months prior to the measurement periodEquals Initial PopulationNot ApplicablePatients who have documentation of use of aspirin or another antithrombotic during the measurement periodNot ApplicableNoneNot ApplicableNot ApplicableNot ApplicableFor every patient evaluated by this measure also identify payer, race, ethnicity and sexNone - - \ No newline at end of file diff --git a/test/fixtures/hqmf/simplexml/CMS165v4_SimpleXML.xml b/test/fixtures/hqmf/simplexml/CMS165v4_SimpleXML.xml deleted file mode 100755 index 49e0a156..00000000 --- a/test/fixtures/hqmf/simplexml/CMS165v4_SimpleXML.xml +++ /dev/null @@ -1,23 +0,0 @@ -40280381-4b9a-3825-014b-c290abf408caControlling High Blood PressureHigh_Blood_Press165abdc37cc-bac6-4156-9b91-d1be2c8b72684.0.0000000010100001231National Committee for Quality AssuranceNational Committee for Quality AssuranceNational Quality ForumPercentage of patients 18-85 years of age who had a diagnosis of hypertension and whose blood pressure was adequately controlled (<140/90mmHg) during the measurement period.Physician Performance Measure (Measures) and related data specifications were developed by the National Committee for Quality Assurance (NCQA). - -The Measures are copyrighted but can be reproduced and distributed, without modification, for noncommercial purposes (eg, use by healthcare providers in connection with their practices). Commercial use is defined as the sale, licensing, or distribution of the Measures for commercial gain, or incorporation of the Measures into a product or service that is sold, licensed or distributed for commercial gain. Commercial use of the Measures requires a license agreement between the user and NCQA. NCQA is not responsible for any use of the Measures. - -(c) 2008-2015 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 CPT or other codes contained in the specifications. - -CPT(R) contained in the Measure specifications is copyright 2004-2014 American Medical Association. LOINC(R) copyright 2004-2014 Regenstrief Institute, Inc. This material contains SNOMED Clinical Terms(R) (SNOMED CT[R]) copyright 2004-2014 International Health Terminology Standards Development Organisation. ICD-10 copyright 2014 World Health Organization. All Rights Reserved.These performance Measures are not clinical guidelines and do not establish a standard of medical care, and have not been tested for all potential applications. - -THE MEASURES 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].ProportionProcessNoneNoneNoneHypertension is a very significant health issue in the United States. Fifty million or more Americans have high blood pressure that warrants treatment, according to the National Health and Nutrition Examination Survey (NHANES) survey (Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure 2003). The United States Preventive Services Task Force (USPSTF) recommends that clinicians screen adults aged 18 and older for high blood pressure (United States Preventive Services Task Force 2007). - -The most frequent and serious complications of uncontrolled hypertension include coronary heart disease, congestive heart failure, stroke, ruptured aortic aneurysm, renal disease, and retinopathy. The increased risks of hypertension are present in individuals ranging from 40 to 89 years of age. For every 20 mmHg systolic or 10 mmHg diastolic increase in blood pressure, there is a doubling of mortality from both ischemic heart disease and stroke (Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure 2003). - -Better control of blood pressure has been shown to significantly reduce the probability that these undesirable and costly outcomes will occur. The relationship between the measure (control of hypertension) and the long-term clinical outcomes listed is well established. In clinical trials, antihypertensive therapy has been associated with reductions in stroke incidence (35-40 percent), myocardial infarction incidence (20-25 percent) and heart failure incidence (>50 percent) (Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure 2003).The United States Preventive Services Task Force (2007) recommends screening for high blood pressure in adults age 18 years and older. This is a grade A recommendation. - -Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure (2003): Treating systolic blood pressure and diastolic blood pressure to targets that are <140/90 mmHg is associated with a decrease in cardiovascular disease complications.Higher score indicates better qualityU.S. Preventive Services Task Force. 2007. "Screening for high blood pressure: U.S. Preventive Services Task Force reaffirmation recommendation statement." Ann Intern Med 147(11):783-6.Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure. 2003. "Prevention, Detection, Evaluation, and Treatment of High Blood Pressure. The Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure." NIH Publication No. 035233.NoneIn reference to the numerator element, only blood pressure readings performed by a clinician in the provider office are acceptable for numerator compliance with this measure. Blood pressure readings from the patient's home (including readings directly from monitoring devices) are not acceptable. - -If no blood pressure is recorded during the measurement period, the patient's blood pressure is assumed "not controlled."NonePatients 18-85 years of age who had a diagnosis of essential hypertension within the first six months of the measurement period or any time prior to the measurement periodEquals Initial PopulationPatients with evidence of end stage renal disease (ESRD), dialysis or renal transplant before or during the measurement period. Also exclude patients with a diagnosis of pregnancy during the measurement period.Patients whose blood pressure at the most recent visit is adequately controlled (systolic blood pressure < 140 mmHg and diastolic blood pressure < 90 mmHg) during the measurement period.Not ApplicableNoneNot ApplicableNot ApplicableNot ApplicableFor every patient evaluated by this measure also identify payer, race, ethnicity and sex.None - - \ No newline at end of file diff --git a/test/fixtures/hqmf/simplexml/CMS166v5_SimpleXML.xml b/test/fixtures/hqmf/simplexml/CMS166v5_SimpleXML.xml deleted file mode 100755 index 593e0733..00000000 --- a/test/fixtures/hqmf/simplexml/CMS166v5_SimpleXML.xml +++ /dev/null @@ -1,31 +0,0 @@ -40280381-4b9a-3825-014b-e07d028011c2Use of Imaging Studies for Low Back PainLow_Back_Pain166b6016b47-b65d-4be0-866f-1d397886ca895.0.0000000010100001231National Committee for Quality AssuranceNational Committee for Quality AssuranceNational Quality ForumPercentage of patients 18-50 years of age with a diagnosis of low back pain who did not have an imaging study (plain X-ray, MRI, CT scan) within 28 days of the diagnosis.Physician Performance Measure (Measures) and related data specifications were developed by the National Committee for Quality Assurance (NCQA). - -The Measures are copyrighted but can be reproduced and distributed, without modification, for noncommercial purposes (eg, use by healthcare providers in connection with their practices). Commercial use is defined as the sale, licensing, or distribution of the Measures for commercial gain, or incorporation of the Measures into a product or service that is sold, licensed or distributed for commercial gain. Commercial use of the Measures requires a license agreement between the user and NCQA. NCQA is not responsible for any use of the Measures. - -(C) 2008-2015 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 CPT or other codes contained in the specifications. - -CPT(R) contained in the Measure specifications is copyright 2004-2014 American Medical Association. LOINC(R) copyright 2004-2014 Regenstrief Institute, Inc. This material contains SNOMED Clinical Terms(R) (SNOMED CT[R]) copyright 2004-2014 International Health Terminology Standards Development Organisation. ICD-10 copyright 2014 World Health Organization. All Rights Reserved.These performance Measures are not clinical guidelines and do not establish a standard of medical care, and have not been tested for all potential applications. - -THE MEASURES 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].ProportionProcessNoneNoneNoneLow back pain is a pervasive problem that affects three quarters of adults at some time in their lives (Chou, 2012). It ranks among the top ten reasons for patient visits to internists and is the most common and expensive reason for work disability in the U.S. Low back pain is second only to upper respiratory problems as a symptom-related reason for visits to a physician (Jarvik and Deyo 2002). - -Each year in the United States low back pain is experienced by 25 to 50 percent of adults, making it one of the most common reasons for seeking health care services (Haldeman, 2008). Low back pain results in high indirect costs from disability, lost time from work, and decreased productivity while at work, and is the number one cause for activity limitations in younger adults (Chou, 2012). The costs associated with health care services for spine pain (primarily low back pain) in the U.S. increased from $45.9 billion in 1997 to $102.6 billion in 2004 (Martin, 2008).American College of Physicians and the American Pain Society (Chou et al. 2007) - -Clinicians should not routinely obtain imaging or other diagnostic tests in patients with nonspecific low back pain (strong recommendation, moderate-quality evidence). - -Institute for Clinical Systems Improvement (2012) - -Clinicians should not recommend imaging (including computed tomography [CT], magnetic resonance imaging [MRI] and x-ray) for patients with non-specific low back pain (Strong Recommendation, Moderate Quality Evidence). - -* Low back pain assessment should include a subjective pain rating, functional status, patient history including notation of presence or absence of "red flags," psychosocial indicators, assessment of prior treatment and response, employment status, and clinician's objective assessment. -* Reduce or eliminate imaging for diagnosis of non-specific low back pain in patients 18 years and older. -* First-line treatment should emphasize patient education and a core treatment plan, that includes encouraging activity, use of heat, no imaging, cautious and responsible use of opioids, anti-inflammatory and analgesic over-the-counter medications and return to work assessment. -* Patients with acute or subacute low back pain should be advised to stay active and continue ordinary daily activity as tolerated. -* Use opioids cautiously and responsibly in the presence of acute or subacute low back pain.Higher score indicates better qualityChou, R., A. Qaseem, V. Snow, D. Casey, J.T. Cross Jr., P. Shekelle, D.K. Owens, and the Clinical Efficacy Assessment Subcommittee of the American College of Physicians and the American College of Physicians/American Pain Society Low Back Pain Guidelines Panel. 2007. "Diagnosis and treatment of low back pain: A joint clinical practice guideline from the American College of Physicians and the American Pain Society." Ann Intern Med 147(7):478-491.Chou R, et al. Radiologic Clinics of North America. Appropriate Use of Lumbar Imaging for Evaluation of Low Back Pain. 2012 Jul, Vol. 50, No. 4: 569-85.Haldeman S, Dagenais S. A supermarket approach to the evidence informed management of chronic low back pain. Spine J 2008;8: 1-7.Institute for Clinical Systems Improvement. 2012. "Health Care Guideline: Adult Low Back Pain" Bloomington: Institute for Clinical Systems Improvement.Jarvik, J.G., and R.A. Deyo. 2002. "Diagnostic evaluation of low back pain with emphasis on imaging." Ann Intern Med 137:586-597.Martin BI, Deyo RA, Mirza SK, et al. Expenditures and health status among adults with back and neck problems. JAMA 2008;299: 656-64.This measure applies to the first episode of low back pain during the measurement period.The outpatient or emergency department visit in the Initial Patient Population needs to occur during the first 337 days of the measurement period (337 days allows 28 days for the numerator event). This visit must be the first visit for low back pain during the measurement period.TBDPatients 18-50 years of age with a diagnosis of low back pain during an outpatient or emergency department visitEquals Initial PopulationExclude patients with a diagnosis of cancer any time in their history or patients with a diagnosis of recent trauma, IV drug abuse, or neurologic impairment during the 12-month period prior to through the 28 days after the outpatient or emergency department visit. - -Exclude patients with a diagnosis of low back pain within the 180 days prior to the outpatient or emergency department visit.Patients without an imaging study conducted on the date of the outpatient or emergency department visit or in the 28 days following the outpatient or emergency department visitNot ApplicableNoneNot ApplicableNot ApplicableNot ApplicableFor every patient evaluated by this measure also identify payer, race, ethnicity and sex.None - - \ No newline at end of file diff --git a/test/fixtures/hqmf/simplexml/CMS167v4_SimpleXML.xml b/test/fixtures/hqmf/simplexml/CMS167v4_SimpleXML.xml deleted file mode 100755 index 09ec0097..00000000 --- a/test/fixtures/hqmf/simplexml/CMS167v4_SimpleXML.xml +++ /dev/null @@ -1,20 +0,0 @@ -40280381-4c18-79df-014c-20a0e46900c0Diabetic Retinopathy: Documentation of Presence or Absence of Macular Edema and Level of Severity of RetinopathyDiab_Retin_Mac_Edema16750164228-9d64-4efc-af67-da0547ff61f14.0.0000000010100001231American Medical Association-convened Physician Consortium for Performance Improvement(R) (AMA-PCPI)American Medical Association-convened Physician Consortium for Performance Improvement(R) (AMA-PCPI)National Quality ForumPercentage of patients aged 18 years and older with a diagnosis of diabetic retinopathy who had a dilated macular or fundus exam performed which included documentation of the level of severity of retinopathy and the presence or absence of macular edema during one or more office visits within 12 monthsCopyright 2014 American Medical Association. All Rights Reserved.Physician Performance Measures (Measures) and related data specifications have been developed by the American Medical Association (AMA) - convened Physician Consortium for Performance Improvement(R) (PCPI[R]). These Measures are not clinical guidelines and do not establish a standard of medical care, and have not been tested for all potential applications. The Measures, while copyrighted, can be reproduced and distributed, without modification, for noncommercial purposes, eg, use by health care providers in connection with their practices. Commercial use is defined as the sale, license, or distribution of the Measures for commercial gain, or incorporation of the Measures into a product or service that is sold, licensed or distributed for commercial gain. Commercial uses of the Measures require a license agreement between the user and the AMA (on behalf of the PCPI). Neither the AMA, PCPI, nor its members shall be responsible for any use of the Measures. - -The National Committee for Quality Assurance's significant past efforts and contributions to the development and updating of the Measures is acknowledged. - -THE MEASURES AND SPECIFICATIONS ARE PROVIDED "AS IS" WITHOUT WARRANTY OF ANY KIND. - -Limited proprietary coding is contained in the Measure specifications for convenience. Users of the proprietary code sets should obtain all necessary licenses from the owners of these code sets. The AMA, PCPI, and its members disclaim all liability for use or accuracy of any Current Procedural Terminology (CPT[R]) or other coding contained in the specifications. - -CPT(R) contained in the Measure specifications is copyright 2004-2014 American Medical Association. LOINC(R) copyright 2004-2014 Regenstrief Institute, Inc. This material contains SNOMED Clinical Terms(R) (SNOMED CT[R]) copyright 2004-2014 International Health Terminology Standards Development Organisation. ICD-10 copyright 2014 World Health Organization. All Rights Reserved. - -Due to technical limitations, registered trademarks are indicated by (R) or [R].ProportionProcessNoneNoneNoneDiabetic retinopathy is a leading cause of new cases of legal blindness among working-age Americans and represents a leading cause of blindness in this age group worldwide. (Klein, 2007). In 2005-2008, the estimated prevalence of diabetic retinopathy and vision-threatening diabetic retinopathy was 28.5 percent among persons with diabetes aged 40 years and older (Zhang, 2010). Approximately 1.5% of adults with diabetes had proliferative diabetic retinopathy and 2.7% had clinically significant macular edema (Zhang, 2010). - -Several level 1 RCT studies demonstrate the ability of timely treatment to reduce the rate and severity of vision loss from diabetes (Diabetic Retinopathy Study -- DRS, Early Treatment Diabetic Retinopathy Study -- ETDRS). Necessary examination prerequisites to applying the study results are that the presence and severity of both peripheral diabetic retinopathy and macular edema be accurately documented. In the RAND chronic disease quality project, while administrative data indicated that roughly half of the patients had an eye exam in the recommended time period, chart review data indicated that only 19% had documented evidence of a dilated examination (McGlynn, 2003). Thus, ensuring timely treatment that could prevent 95% of the blindness due to diabetes requires the performance and documentation of key examination parameters. The documented level of severity of retinopathy and the documented presence or absence of macular edema assists with the on-going plan of care for the patient with diabetic retinopathy.Because treatment is effective in reducing the risk of visual loss, detailed examination is indicated to assess for the following features that often lead to visual impairment: presence of macular edema, optic nerve neovascularization and/or neovascularization elsewhere, signs of severe NPDR (extensive retinal hemorrhages/microaneurysms, venous beading, and IRMA), and vitreous or preretinal hemorrhage. (Good evidence; Strong recommendation) (AAO, 2014)Higher score indicates better qualityAmerican Academy of Ophthalmology Retina/Vitreous Panel. Preferred Practice Pattern Guidelines. Diabetic Retinopathy. San Francisco, CA: American Academy of Ophthalmology; 2014.Klein BE. Overview of epidemiologic studies of diabetic retinopathy. Ophthalmic Epidemiol. 2007;14:179-83. Zhang X, Saaddine JB, Chou CF, et al. Prevalence of diabetic retinopathy in the United States, 2005-2008. JAMA. 2010;304:649-56. McGlynn EA, Asch SM, Adams J, Keesey J, Hicks J, DeCristofaro A, Kerr EA. The quality of health care delivered to adults in the United States. N Engl J Med. 2003;348(26):2635-45.Documentation - The medical record must include: documentation of the level of severity of retinopathy AND documentation of whether macular edema was present or absent - -Macular Edema - Acceptable synonyms for macular edema include: macular thickening, intraretinal thickening, serous detachment of the retina, or pigment epithelial detachment - -Severity of Retinopathy - Mild nonproliferative, moderate nonproliferative, severe nonproliferative, very severe nonproliferative, proliferativeThe measure, as written, does not specifically require documentation of laterality. Coding limitations in particular clinical terminologies do not currently allow for that level of specificity (ICD-10-CM includes laterality, but ICD-9-CM and SNOMED-CT do not uniformly include this distinction). Therefore, at this time, it is not a requirement of this measure to indicate laterality of the diagnoses, findings or procedures. Available coding to capture the data elements specified in this measure has been provided. It is assumed that the eligible professional will record laterality in the patient medical record, as quality care and clinical documentation should include laterality.TBDAll patients aged 18 years and older with a diagnosis of diabetic retinopathyEquals Initial PopulationNonePatients who had a dilated macular or fundus exam performed which included documentation of the level of severity of retinopathy AND the presence or absence of macular edema during one or more office visits within 12 monthsNot ApplicableDocumentation of medical reason(s) for not performing a dilated macular or fundus examination -Documentation of patient reason(s) for not performing a dilated macular or fundus examinationNot ApplicableNot ApplicableNot ApplicableFor every patient evaluated by this measure also identify payer, race, ethnicity and sex.None - - \ No newline at end of file diff --git a/test/fixtures/hqmf/simplexml/CMS169v4_SimpleXML.xml b/test/fixtures/hqmf/simplexml/CMS169v4_SimpleXML.xml deleted file mode 100755 index 57fbc36c..00000000 --- a/test/fixtures/hqmf/simplexml/CMS169v4_SimpleXML.xml +++ /dev/null @@ -1,11 +0,0 @@ -40280381-4cc2-8ffd-014c-d841bbd9082dBipolar Disorder and Major Depression: Appraisal for alcohol or chemical substance useNQF0110169b99aaef6-7889-4aba-85fc-5a2b739dd0984.1.0000000010100001231Centers for Medicare & Medicaid Services (CMS)Center for Quality Assessment & Improvement in Mental Health (CQAIMH)Percentage of patients with depression or bipolar disorder with evidence of an initial assessment that includes an appraisal for alcohol or chemical substance use.This measure is copyrighted by CQAIMH. It may be used for research, teaching, and quality measurement / improvement activities - provided the following: -* The materials are not sold, distributed or licensed for commercial purposes -* CQAIMH's copyright is acknowledged in reproductions of these materials -* Modifications to the materials are not made without CQAIMH's permissionThis measure is an initial eSpecification of the endorsed measure, and has not been field tested. CMS has contracted with Mathematica Policy Research and its subcontractors, Lantana and Telligen, for the continued maintenance of this electronic measure.ProportionProcessNoneNoneNoneIndividuals with bipolar disorder or major depression have high rates of co-morbid substance abuse and should be screened for substance use disorders. Between 40-70% of people with bipolar disorder have a history of substance use disorder. A current or past co-morbid substance use disorder may lead to worse outcomes for bipolar disorders, including more symptoms, more suicide attempts, longer episodes and lower quality of life. Substance abuse may obscure or exacerbate mood swings that have no other apparent external cause. Substance abuse may also precipitate mood episodes or be used by patients to self-treat in an attempt to improve the symptoms of episodes. Patients suffering from major depressive disorder with co-morbid addiction are more likely to require hospitalization, more likely to attempt suicide and less likely to comply with treatment than are patients with these disorders of similar severity not complicated by these factors.Perform a diagnostic evaluation to assess the presence of an alcohol or substance use disorder or other factors that may contribute to the disease process or complicate its treatment. A complete diagnosis of depression should address history of substance use and treatment for substance use disorders.Higher score indicates better qualityOstacher, MJ; Sachs, GS, Update on Bipolar Disorder and Substance Abuse: Recent Findings and Treatment Strategies, J Clin Psychiatry 2006; 67[9]:e10 - - -Regier DA, Farmer ME, Rae DS, et al. Comorbidity of mental disorders with alcohol and other drug abuse: results from the Epidemiologic Catchment Area (ECA) Study, JAMA 1990; 264:2511-1518American Psychiatric Association, Practice Guideline for the Treatment of Patients with Bipolar Disorder, Am J Psychiatry 159: 4, April 2002 SupplementAmerican Psychiatric Association, Practice Guideline for the Treatment of Patients with Major Depressive Disorder (2000)NoneThe intent of the measure is that the assessment be performed for a single episode for each patient. Due to current limitations of the eMeasure specification system, it is possible for there to be up to two treatment episodes per patient, identified through up to two index episodes. As a result, the numerator criteria of this measure can be satisfied if a substance use assessment is performed within either treatment episode. Future versions of the measure should address this issue.TBDPatients 18 years of age or older at the start of the measurement period with a new diagnosis of unipolar depression or bipolar disorder during the first 323 days of the measurement period, and evidence of treatment for unipolar depression or bipolar disorder within 42 days of diagnosis. The existence of a 'new diagnosis' is established by the absence of diagnoses and treatments of unipolar depression or bipolar disorder during the 180 days prior to the diagnosis.Equals Initial PopulationNonePatients in the denominator with evidence of an assessment for alcohol or other substance use following or concurrent with the new diagnosis, and prior to or concurrent with the initiation of treatment for that diagnosis. - -(Note: the endorsed measure calls for the assessment to be performed prior to discussion of the treatment plan with the patient, but the current approach was considered more feasible in an EHR setting. The "Assessment for Alcohol or Other Drug Use" required in the numerator is meant to capture a provider's assessment of the patient's symptoms of substance use. The essence of the measure is to avoid treating the patient for unipolar depression or bipolar disorder without an assessment of their use of alcohol or other drugs.)NoneNoneNot ApplicableNot ApplicableNot ApplicableFor every patient evaluated by this measure also identify payer, race, ethnicity, and sex.None - - \ No newline at end of file diff --git a/test/fixtures/hqmf/simplexml/CMS171v5_SimpleXML.xml b/test/fixtures/hqmf/simplexml/CMS171v5_SimpleXML.xml deleted file mode 100755 index 1e4bfdf9..00000000 --- a/test/fixtures/hqmf/simplexml/CMS171v5_SimpleXML.xml +++ /dev/null @@ -1,29 +0,0 @@ -40280381-4de7-db4d-014d-e8631eb001afProphylactic Antibiotic Received Within One Hour Prior to Surgical IncisionSCIP Prophylactic Antibiotic 1 H171d09add1d-30f5-462d-b677-3d17d9ccd6645.1.0000000010100001231Centers for Medicare & Medicaid Services (CMS)Oklahoma Foundation for Medical QualityNational Quality ForumSurgical patients with prophylactic antibiotics initiated within one hour prior to surgical incision. Patients who received vancomycin or a fluoroquinolone for prophylactic antibiotics should have the antibiotics initiated within two hours prior to surgical incision. Due to the longer infusion time required for vancomycin or a fluoroquinolone, it is acceptable to start these antibiotics within two hours prior to incision time.Measure specifications are in the Public Domain. - -LOINC(R) is a registered trademark of the Regenstrief Institute. - -This material contains SNOMED Clinical Terms (R) (SNOMED CT(C)) copyright 2004-2014 International Health Terminology Standards Development Organization. All rights reserved.These performance measures are not clinical guidelines and do not establish a standard of medical care, and have not been tested for all potential applications. The measures and specifications are provided without warranty. CMS has contracted with Mathematica Policy Research and its subcontractors, Lantana and Telligen, for the continued maintenance of this electronic measure.ProportionProcessNoneNoneNoneA goal of prophylaxis with antibiotics is to establish bactericidal tissue and serum levels at the time of skin incision. Studies performed in the 1960's and 1970's demonstrated that a common reason for failure of prophylaxis was delay of antibiotic administration until after the operation. In a study of 2,847 surgery patients at LDS Hospital in Salt Lake City, it was found that the lowest incidence of post-operative infection was associated with antibiotic administration during the one hour prior to surgery. The risk of infection increased progressively with greater time intervals between administration and skin incision. This relationship was observed whether antibiotics preceded or followed skin incision (Classen 1993). Opportunities to improve care have been demonstrated and timely administration has been recommended. For example, at LDS Hospital, administration of the first antibiotic dose "on call" to the operating room was frequently associated with timing errors. Altering the system there resulted in an increase in appropriate timing from 40% of cases in 1985 to 99% of cases in 1998.NoneImprovement noted as an increase in rateBratzler DW, Houck PM, for the Surgical Infection Prevention Guidelines Writers Group. Antimicrobial prophylaxis for surgery: An advisory statement from the National Surgical Infection Prevention Project. CID. 2004:38(15 June):1706-1715. -Mangram AJ, Horan TC, Pearson ML, et al. Guidelines for prevention of surgical site infection, 1999. Infect Control Hosp Epidemiol. 1999;20:247-280. -Silver A, Eichorn A, Kral J, et al. Timeliness and use of antibiotic prophylaxis in selected inpatient surgical procedures. Am J Surg. 1996;171:548-552. -Larsen RA, Evans RS, Burke JP, et al. Improved perioperative antibiotic use and reduced surgical wound infections through use of computer decision analysis. Infect Control Hosp Epidemiol. 1989;10:316-320. -Finkelstein R, Reinhertz G, Embom A. Surveillance of the use of antibiotic prophylaxis in surgery. Isr J Med Sci. 1996;32:1093-1097. -Matuschka PR, Cheadle WG, Burke JD, et al. A new standard of care: administration of preoperative antibiotics in the operating room. Am Surg. 1997;63:500-503. -Gorecki P, Schein M, Rucinski JC, et al. Antibiotic administration in patients undergoing common surgical procedures in a community teaching hospital: the chaos continues. World J Surg. 1999;23:429-432. -Bernard HR, Cole WR. The prophylaxis of surgical infections: the effect of prophylactic antimicrobial drugs on the incidence of infection following potentially contaminated operations. Surgery. 1964;56:151-157. -Polk HC, Lopez-Mayor JF. Postoperative wound infection: a prospective study of determinant factors and prevention. Surgery. 1969;66:97-103. -Stone HH, Hooper CA, Kolb LD, et al. Antibiotic prophylaxis in gastric, biliary, and colonic surgery. Ann Surg. 1976;184:443-452. -American College of Obstetricians and Gynecologists (ACOG) Committee on Practice Bulletins ACOG Practice Bulletin No 104 Antibiotic prophylaxis for gynecologic procedures. Obstet Gynecol May 2009; 113(5) : 1180-1189. -NoneThe measurement period is one calendar year but the reporting period is 3 months as a calendar quarter; Q1 = Jan - Mar, Q2 = Apr - Jun, Q3 = Jul - Sep, Q4 = Oct - Dec.TBDAll hospital discharges for selective surgery with hospital stays <= 120 days during the measurement year for patients age 18 and older at the time of hospital admission with no evidence of prior infectionDenominator(s): All selected surgical patients 18 years of age and older with no evidence of prior infection with a Principal Procedure Code of selected surgeries. -Denominator for population 1 - Coronary artery bypass graft (CABG) procedures -Denominator for population 2 - Other cardiac surgery -Denominator for population 3 - Hip arthroplasty -Denominator for population 4 - Knee arthroplasty -Denominator for population 5 - Colon surgery -Denominator for population 6 - Abdominal hysterectomy -Denominator for population 7 - Vaginal hysterectomy -Denominator for population 8 - Vascular surgery* Patients who had a hysterectomy and a caesarean section performed during this hospitalization -* Patients who had a principal diagnosis suggestive of preoperative infectious diseases -* Patients with physician/advanced practice nurse/physician assistant (physician/APN/PA) documented infection prior to surgical procedure of interest -* Patients who had other procedures requiring general or spinal anesthesia that occurred within 3 days (4 days for CABG or Other Cardiac Surgery) prior to or after the procedure of interest (during separate surgical episodes) during this hospital stayNumber of surgical patients with prophylactic antibiotics initiated within one hour prior to surgical incision (two hours if receiving vancomycin or a fluoroquinolone).Not applicableNoneNot applicableNot applicableNot applicableFor every patient evaluated by this measure also identify payer, race, ethnicity, and sex.Surgical Care Improvement Project - - \ No newline at end of file diff --git a/test/fixtures/hqmf/simplexml/CMS172v5_SimpleXML.xml b/test/fixtures/hqmf/simplexml/CMS172v5_SimpleXML.xml deleted file mode 100755 index bf87ea6e..00000000 --- a/test/fixtures/hqmf/simplexml/CMS172v5_SimpleXML.xml +++ /dev/null @@ -1,26 +0,0 @@ -40280381-4de7-db4d-014d-e88b72cf0211Prophylactic Antibiotic Selection for Surgical PatientsSCIP Antibiotic Selection172feea3922-f61f-4b05-98f9-b72a11815f125.1.0000000010100001231Centers for Medicare & Medicaid Services (CMS)Oklahoma Foundation for Medical QualityNational Quality ForumSurgical patients who received prophylactic antibiotics consistent with current guidelines (specific to each type of surgical procedure).Measure specifications are in the Public Domain - -LOINC(R) is a registered trademark of the Regenstrief Institute. - -This material contains SNOMED Clinical Terms (R) (SNOMED CT(C)) copyright 2004-2014 International Health Terminology Standards Development Organization. All rights reserved.These performance measures are not clinical guidelines and do not establish a standard of medical care, and have not been tested for all potential applications. The measures and specifications are provided without warranty. CMS has contracted with Mathematica Policy Research and its subcontractors, Lantana and Telligen, for the continued maintenance of this electronic measure.ProportionProcessNoneNoneNoneA goal of prophylaxis with antibiotics is to use an agent that is safe, cost-effective, and has a spectrum of action that covers most of the probable intraoperative contaminants for the operation. First or second-generation cephalosporins satisfy these criteria for most operations, although anaerobic coverage is needed for colon surgery. Vancomycin is not recommended for routine use because of the potential for development of antibiotic resistance, but is acceptable if a patient is allergic to beta-lactams, as are fluoroquinolones and clindamycin in selected situations.National guidelines recommend specific classes of antibiotics for surgical procedures. First or second-generation cephalosporins satisfy the criteria (safe, cost-effective, and coverage for most probable contaminants) for most operations, although anaerobic coverage is needed for colon surgery.Improvement noted as an increase in rateBratzler DW, Houck PM, for the Surgical Infection Prevention Guidelines Writers Group. Antimicrobial prophylaxis for surgery: An advisory statement from the National Surgical Infection Prevention Project. CID. 2004:38(15 June):1706-1715.Mangram AJ, Horan TC, Pearson ML, et al. Guidelines for prevention of surgical site infection, 1999. Infect Control Hosp Epidemiol. 1999;20:247-280.American Society of Health-System Pharmacists. ASHP therapeutic guidelines on antimicrobial prophylaxis in surgery. Am J Health Syst Pharm. 1999;56:1839-1888.No author listed. The Medical letter. Antimicrobial prophylaxis for Surgery. Med Lett Drugs Ther. 2009; 82: 47-52.Dellinger EP, Gross PA, Barrett TL, et al. Quality standard for antimicrobial prophylaxis in surgical procedures. Clin Infect Dis. 1994;18:422-427.Gilbert DN, Moellering RC Jr., Elipoulos GM, Chamber HF, Saag MS, eds. The Sanford Guide to Antimicrobial Therapy 2009. 39st ed. Sperryville, VA: Antimicrobial Therapy, Inc; 2009.Itani KMF, Wilson SE, Awad SS, Jensen EH, Finn TS, Abramson MA. Ertapenem versus cefotetan prophylaxis in elective colorectal surgery. N Engl J Med. 2006 Dec 21; 355 (25): 2640-2651.Page CP, Bohnen JM, Fletcher JR, et al. Antimicrobial prophylaxis for surgical wounds. Arch Surg. 1993;128:79-88.American College of Obstetricians and Gynecologists (ACOG) Committee on Practice Bulletins ACOG Practice Bulletin No 104 Antibiotic prophylaxis for gynecologic procedures. Obstet Gynecol May 2009; 113(5) : 1180-1189.Bratzler DW, Houck PM, for the Surgical Infection Prevention Guidelines Writers Group. Antimicrobial prophylaxis for surgery: An advisory statement from the National Surgical Infection Prevention Project. CID. 2004:38(15 June):1706-1715.NoneThe measurement period is one calendar year but the reporting period is 3 months as a calendar quarter; Q1 = Jan - Mar, Q2 = Apr - Jun, Q3 = Jul - Sep, Q4 = Oct - Dec. - -Numerator element guidance: -Vancomycin is acceptable for CABG, other cardiac procedures, hip arthroplasty, knee arthroplasty and vascular surgery if there is an increased MRSA rate facility-wide or operation-specific. For the purpose of using vancomycin for prophylaxis, it is expected that vancomycin is given ONLY if one of the allowable conditions is TRUE.TBDAll hospital discharges for selective surgery with hospital stays <= 120 days during the measurement year for patients age 18 and older at the time of hospital admissionInitial Population: -The measure is divided into 8 populations by type of surgery. Each denominator provides criteria for the types of surgery -Denominator for population 1 - Coronary artery bypass graft (CABG) procedures -Denominator for population 2 - Other cardiac surgery excluding CABG -Denominator for population 3 - Hip arthroplasty -Denominator for population 4 - Knee arthroplasty -Denominator for population 5 - Colon surgery -Denominator for population 6 - Abdominal hysterectomy -Denominator for population 7 - Vaginal hysterectomy -Denominator for population 8 - Vascular surgery*Patients who had a principal diagnosis suggestive of preoperative infectious diseases -*Patients who had any infection prior to anesthesia -*Patients who expired perioperatively -*Patients who received ONLY oral or intramuscular (IM) antibiotics or the route was unable to be determined during this inpatient stay -*Patients who received ALL antibiotics greater than 1440 minutes prior to anesthesia end date and time -*Patients who did not receive any antibiotics within the timeframe 1440 minutes before Surgical Incision Date and Time (i.e., patient did not receive prophylactic antibiotics) through discharge -*Patients who received antibiotics prior to arrival and did not receive any antibiotics during this hospitalization -*Patients who had other procedures requiring general or spinal anesthesia that occurred within 3 days (4 days for CABG or Other Cardiac Surgery) prior to or after the procedure of interest (during separate surgical episodes) during this hospital stay. This could also include implantation of pocketed devices.Number of surgical patients who received prophylactic antibiotics recommended for their specific surgical procedure.Not applicableNoneNot applicableNot applicableNot applicableFor every patient evaluated by this measure also identify payer, race, ethnicity, and sex.Surgical Care Improvement Project - - \ No newline at end of file diff --git a/test/fixtures/hqmf/simplexml/CMS177v4_SimpleXML.xml b/test/fixtures/hqmf/simplexml/CMS177v4_SimpleXML.xml deleted file mode 100755 index 5593d153..00000000 --- a/test/fixtures/hqmf/simplexml/CMS177v4_SimpleXML.xml +++ /dev/null @@ -1,28 +0,0 @@ -40280381-4c72-51df-014c-75b00a130105Child and Adolescent Major Depressive Disorder (MDD): Suicide Risk AssessmentCA MDD SRA177848d09de-7e6b-43c4-bedd-5a2957ccffe34.1.0000000010100001231American Medical Association-convened Physician Consortium for Performance Improvement(R) (AMA-PCPI)American Medical Association-convened Physician Consortium for Performance Improvement(R) (AMA-PCPI)National Quality ForumPercentage of patient visits for those patients aged 6 through 17 years with a -diagnosis of major depressive disorder with an assessment for suicide riskCopyright 2014 American Medical Association. All Rights Reserved.Physician Performance Measures (Measures) and related data specifications have been developed by the American Medical Association (AMA) - convened Physician Consortium for Performance Improvement(R) (PCPI[R]). These Measures are not clinical guidelines and do not establish a standard of medical care, and have not been tested for all potential applications. The Measures, while copyrighted, can be reproduced and distributed, without modification, for noncommercial purposes, eg, use by health care providers in connection with their practices. Commercial use is defined as the sale, license, or distribution of the Measures for commercial gain, or incorporation of the Measures into a product or service that is sold, licensed or distributed for commercial gain. Commercial uses of the Measures require a license agreement between the user and the AMA, (on behalf of the PCPI). Neither the AMA, PCPI nor its members shall be responsible for any use of the Measures. - -THE MEASURES AND SPECIFICATIONS ARE PROVIDED "AS IS" WITHOUT WARRANTY OF ANY KIND. - -Limited proprietary coding is contained in the Measure specifications for convenience. Users of the proprietary code sets should obtain all necessary licenses from the owners of these code sets. The AMA, the PCPI and its members disclaim all liability for use or accuracy of any Current Procedural Terminology (CPT[R]) or other coding contained in the specifications. - -CPT(R) contained in the Measure specifications is copyright 2004-2014 American Medical Association. LOINC(R) copyright 2004-2014 Regenstrief Institute, Inc. This material contains SNOMED Clinical Terms(R) (SNOMED CT[R]) copyright 2004-2014 International Health Terminology Standards Development Organisation. ICD-10 copyright 2014 World Health Organization. All Rights Reserved. - -Due to technical limitations, registered trademarks are indicated by (R) or [R].ProportionProcessNoneNoneNoneResearch has shown that patients with major depressive disorder are at a high risk for suicide, which makes this assessment an important aspect of care that should be assessed at each visit. According to a study analyzing the quality of health care in the United States, only about 25.8% of patients with depression had documentation of the presence or absence of suicidal ideation during the first or second diagnostic visit. 76.11% of those patients who have suicidality were asked if they have specific plans to carry out suicide. A 2003 study reviewed medical records to assess the degree to which providers adhered to depression guidelines in a VA primary care setting. Providers documented exploration for suicidal ideation in 57% of the records.The evaluation must include assessment for the presence of harm to self or others (MS). (AACAP) - -Suicidal behavior exists along a continuum from passive thoughts of death to a clearly developed plan and intent to carry out that plan. Because depression is closely associated with suicidal thoughts and behavior, it is imperative to evaluate these symptoms at the initial and subsequent assessments. For this purpose, low burden tools to track suicidal ideation and behavior such as the Columbia-Suicidal Severity Rating Scale can be used. Also, it is crucial to evaluate the risk (e.g., age, sex, stressors, comorbid conditions, hopelessness, impulsivity) and protective factors (e.g., religious belief, concern not to hurt family) that might influence the desire to attempt suicide. The risk for suicidal behavior increases if there is a history of suicide attempts, comorbid psychiatric disorders (e.g., disruptive disorders, substance abuse), impulsivity and aggression, availability of lethal agents (e.g., firearms), exposure to negative events (e.g., physical or sexual abuse, violence), and a family history of suicidal behavior. (AACAP) - -A careful and ongoing evaluation of suicide risk is necessary for all patients with major depressive disorder (Category I). Such an assessment includes specific inquiry about suicidal thoughts, intent, plans, means, and behaviors; identification of specific psychiatric symptoms (e.g., psychosis, severe anxiety, substance use) or general medical conditions that may increase the likelihood of acting on suicidal ideas; assessment of past and, particularly, recent suicidal behavior; delineation of current stressors and potential protective factors (e.g., positive reasons for living, strong social support); and identification of any family history of suicide or mental illness (Category I). (APA)Higher score indicates better qualityAmerican Academy of Child and Adolescent Psychiatry (AACAP). Practice parameters for the assessment and treatment of children and adolescents with depressive disorders. J. Am. Acad. Child Adolesc. Psychiatry, 2007; -46(11):1503-1526. Available at: -http://www.aacap.org/App_Themes/AACAP/docs/practice_parameters/depressive_disorders_practice_parameter.pdfGelenberg AJ, Freeman MP, Markowitz JC, et al; American Psychiatric Association Work Group on Major Depressive Disorder. Practice guideline for the treatment of patients with major depressive disorder. 3rd ed. http://www.psychiatryonline.com/pracGuide/pracGuideTopic_7.aspx. Published October 2010. Accessed November 24, 2010. -Zimmerman M, Galione J. Psychiatrists' and Nonpsychiatrist Physicians' Reported Use of the DSM-IV Criteria for Major Depressive Disorder. J Clin Psychiatry. 2010;71:235-238.Dobscha SK, Gerrity MS, Corson K, Bahr A, Cuilwik NM. Measuring adherence to depression treatment guidelines in a VA primary care clinic. Gen Hosp Psychiatry. 2003;25:230-7.McGlynn EA, Asch SM, Adams J, Keesey J, Hicks J, DeCristofaro A, Kerr EA. The quality of health care delivered to adults in the United States. New England Journal of Medicine. 2003;348(26):2635-2645.Numerator Definition: The specific type and magnitude of the suicide risk assessment is intended to be at the discretion of the individual clinician and should be specific to the needs of the patient. At a minimum, suicide risk assessment should evaluate: -1. Risk (eg, age, sex, stressors, comorbid conditions, hopelessness, impulsivity) and protective factors (eg, religious belief, concern not to hurt family) that may influence the desire to attempt suicide. -2. Current severity of suicidality. -3. Most severe point of suicidality in episode and lifetime. - -Low burden tools to track suicidal ideation and behavior such as the Columbia-Suicidal Severity Rating Scale can also be used.A suicide risk assessment should be performed at every visit for major depressive disorder during the measurement period. - -This measure is an episode-of-care measure; the level of analysis for this measure is every visit for major depressive disorder during the measurement period. For example, at every visit for MDD, the patient should have a suicide risk assessment. - -Use of a standardized tool or instrument to assess suicide risk will meet numerator performance. Standardized tools can be mapped to the concept "Intervention, Performed: Suicide Risk Assessment" included in the numerator logic below.TBDAll patient visits for those patients aged 6 through 17 years with a diagnosis of major depressive disorderEquals Initial PopulationNonePatient visits with an assessment for suicide riskNot ApplicableNoneNot ApplicableNot ApplicableNot ApplicableFor every patient evaluated by this measure also identify payer, race, ethnicity and sex.None - - \ No newline at end of file diff --git a/test/fixtures/hqmf/simplexml/CMS178v5_SimpleXML.xml b/test/fixtures/hqmf/simplexml/CMS178v5_SimpleXML.xml deleted file mode 100755 index d6d7d0d4..00000000 --- a/test/fixtures/hqmf/simplexml/CMS178v5_SimpleXML.xml +++ /dev/null @@ -1,20 +0,0 @@ -40280381-4c18-79df-014c-284cd800045bUrinary catheter removed on Postoperative Day 1 (POD 1) or Postoperative Day 2 (POD 2) with day of surgery being day zeroUrinary catheter removed postop178d78ce034-8288-4012-a31e-7f485a74f2a95.0.0000000010100001231Centers for Medicare & Medicaid Services (CMS)Oklahoma Foundation for Medical QualityNational Quality ForumSurgical patients with urinary catheter removed on Postoperative Day 1 or Postoperative Day 2 with day of surgery being day zero.Measure specifications are in the Public Domain - -LOINC(R) is a registered trademark of the Regenstrief Institute. - -This material contains SNOMED Clinical Terms (R) (SNOMED CT(C)) copyright 2004-2014 International Health Terminology Standards Development Organization. All rights reserved.These performance measures are not clinical guidelines and do not establish a standard of medical care, and have not been tested for all potential applications. The measures and specifications are provided without warranty. CMS has contracted with Mathematica Policy Research and its subcontractors, Lantana and Telligen, for the continued maintenance of this electronic measure.ProportionProcessNoneNoneNoneIt is well-established that the risk of catheter-associated urinary tract infection (UTI) increases with increasing duration of indwelling urinary catheterization. In 2000, Saint reported the results of a pooled analysis of 10 prospective trials dating from 1983 to 1995 which estimated that bacteriuria will develop in 26% of patients after 2 to 10 days of catheterization (95% CI 23-25%). Additional pooled analyses demonstrated that 24% (95% CI 16% to 32%) of those patients will develop symptomatic UTI and bacteremia will develop in 3.6%. Among surgical patients, two studies of postoperative patients discharged to subacute care with urinary catheters were more likely to be readmitted to the hospital with a UTI compared with those who had catheters removed prior to hospital discharges (Wald, 2005 and Wald, 2008). Among selected major surgical patients in the Surgical Infection Project (SIP) cohort, Wald demonstrated (in press) that 85% had perioperative indwelling catheters placed and half of those patients had catheters for greater than 2 days postoperatively. These patients were twice as likely to develop UTIs prior to hospital discharge. On multivariate analysis, those who had indwelling bladder catheters for more than 2 days postoperatively were 21% more likely to develop UTI, significantly less likely to be discharged to home, and had a significant increase in mortality at 30 days. Additional analyses suggest that there is sizeable variation in the duration of postoperative catheterization among hospitals and that hospital factors may account for this variation. In 2006, Stephan reported the results of a multifaceted intervention study in orthopedic surgery patients in which protocols limiting the use and duration of postoperative catheterization played a large role. They reported a resultant 60% reduction in UTI incidence-density.Minimizing the duration of indwelling urinary catheterization can reduce the risk of catheter-associated urinary tract infection.Improvement noted as an increase in rate.Saint S. Clinical and economic consequences of nosocomial catheter-related bacteremia. Am J Infect Control 2000; 28: 68-75.Stephan F, Sax H, Wachsmuth M, et al. Reduction of urinary tract infection and antibiotic use after surgery: a controlled, prospective before-after study. Clin Infect Dis. 2006; 42; 1544.Wald HL, Ma A, Bratzler DW, Kramer AM. Indwelling Urinary Catheter Use in the Postoperative Period: Analysis of The National Surgical Infection Prevention Project Data. Arch Surg. In press.Wald H, Epstein A, Kramer A. Extended Urinary Catheterization Among Hip Fracture Patients Discharged to Skilled Nursing Facilities. Med Care 2005; 43:1009-1017.Wald HL, Epstein AM, Radcliff TA, Kramer AM. Extended Use of Urinary Catheters in Older Surgical Patients: A Patient Safety Problem? Infect Cont Hosp Epidemiol 2008; 29:116-124.Initial Population(s): All hospital discharges for selective surgery with hospital stays <= 120 days during the measurement period for patients age 18 and older at the time of hospital admission with a catheter in place postoperatively.The measurement period is one calendar year but the reporting period is 3 months as a calendar quarter; Q1 = Jan - Mar, Q2 = Apr - Jun, Q3 = Jul - Sep, Q4 = Oct - Dec. - -Denominator element guidance: - -The denominator in this measure specifically excludes surgical procedures that may be associated with post-operative indwelling urinary catheter usage and that occur in close time proximity to the index major surgical procedure.TBDAll hospital discharges for selective surgery with hospital stays <= 120 days during the measurement period for patients age 18 and older at the time of hospital admission and who have a Principal Procedure Code of selected surgeries.All selected surgical patients 18 years of age and older with a catheter placed between hospital arrival and the end of the recovery period, defined as within 6 hours after the end of anesthesia for a SCIP selected surgery as defined in the Initial Population. The catheter must still be in place after the end of the recovery period.Patients who had a urological, gynecological or perineal procedure performed. -Patients who expired perioperatively. -Patients whose length of stay was less than two days postoperatively. -Patients who had a urinary diversion or a suprapubic catheter or were being intermittently catheterized prior to hospital arrival. -Patients who did not have a catheter in place postoperatively. -Patients who had physician/APN/PA documentation of a reason for not removing the urinary catheter postoperatively. -In ICU on POD 1 or POD 2 AND receives at least one or more dose(s) of one or more of the following medications: - * Diuretic - * Vasopressor/inotropic - * ParalyticNumber of surgical patients whose urinary catheter is removed on postoperative day (POD) 1 or postoperative day (POD) 2 with day of surgery being day zero.Not applicableNoneNot applicableNot applicableNot applicableFor every patient evaluated by this measure also identify payer, race, ethnicity and sex.Surgical Care Improvement Project (SCIP) - - \ No newline at end of file diff --git a/test/fixtures/hqmf/simplexml/CMS179v4_SimpleXML.xml b/test/fixtures/hqmf/simplexml/CMS179v4_SimpleXML.xml deleted file mode 100755 index 0e1d5d90..00000000 --- a/test/fixtures/hqmf/simplexml/CMS179v4_SimpleXML.xml +++ /dev/null @@ -1,49 +0,0 @@ -40280381-4c72-51df-014c-76d330d60481ADE Prevention and Monitoring: Warfarin Time in Therapeutic RangeADE TTR CVM179a5e96a45-8132-4e72-bf4f-e8c81db9e6414.0.0000000010100001231Centers for Medicare & Medicaid Services (CMS)National Committee for Quality AssuranceAverage percentage of time in which patients aged 18 and older with atrial fibrillation who are on chronic warfarin therapy have International Normalized Ratio (INR) test results within the therapeutic range (i.e., TTR) during the measurement period.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. - -CPT(R) contained in the Measure specifications is copyright 2004-2014 American Medical Association. LOINC(R) copyright 2004-2014 Regenstrief Institute, Inc. This material contains SNOMED Clinical Terms(R) (SNOMED CT[R]) copyright 2004-2014 International Health Terminology Standards Development Organisation. ICD-10 copyright 2014 World Health Organization. All Rights Reserved.These performance Measures are not clinical guidelines and do not establish a standard of medical care, and have not been tested for all potential applications. - -THE MEASURES 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].Continuous VariableOutcomeNoneNoneNoneMillions of patients in the United States use warfarin to prevent strokes or to prevent or treat venous thromboembolism. Warfarin is highly effective, and has been in clinical use for over 50 years. However, warfarin is difficult to manage because it has many possible interactions with diet, other drugs, and comorbid conditions that may destabilize anticoagulation control. The possible consequences of insufficient or excessive anticoagulation are extremely serious and often fatal, making it imperative to pursue good control. - -The international normalized ratio (INR) test is the laboratory test used to determine the degree to which the patient's coagulation has been successfully suppressed by the vitamin K antagonist (VKA). For most patients, the goal is to keep the INR between 2 and 3, which roughly corresponds to the blood taking 2 to 3 times as long to clot as would a normal person's blood. This level of anticoagulation has been shown to maximize benefit (i.e., protect patients from blood clots) while minimizing risk (i.e., risk of hemorrhage attributable to excessive anticoagulation). Therapeutic INR range (TTR) is a way of summarizing INR control over time. - -TTR has been followed before, mostly in the setting of clinical trials where it is used to evaluate the effectiveness of warfarin therapy, particularly when warfarin is being compared to some other strategy. However, TTR has not previously been used as a quality measure - in fact, there has been a general lack of quality measurement in oral anticoagulation. There is much evidence that better anticoagulation control (i.e., higher TTR) can protect patients from severe or even fatal adverse events. - -We are using a well-established guideline for the expected frequency of warfarin monitoring. The ACCP clinical practice guidelines for the management of antithrombotic agents published in 2008 recommends that laboratory monitoring of warfarin in patients on stable doses of warfarin occur at an interval of no longer than 4 weeks. There is fairly strong support for extending this interval from 28 to 42 days with patients who have achieved stable control. For example, researchers at the VA who used the TTR as an outcome reported that the maximum follow-up interval can be safely extended from 28 days to 42 days after the patient has recorded three in-range INR values, without adversely impacting TTR. - -In 2012, the ACCP anticoagulation guidelines were updated to recommend that patients with very stable INRs can be tested every 12 weeks (or 84 days). The new guideline significantly increases the interval for which testing should occur in a subset of patients that are "very stable" - defined as a warfarin dose that has not changed in 6 months. Because the measurement period is set to only one year, it would be impossible to fully implement criteria for identifying patients whose dose has not changed in 6 months. Also, because dose information is not consistently found in EHRs, building measure logic that is dependent on the availability of dose and dose adjustments was determined to be not currently feasible. Therefore, we have chosen not to allow an 84-day follow-up interval, given its current level of evidentiary support and implementation challenges. - -Because the target therapeutic range for patients with atrial flutter is the same as that for atrial fibrillation without valvular heart disease, patients with atrial flutter are also included in the denominator of this measure."In patients with atrial fibrillation (AF), including those with paroxysmal AF, who have had a prior ischemic stroke, transient ischemic attack, or systemic embolism, we recommend long-term anticoagulation with an oral [vitamin K antagonist] VKA, such as warfarin, targeted at an INR of 2.5 (range, 2.0 to 3.0) because of the high risk of future ischemic stroke faced by this set of patients (Grade 1A)." - -"In patients with AF, including those with paroxysmal AF, who have two or more of the following risk factors for future ischemic stroke, we recommend long-term anticoagulation with an oral VKA, such as warfarin, targeted at an INR of 2.5 (range, 2.0 to 3.0) because of the increased risk of future ischemic stroke faced by this set of patients (Grade 1A). Two or more of the following risk factors apply: (1) age> 75 years, (2) history of hypertension, (3) diabetes mellitus, and (4) moderately or severely impaired left ventricular systolic function and/or heart failure." - -"In patients with AF, including those with paroxysmal AF, with only one of the risk factors listed below, we recommend long-term antithrombotic therapy (Grade 1A), either as anticoagulation with an oral VKA, such as warfarin, targeted at an INR of 2.5 (range, 2.0 to 3.0) [Grade 1A], or as aspirin, at a dose of 75 to 325 mg/d (Grade 1B). For these patients at intermediate risk of ischemic stroke, we suggest a VKA rather than aspirin (Grade 2A). This set of patients with AF is defined by having one of the following risk factors: (1) age > 75 years, (2) history of hypertension, (3) diabetes mellitus, and (4) moderately or severely impaired left ventricular systolic function and/or heart failure." - -"For patients with atrial flutter, we recommend that antithrombotic therapy decisions follow the same risk-based recommendations as for AF (Grade 1C)." - -"For patients who are receiving a stable dose of oral anticoagulants, we suggest monitoring at an interval of no longer than every 4 weeks."A higher score indicates higher qualityConnolly SJ, Pogue J, Eikelboom J, Flaker G, Commerford P, Franzosi MG, Healey JS, Yusuf S, ACTIVE W Investigators. Benefit of oral anticoagulant over antiplatelet therapy in atrial fibrillation depends on the quality of international normalized ratio control achieved by centers and countries as measured by time in therapeutic range. Circulation 2008 Nov 11;118(20):2029-37. [21 references] PubMedRose A. Staff physician, Bedford VA Medical Center. Investigator, VA Center for Health Quality, Outcomes, and Economic Research at the Bedford VA. Assistant Professor, Boston University School of Medicine. Percent time in therapeutic INR range (TTR). 2010 Oct 7. 8 p.Rose AJ, Berlowitz DR, Frayne SM, Hylek EM. Measuring quality of oral anticoagulation care: extending quality measurement to a new field. Jt Comm J Qual Patient Saf 2009 Mar;35(3):146-55. [115 references] PubMedRosendaal FR, Cannegieter SC, van der Meer FJ, Briet E. A method to determine the optimal intensity of oral anticoagulant therapy. Thromb Haemost 1993 Mar 1;69(3):236-9. PubMedVan Leeuwen Y, Rosendaal FR, Cannegieter SC. Prediction of hemorrhagic and thrombotic events in patients with mechanical heart valve prostheses treated with oral anticoagulants. J Thromb Haemost 2008 Mar;6(3):451-6. PubMedVan Walraven C, Jennings A, Oake N, Fergusson D, Forster AJ. Effect of study setting on anticoagulation control: a systematic review and metaregression. Chest 2006 May;129(5):1155-66. [97 references] PubMedVeeger NJ, Piersma-Wichers M, Tijssen JG, Hillege HL, van der Meer J. Individual time within target range in patients treated with vitamin K antagonists: main determinant of quality of anticoagulation and predictor of clinical outcome. A retrospective study of 2300 consecutive patients with venous thromboembolism. Br J Haematol 2005 Feb;128(4):513-9. PubMedWhite HD, Gruber M, Feyzi J, Kaatz S, Tse HF, Husted S, Albers GW. Comparison of outcomes among patients randomized to warfarin therapy according to anticoagulant control: results from SPORTIF III and V. Arch Intern Med 2007 Feb 12;167(3):239-45.Hirsh J, Guyatt G, Albers GW, Harrington R, Schunemann HJ. Antithrombotic and Thrombolytic Therapy: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines (8th Edition). CHEST 2008; 133(6_suppl);110S-112S.Ansell J, Hirsh J, Hylek E, Jacobson A, Crowther M, Palareti G. Pharmacology and management of the vitamin K antagonists: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines (8th Edition). Chest. 2008; 133: 160S-98S.Holbrook A, Schulman S, Witt DM, Vandvik PO, Fish J, Kovacs MJ, Svensson PJ, Veenstra DL, Crowther M, Guyatt GH. Evidence-Based Management of Anticoagulant Therapy: Antithrombotic Therapy and Prevention of Thrombosis, 9th ed: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines. Chest. 2012; 141: e152S-e84S.Rose AJ, Ozonoff A, Berlowitz DR, Ash AS, Reisman JI, Hylek EM. Reexamining the recommended follow-up interval after obtaining an in-range international normalized ratio value: results from the Veterans Affairs study to improve anticoagulation. Chest. 2011; 140: 359-65. chest.10-2738 [pii]. 10.1378/chest.10-2738.Schulman S, Parpia S, Stewart C, Rudd-Scott L, Julian JA, Levine M. Warfarin dose assessment every 4 weeks versus every 12 weeks in patients with stable international normalized ratios: a randomized trial. Ann Intern Med. 2011; 155: 653-9. 155/10/653 [pii]. 10.1059/0003-4819-155-10-201111150-00003.CUMULATIVE MEDICATION DURATION is the total number of calendar days that an individual has active medications that contain the same drug ingredient of interest. In this measure, the active drug ingredient is warfarin. The number of active days of an occurrence of a medication (eg, a medication order or an entry in a patient's medication list) is calculated by taking the difference (in calendar days) between the date that the medication became active and the date that the medication stopped being active. The cumulative medication duration is calculated as the sum of the number of active calendar days for each occurrence of a medication that contains the same active ingredient over a set period of time, excluding any gaps during which a medication was not active. All of the entries in the value set for warfarin (OID: 2.16.840.1.113883.3.117.1.7.1.232) must be included in determining the cumulative medication duration. All medication occurrences considered for the calculation of cumulative medication duration for this measure must be active within 200 days immediately prior to the measurement period. This lookback period of 200 days is based on the original warfarin TTR measure used by the Veterans Affairs health care system. Please refer to the supplemental file named "CMS179v2_Supplemental_SQL_Logic_Reference.pdf" for this logic. - -A VALID INR INTERVAL is two INR values separated by 56 days or less. INR values must be obtained in outpatient care settings; INR values while the patient is admitted to a hospital for more than 23 hours should not be included. - -THERAPEUTIC RANGE: for patients with atrial fibrillation and no valvular involvement, the target INR result = 2.0 - 3.0. - -PERCENT OF TIME IN THERAPEUTIC RANGE (TTR) is the percentage of time during which the interpolated INR values lie between 2.0 and 3.0. This can be from 0% to 100%. TTR percentage should be calculated for each patient that meets the criteria for the Measure Population. The average of these values is reported as the Measure Observation. The calculation for TTR is provided in the supplemental file named "CMS179v2 _Supplemental_SQL_Logic_Reference.pdf". - -INTERPOLATED INR VALUES are obtained through the use of linear interpolation to assign an INR value to each day between successive observed INR values. The Rosendaal linear interpolation methodology used in this measure assumes a linear relationship between two INR values and allows the assignment of a specific INR to each day for each patient.Please note that the logic expressions in the body section of the HQMF of this measure should *not* be used to calculate this clinical quality measure. They are only provided to represent the data elements needed for the calculation. In order to calculate this clinical quality measure correctly, only use the narrative specifications contained in the header section of the HQMF and the annotated database query found in the supplemental file named "CMS179v4_Supplemental_SQL_Logic_Reference.pdf". - -The calculation of TTR should include all available INR values for a given patient during the measurement period. When generating a QRDA-1 document for this measure, all available INR values during the measurement period should be included. - -The following filters are applied to each patient's INRs in order to calculate a patient-level TTR. INR values must be at least 0.8. Values less than 0.8 may represent aberrant results. INR values greater than 10 (i.e., outliers) must be replaced with a value of 10. An INR of 10 represents an abnormally high INR and would skew the results of the calculated TTR less than extreme values would (i.e., INR > 10). The INR value closest to "2.5" is used to calculate TTR, when there are more than one INR result on a single date. - -In this measure, the active drug ingredient of primary interest is warfarin. CUMULATIVE MEDICATION DURATION should be calculated for all active warfarin-containing medications. All of the entries in the value set for warfarin must be included when determining the cumulative medication duration. All medication occurrences considered for the calculation of cumulative medication duration for this measure must be active within 200 days immediately prior to the measurement period. This lookback period of 200 days is based on the original warfarin TTR measure used by the Veterans Affairs health care system. Please refer to the supplemental file named "CMS179v4 _Supplemental_SQL_Logic_Reference.pdf" for this logic. - -To be excluded from the initial patient population, patients must have an active diagnosis of valvular heart disease during the measurement period. - -To determine the proportion of patients with atrial fibrillation who are on chronic warfarin therapy and have sufficient INR monitoring to calculate a TTR, the reporting provider can divide the Measure Population by the Initial Patient Population. - -The calculation for TTR is provided in the supplemental file named "CMS179v4 _Supplemental_SQL_Logic_Reference.pdf". - -The Measure Observation is the average of all patients' percent TTR, which can be calculated by dividing the sum of all patients' percent TTR by the number of patients in the Measure Population.NonePatients aged 18 and older with atrial fibrillation without valvular heart disease who had been on chronic warfarin therapy for at least 180 days before the start of and during the measurement period. Patient should have at least one outpatient visit during the measurement periodNot ApplicableNot ApplicableNot ApplicableNot ApplicableNot ApplicableEquals All in Initial Population with sufficient international normalized ratio (INR) results to calculate a warfarin time in therapeutic range (TTR)Not ApplicableAverage percentage of time that patients in the measure population have INR results within the therapeutic range (i.e., TTR)For every patient evaluated by this measure also identify payer, race, ethnicity and sex.None - - \ No newline at end of file diff --git a/test/fixtures/hqmf/simplexml/CMS182v5_SimpleXML.xml b/test/fixtures/hqmf/simplexml/CMS182v5_SimpleXML.xml deleted file mode 100755 index 5a813db4..00000000 --- a/test/fixtures/hqmf/simplexml/CMS182v5_SimpleXML.xml +++ /dev/null @@ -1,33 +0,0 @@ -40280381-4de7-db4d-014d-e861ea2d01a1Ischemic Vascular Disease (IVD): Complete Lipid Panel and LDL ControlIVD_Lipid_LDL182500e4792-7f94-4e34-8546-ee71c56fe4635.2.0000000010100001231National Committee for Quality AssuranceNational Committee for Quality AssurancePercentage of patients 18 years of age and older who were discharged alive for acute myocardial infarction (AMI), coronary artery bypass graft (CABG) or percutaneous coronary interventions (PCI) in the 12 months prior to the measurement period, or who had an active diagnosis of ischemic vascular disease (IVD) during the measurement period, and who had a complete lipid profile performed during the measurement period and whose LDL-C was adequately controlled (< 100 mg/dL).Physician Performance Measure (Measures) and related data specifications were developed by the National Committee for Quality Assurance (NCQA). - -The Measures are copyrighted but can be reproduced and distributed, without modification, for noncommercial purposes (eg, use by healthcare providers in connection with their practices). Commercial use is defined as the sale, licensing, or distribution of the Measures for commercial gain, or incorporation of the Measures into a product or service that is sold, licensed or distributed for commercial gain. Commercial use of the Measures requires a license agreement between the user and NCQA. NCQA is not responsible for any use of the Measures. - -(C) 2008-2015 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 CPT or other codes contained in the specifications. - -CPT(R) contained in the Measure specifications is copyright 2004-2014 American Medical Association. LOINC(R) copyright 2004-2014 Regenstrief Institute, Inc. This material contains SNOMED Clinical Terms(R) (SNOMED CT [R]) copyright 2004-2014 International Health Terminology Standards Development Organisation. ICD-10 copyright 2014 World Health Organization. All Rights Reserved.These performance Measures are not clinical guidelines and do not establish a standard of medical care, and have not been tested for all potential applications. - -THE MEASURES 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].ProportionProcessNoneNoneNoneA 10 percent decrease in total cholesterol levels (population wide) may result in an estimated 30 percent reduction in the incidence of coronary heart disease (CHD) (Centers for Disease Control and Prevention 2000). Based on data from the Third Report of the Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults: -*Less than half of persons who qualify for any kind of lipid-modifying treatment for CHD risk reduction are receiving it -*Less than half of even the highest-risk persons, those who have symptomatic CHD, are receiving lipid-lowering treatment -*Only about a third of treated patients are achieving their LDL goal; less than 20 percent of CHD patients are at their LDL goal (National Cholesterol Education Program (NCEP) Expert Panel on Detection, Evaluation, and Treatment of High Blood Pressure 2002) - -According to data from the Behavioral Risk Factor Surveillance System (BRFSS) from 1991 - 2003, the prevalence of cholesterol screening during the preceding 5 years increased from 67.3 percent in 1991 to 73.1 percent in 2003 (Centers for Disease Control and Prevention 2005). - -Between 1988-94 and 1999-2002, the age-adjusted mean total serum cholesterol level of adults 20 years of age and older decreased from 206 mg/dL to 203 mg/dL, and LDL cholesterol levels decreased from 129 mg/dL to 123 mg/dL. The mean level of LDL cholesterol for American adults age 20 and older is 123 mg/dL (Carroll et al. 2005). However, even given this decrease, there is still a significant amount of room for improvement.Third report of the National Cholesterol Education Program (NCEP) Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (Adult Treatment Panel III). (2002) AND Implications of recent clinical trials for the National Cholesterol Education Program Adult Treatment Panel III guidelines (2004) -In high-risk persons, the recommended LDL-C goal is < 100 mg/dL. - -* An LDL-C goal of < 70 mg/dL is a therapeutic option on the basis of available clinical trial evidence, especially for patients at very high risk. -* If LDL-C is > 100 mg/dL, an LDL-lowering drug is indicated simultaneously with lifestyle changes. -* If baseline LDL-C is < 100 mg/dL, institution of an LDL-lowering drug to achieve an LDL-C level -< 70 mg/dL is a therapeutic option on the basis of available clinical trial evidence. -* If a high-risk person has high triglycerides or low HDL-C, consideration can be given to combining a fibrate or nicotinic acid with an LDL-lowering drug. When triglycerides are > 200 mg/dL, non-HDL-C is a secondary target of therapy, with a goal 30 mg/dL higher than the identified LDL-C goal. - -The U.S. Preventive Services Task Force (USPSTF) strongly recommends screening men aged 35 and older for lipid disorders and recommends screening men aged 20 to 35 for lipid disorders if they are at increased risk for coronary heart disease. The USPSTF also strongly recommends screening women aged 45 and older for lipid disorders if they are at increased risk for coronary heart disease and recommends screening women aged 20 to 45 for lipid disorders if they are at increased risk for coronary heart disease.Higher score indicates better qualityCenters for Disease Control and Prevention (CDC). 2005. "Trends in cholesterol screening and awareness of high blood cholesterol - United States, 1991-2003." MMWR 54;865-870.Carroll, M.D., D.A. Lacher, P.D. Sorlie, J.I. Cleeman, D.J. Gordon, M. Wolz, S.M. Grundy, C.L. Johnson. 2005. "Trends in serum lipids and lipoproteins of adults. 1960-2002." JAMA 294:1773-1781.Centers for Disease Control and Prevention (CDC). 2000. "State-specific cholesterol screening trends - United States, 1991-1999." MMWR 49:750-755.National Cholesterol Education Program (NCEP) Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (Adult Treatment Panel III). 2002. "Third Report of the National Cholesterol Education Program (NCEP) Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (Adult Treatment Panel III) final report." Circulation 106(25):3143-421. Grundy SM, Cleeman JI, Merz CN, et al. Implications of recent clinical trials for the National Cholesterol Education Program Adult Treatment Panel III guidelines. Circulation 2004; 110: 227-39.U.S. Preventive Services Task Force. 2008. "Screening for lipid disorders in adults" (June) http://www.uspreventiveservicestaskforce.org/uspstf/uspschol.htm -NoneOnly patients who were discharged alive for acute myocardial infarction (AMI), coronary artery bypass graft (CABG) or percutaneous coronary interventions (PCI) are included in this measureNonePatients 18 years of age and older with a visit during the measurement period, and an active diagnosis of ischemic vascular disease (IVD) during the measurement period, or who were discharged alive for acute myocardial infarction (AMI), coronary artery bypass graft (CABG) or percutaneous coronary interventions (PCI) in the 12 months prior to the measurement periodEquals Initial PopulationNot ApplicableNumerator 1: Patients with a complete lipid profile performed during the measurement period -Numerator 2: Patients whose most recent LDL-C level performed during the measurement period is <100 mg/dLNot ApplicableNoneNot ApplicableNot ApplicableNot ApplicableFor every patient evaluated by this measure also identify payer, race, ethnicity and sex.None - - \ No newline at end of file diff --git a/test/fixtures/hqmf/simplexml/CMS185v4_SimpleXML.xml b/test/fixtures/hqmf/simplexml/CMS185v4_SimpleXML.xml deleted file mode 100755 index 2be3e47f..00000000 --- a/test/fixtures/hqmf/simplexml/CMS185v4_SimpleXML.xml +++ /dev/null @@ -1,15 +0,0 @@ -40280381-4a43-a22d-014a-cb65430e2df5Healthy Term NewbornHealthy Term Newborn185ff796fd9-f99d-41fd-b8c2-57d0a59a5d8d4.0.0000000010100001231Centers for Medicare & Medicaid Services (CMS)Centers for Medicare & Medicaid Services (CMS)National Quality ForumPercent of term singleton live births (excluding those with diagnoses originating in the fetal period) who DO NOT have significant complications during birth or the nursery care.Measure specifications are in the Public Domain - -CPT(R) is a trademark of the American Medical Association. Current Procedural Terminology. (CPT) is copyright 2014 American Medical Association. All rights reserved. No fee schedules, basic units, relative values, or related listings are included in CPT. The AMA assumes no liability for the data contained herein. Applicable FARS/DFARS restrictions apply to government use. - -LOINC(R) is a registered trademark of the Regenstrief Institute. - -This material contains SNOMED Clinical Terms (R) (SNOMED CT[C]) copyright 2004-2014 International Health Terminology Standards Development Organization. All rights reserved.These performance measures are not clinical guidelines and do not establish a standard of medical care, and have not been tested for all potential applications. The measures and specifications are provided without warranty. CMS has contracted with Mathematica Policy Research and its subcontractors, Lantana and Telligen, for the continued maintenance of this electronic measure.ProportionProcessNoneNoneNoneThe current set of Perinatal measures has no metrics for general term neonatal outcomes which is the most important outcome for most families having babies. This measure sums up the outcomes for term babies that present to Labor and Delivery without underlying fetal conditions so expectations are high. It serves as a balancing measure for other maternal process and outcome measures such as the low-risk first-birth Cesarean rate. An ideal OB unit would have both good baby outcomes and an average or better Cesarean rate.This measure is an outcome measure; therefore clinical guidelines are not directly applicable as they are for process measures. There are a number of obstetric guidelines that direct elements of maternal care that in turn affect the newborn. An example is ACOG Practice Bulletin on Labor Induction (#107) which states that elective deliveries should not occur prior to 39 weeks. This guideline directly affects neonatal outcomes, as measured in this metric, as early term births lead to increased neonatal morbidity and longer neonatal length of stay.Improvement noted as an increase in rateHamilton BE, Martin JA, Ventura SJ. Births: Preliminary data for 2007. National vital statistics reports, Web release; vol 57 no 12.Hyattsville, MD: National Center for Health Statistics. Released March 18, 2009.Gregory KD, Fridman M, Shah S, Korst LM. Global measures of quality- and patient safety-related childbirth outcomes: should we monitor adverse or ideal rates? Am J Obstet Gynecol. 2009 Jun;200(6):681.e1-7.van Handel M, Swaab H, de Vries LS, Jongmans MJ. Long-term cognitive and behavioral consequences of neonatal encephalopathy following perinatal asphyxia: a review. Eur J Pediatr. 2007 Jul;166(7):645-54. Epub 2007 Apr 11.Bailit JL, Garrett JM, Miller WC, McMahon MJ, Cefalo RC. Hospital primary cesarean delivery rates and the risk of poor neonatal outcomes. Am J Obstet Gynecol. 2002 Sep;187(3):721-7.Bailit JL, Love TE, Dawson NV. Quality of obstetric care and risk-adjusted primary cesarean delivery rates. Am J Obstet Gynecol. 2006Clark SL, Miller DD, Belfort MA, Dildy GA, Frye DK, Meyers JA. Neonatal and maternal outcomes associated with elective term delivery. Am J Obstet Gynecol. 2009 Feb;200(2):156.e1-4. Epub 2008 Dec 25Clark SL, Simpson KR, Knox GE, Garite TJ. Oxytocin: new perspectives on an old drug. Am J Obstet Gynecol. 2009 Jan;200(1):35.e1-6. Epub 2008 Jul 29Dunne C, Da Silva O, Schmidt G, Natale R. Outcomes of elective labour induction and elective caesarean section in low-risk pregnancies between 37 and 41 weeks' gestation. J Obstet Gynaecol Can. 2009 Dec;31(12):1124-30.Fisch JM, Labor induction process improvement: A patient quality-of-care initiative. Obset Gynecol 2009;113:797-803.Gould JB, Danielsen B, Korst LM, Phibbs R, Chance K, Main E, Wirtschafter DD, Stevenson DK. Cesarean delivery rates and neonatal morbidity in a low-risk population. Obstet Gynecol. 2004 Jul;104(1):11-9.Hansen AK, Wisborg K, Uldbjerg N, Henriksen TB. Elective caesarean section and respiratory morbidity in the term and near-term neonate. Acta Obstet Gynecol Scand 2007;86:389-94.Hansen AK, Wisborg K, Uldbjerg N, Henriksen TB. Risk of respiratory morbidity in term infants delivered by elective caesarean section: cohort study. BMJ. 2008 336:85-7.Oshiro BT, Henry E, Wilson J, et al. Decreasing elective deliveries before 39 weeks of gestation in an integrated health care system. Obstet Gynecol 2009;113:840-811.Robertson CM, Finer NN. Long-term follow-up of term neonates with perinatal asphyxia. Clin Perinatol. 1993 Jun;20(2):483-500.Russo CA, Andrews RM. Potentially Avoidable Injuries to Mothers and Newborns During Childbirth, 2006. HCUP Statistical Brief #74. June 2009. Agency for Healthcare Research and Quality, Rockville, MD. http://www.hcup-us.ahrq.gov/reports/statbriefs/sb74.pdf.Tita ATN, Landon MB, Spong CY, et al. Timing of Elective Repeat Cesarean Delivery at Term and Neonatal Outcomes. New Engl J Med 360:111, 2009ACOG. Induction of labor. ACOG Practice Bulletin No. 107. Obstet Gynecol 2009; 114: 386-97There are a number of obstetric guidelines that direct elements of the care that in turn affect the newborn. An example is the ACOG Practice bulletin on labor induction (#107): which states that elective deliveries should not occur prior to 39 weeks. This is covered in NQF #0469, Elective delivery prior to 39 completed weeks gestation, but does not have a corresponding measure of neonatal outcomes.Among babies who had no known complications prior to Labor and Delivery (normally grown, no anomalies or other fetal diagnoses) how many left the hospital with their mother without a significant complication.CMS suggests eligible hospitals participating in the Medicare & Medicaid EHR Incentive Programs not select CMS185/NQF0716: Healthy Term Newborn as one of their additional electronic clinical quality measures (eCQMs) for meaningful use. The measure steward is making substantial changes to this measure and is working with NQF on endorsement of the revised measure. CMS will review the changes to this measure and assess its feasibility for future implementation. - -The very first step for this measure, identifying all term singleton infants can be surprisingly challenging. Some hospitals do not do a good job of using the proper v-codes or DRGs so that clinical information such as birthweight and gestational age need to be used in the first step. - -The logic phrase AND: "Occurrence A of Encounter, Performed: Inpatient Encounter (reason: 'Birth')" intends to capture admission type of newborn for the encounter. Where this information is available in existing EHR structured fields (eg data that is fed to UB-04, field location 14), it can be used to map the criterion specified in the logic. - -The logic phrase AND: "Diagnosis, Active: Liveborn Born In Hospital" starts during "Occurrence A of Encounter, Performed: Inpatient Encounter" intends to capture the point of origin for the inpatient admission. Where this information is available in existing EHR structured fields (eg data that is fed to UB-04, field location 15), it can be used to map the criterion specified in the logic.TBDAll patients who are single liveborn term newborns born in a hosptital.The denominator is composed of singleton, term (>=37 weeks), inborn, livebirths in their birth admission. The denominator further has eliminated fetal conditions likely to be present before labor. Maternal and obstetrical conditions (eg hypertension, prior cesarean, malpresentation) are not excluded unless evidence of fetal effect prior to labor (eg IUGR/SGA).Denominator exclusions: multiple gestations, preterm, congenital anomalies or fetuses affected by selected maternal conditions.The absence of conditions or procedures reflecting morbidity that happened during birth and nursery care to an otherwise normal infant.Not ApplicableNoneNot applicableNot ApplicableNot applicableFor every patient evaluated by this measure also identify payer, race, ethnicity and sex.None - - \ No newline at end of file diff --git a/test/fixtures/hqmf/simplexml/CMS188v5_SimpleXML.xml b/test/fixtures/hqmf/simplexml/CMS188v5_SimpleXML.xml deleted file mode 100755 index 41bc8f21..00000000 --- a/test/fixtures/hqmf/simplexml/CMS188v5_SimpleXML.xml +++ /dev/null @@ -1,102 +0,0 @@ -40280381-4de7-db4d-014d-e8361d36015aInitial Antibiotic Selection for Community-Acquired Pneumonia (CAP) in Immunocompetent PatientsPN 61888243eae0-bbd7-4107-920b-fc3db04b95845.2.0000000010100001231Centers for Medicare & Medicaid Services (CMS)Oklahoma Foundation for Medical QualityNational Quality Forum(PN-6) Immunocompetent patients with Community-Acquired Pneumonia who receive an initial antibiotic regimen during the first 24 hours that is consistent with current guidelines - -(Population 1) Immunocompetent ICU patients with Community-Acquired Pneumonia who receive an initial antibiotic regimen during the first 24 hours that is consistent with current guidelines - -(Population 2) Immunocompetent non-Intensive Care Unit (ICU) patients with Community-Acquired Pneumonia who receive an initial antibiotic regimen during the first 24 hours that is consistent with current guidelinesMeasure specifications are in the Public Domain - -CPT(R) is a trademark of the American Medical Association. Current Procedural Terminology. (CPT) is copyright 2014 American Medical Association. All rights reserved. No fee schedules, basic units, relative values, or related listings are included in CPT. The AMA assumes no liability for the data contained herein. Applicable FARS/DFARS restrictions apply to government use. - -LOINC(R) is a registered trademark of the Regenstrief Institute. - -This material contains SNOMED Clinical Terms (R) (SNOMED CT(C)) copyright 2004-2014 International Health Terminology Standards Development Organization. All rights reserved.These performance measures are not clinical guidelines and do not establish a standard of medical care, and have not been tested for all potential applications. The measures and specifications are provided without warranty. CMS has contracted with Mathematica Policy Research and its subcontractors, Lantana and Telligen, for the continued maintenance of this electronic measure.ProportionProcessNoneNoneData from Populations 1 and 2 should also be aggregated to report an aggregate of 'All patients compliant / All patients eligible' - -The numerator includes: ALL ICU numerator 1 compliant + All Non-ICU numerator 2 compliant patients - -The denominator includes: All patients who are ICU denominator 1 compliant (after excluding all in Denominator Exclusion(s) 1) and All Non-ICU denominator 2 compliant (after excluding all in Denominator Exclusion(s) 2)The current North American antibiotic guidelines for Community-Acquired Pneumonia in immunocompetent patients are from the Centers for Disease Control and Prevention (CDC), the Infectious Diseases Society of America (IDSA), the Canadian Infectious Disease Society / Canadian Thoracic Society (CIDS/CTS), and the American Thoracic Society (ATS). All four reflect that Streptococcus pneumoniae is the most common cause of CAP, that treatment that covers "atypical" pathogens (eg Legionella species, Chlamydia pneumoniae, Mycoplasma pneumoniae) can be associated with improved survival, and that the prevalence of antibiotic resistant S. pneumoniae is increasing. -The CMS convened a conference of guideline authors, including Julie Gerberding, MD (CDC), John Bartlett, MD (IDSA), Ronald Grossman, MD (CIDS/CTS), and Michael Niederman, MD (ATS), to reach consensus on the antibiotic regimens that could be considered consistent with all four organizations' guidelines. These regimens are reflected in this measure, and in the Pneumonia Antibiotic Consensus Recommendation located directly behind the measure information form.Antibiotic guidelines reflect that Streptococcus pneumoniae is the most common cause of CAP, that treatment that covers "atypical" pathogens (eg Legionella species, Chlamydia pneumoniae, Mycoplasma pneumoniae) can be associated with improved survival.Improvement noted as an increase in rateButler JC, Hofmann J, Cetron MS, et al. The continued emergence of drug-resistant Streptococcus pneumonia in the United States: an update from the Centers for Disease Control and Prevention's Pneumococcal Sentinel Surveillance System. J Infect Dis. 1996;174:986-993.Fine MJ, Smith MA, Carson CA, et al. Prognosis and outcomes of patients with community-acquired pneumonia. JAMA. 1996;275:134-141.Gleason PP, Meehan TP, Fine JM, et al. Associations between initial antimicrobial regimens and medical outcomes for elderly patients with pneumonia. Arch Intern Med. 1999;159:2562-2572.Heffelfinger JD, Dowell SF, Jorgensen JH, Klugman KP, et al. Management of Community-Acquired Pneumonia in the era of pneumococcal resistance: A Report From the Drug-Resistant Streptococcus pneumoniae Therapeutic Working Group. Archives of Internal Medicine. 2000, 160:1399-1408.Houck PM, MacLehose RF, Niederman MS, Lowery JK. Empiric antibiotic therapy and mortality among Medicare pneumonia inpatients in 10 western states, 1993, 1995, and 1997. Chest. 2001;119;1420-1426.Mandell LA, Marrie TJ, Grossman RF, et al. Canadian guidelines for the initial management of community-acquired pneumonia: an evidence-based update by the Canadian Infectious Disease Society and the Canadian Thoracic Society. Clin Infect Dis. 2000;31:383-421.Mandell LA, Wunderink RG, Anzueta A, Bartlett JG, Infectious Diseases Society of America; American Thoracic Society. Infectious Diseases Society of America/American Thoracic Society consensus guidelines on the management of community-acquired pneumonia in adults. Clin Infect Dis. 2007 March 1;44 Suppl 2:S27-72.File TM, Low DE, Eckburg PB, Talbot GH, Friedland D, Lee J, Llorens L, Critchley I, Thye D. Integrated analysis of FOCUS 1 and FOCUS 2 randomized, double blinded, multicenter phase 3 trials of the efficacy and safety of ceftaroline fosamil versus ceftriaxone in patients with community acquired pneumonia. CID. December 2010; 51 (12): 1395-1405.Wunderlink RJ, Waterer GW, Rello J. Management of Community-acquired Pneumonia in Adults. Am J of Respir and Crit Care Med. August 2010: 2-41.Tessmer, A., T. Welte, P. Martus, M. Schnoor, R. Marre, and N. Suttorp. Impact of intravenous beta-lactam/macrolide versus beta-lactam monotherapy on mortality in hospitalized patients with community-acquired pneumonia. J Antimicrob Chemother 2009; 63:1025-33.Restrepo, M. I., E. M. Mortensen, J. Rello, J. Brody, and A. Anzueto. Late admission to the ICU in patients with community-acquired pneumonia is associated with higher mortality. Chest 2009.NoneGeneral guidance: -The measure criteria indicate scenarios in which the patient is admitted to the hospital directly (to ICU or Non-ICU locations) or the patient is admitted to one of these locations from the Emergency Department (ED). - -The calculation is to indicate the timing from arrival at the facility to the occurrence of an event. The arrival, therefore can be determined from the Emergency Department, the Non-ICU location, or the ICU location, whichever is the first location of contact between the patient and the facility. - -Exclusion element guidance: -Transfers from another hospital that is not part of the hospital's organization are excluded since care may have been delivered in the other setting. The measure as specified for abstraction allowed determination of other hospitals by hospital billing number. - -Transfers within 1 day from those hospitals using the same facility number are not considered transfers for the exclusion section of this measure, those using other facility numbers are considered exclusions. - -Respiratory Infection exclusion- the logic indicates that the patient is included if they have a respiratory infection but excluded for any other infection unless the encounter ends <=24 hr after the start. - -The exclusion for absolute neutrophil count < 500 may require calculation. The absolute neutrophil count (ANC) = Total WBC x (% "Segs" + % "Bands"), OR WBC x ((Segs/100) + (Bands/100)).TBDPneumonia patients 18 years of age and older at the time of admission to acute inpatient care with a discharge principal diagnosis of pneumonia, OR Principal Diagnosis of septicemia or respiratory failure (acute or chronic) AND also a secondary other diagnosis code of pneumonia. Patient with a LOS <=120 days and discharged during the measurement period. - -This measure is divided into patients admitted to the intensive care unit (ICU population 1), and those admitted to non-ICU hospital locations (population 2). -For both populations, arrival at the hospital means either arrival at the ED or arrival as a direct admit to the inpatient setting.ICU population: -Patients who meet the Initial Population and: -* Arrival at hospital is either arrival in ED or arrival to floor as direct admit -* Admitted to ICU within 24 hours after arrival at hospital with reasons for admission due to pneumonia -* Pneumonia related reasons for admission to ICU include: - * Septic shock - * Respiratory distress or failure - * Hypotension - * Tachypnea - * Hypoxemia - * Need for a ventilator - * Tachycardia -* Diagnosis of pneumonia documented within 24 hours after arrival; if seen in ED diagnosis must be documented in ED -* Antibiotics received within 24 hours of arrival or within 1 day prior to hospital arrival and during hospital stay. - -Non-ICU population: -Patient who meet the Initial Population and: -* Arrival at hospital is either arrival in ED or arrival to floor as direct admit -* Diagnosis of pneumonia documented within 24 hours after arrival; if seen in ED diagnosis must be documented in ED -* Antibiotics received within 24 hours after arrivalICU Population only: -Patients transferred/admitted to the ICU within 24 hours after arrival to this hospital, with a beta-lactam allergy (population 1 only). -For patients in both ICU and non-ICU the rest of the denominator exclusions are the same: -* Patients with either a normal Chest X-ray or a normal CT scan which includes the chest within 1 day prior to arrival at the hospital or during the hospitalization -* Patients who have "Comfort Measures" documented as performed or ordered on the day of or the day after arrival at the hospital or after arrival in the ED -* Patients who are transferred from one of the following within 24 hours before the start of the ED encounter or the hospital encounter: - * An acute care hospital - * An ambulatory surgical center - * A transfer from an emergency department of an outside hospital - * A transfer from an outpatient department of an outside hospital -* Patients who were an inpatient less than or equal to 1 day. - -The following exclusions are "reasons for alternative empiric antibiotic therapy": -*Patients who have a diagnosis of a "prolonged QT interval" documented within 24 hours after arrival at the ED or the hospital -* Patients who have an active diagnosis of an immunocompromised condition within the last 3 months before arrival at the ED or arrival at the hospital or during the hospitalization -* Patients who have significant neutropenia, which is defined as a Neutrophil count of <500 per mm3 within the last 3 months before arrival at the ED or arrival at the hospital or during the hospitalization -* Patients who have any of the following within 30 days before arrival at the ED or arrival at the hospital: - * Hemodialysis or peritoneal dialysis - * Wound care - * Tracheostomy care - * Ventilator care - * Diagnosis of healthcare associated pneumonia -* Patients who have any of the following which starts before the end of the inpatient hospitalization: - * Immunodeficient conditions - * Cystic Fibrosis - * History of an organ transplant -* Patients who have any of the following within 90 days before the start of either the ED or the direct admit: - * Immunocompromised Therapies (radiation treatments, for instance) - * Systemic Immunosuppressive therapy (chemotherapy, for instance) - * A patient in a nursing home or an extended care facility - * A patient in another acute care hospitalPneumonia patients who received an initial antibiotic regimen consistent with current guidelines during the first 24 hours of their hospitalization. - -Numerator 1 (in population 1) defines appropriate antibiotics for ICU patients. - -Numerator 2 (in population 2) defines appropriate antibiotics for non-ICU patients. -Non-ICU patients are evaluated for pseudomonal risk. - -Pseudomonal risk requires certain antibiotics per clinical guidelines. -Pseudomonal risk includes: -* Bronchiectasis -* Structural lung disease which includes the following: - * "Diagnosis, Active: COPD" - * "Diagnosis, Active: Chronic bronchitis" - * "Diagnosis, Active: Emphysema" - * "Diagnosis, Active: Interstitial lung disease" - * "Diagnosis, Active: Restrictive lung disease" - * "Diagnosis, Active: Structural lung disease"Not ApplicablePneumonia patients with Another Source of Infection who did not receive an antibiotic regimen recommended for pneumonia, but did receive antibiotics within the first 24 hours of hospitalization. Pneumonia patients who have been on systemic corticosteroid/prednisone therapy within the last 90 days prior to arrival to the hospital.Not ApplicableNot ApplicableNot ApplicableFor every patient evaluated by this measure also identify payer, race, ethnicity and sex. -"Patient Characteristic Payer: Payer" using "Payer Source of Payment Typology Value Set (2.16.840.1.114222.4.11.3591)" -"Patient Characteristic Race: Race" using "Race CDC Value Set (2.16.840.1.114222.4.11.836)" -"Patient Characteristic Ethnicity: Ethnicity" using "Ethnicity CDC Value Set (2.16.840.1.114222.4.11.837)" -"Patient Characteristic:Sex: ONC Administrative Sex" using "ONC Administrative Sex Value Set (2.16.840.1.113762.1.4.1)"Not Applicable - -Non-ICU PatientsPseudomonal risk: Non-ICU patients are evaluated for pseudomonal risk. If they meet this criteria they must receive a different antibiotic regimen than patient without a pseudomonal risk.Non-ICU patients with pseudomonal risk and an allergy to beta lactams receive a different antibiotic regimen than patients with just a pseudomonal risk or with no pseudomonal risk. \ No newline at end of file diff --git a/test/fixtures/hqmf/simplexml/CMS190v4_SimpleXML.xml b/test/fixtures/hqmf/simplexml/CMS190v4_SimpleXML.xml deleted file mode 100755 index 946fc96b..00000000 --- a/test/fixtures/hqmf/simplexml/CMS190v4_SimpleXML.xml +++ /dev/null @@ -1,28 +0,0 @@ -40280381-4c18-79df-014c-3364efa21057Intensive Care Unit Venous Thromboembolism ProphylaxisVTE-2190fa91ba68-1e66-4a23-8eb2-baa8e6df2f2f4.0.0000000010100001231The Joint CommissionThe Joint CommissionNational Quality ForumThis measure assesses the number of patients who received VTE prophylaxis or have documentation why no VTE prophylaxis was given the day of or the day after the initial admission (or transfer) to the Intensive Care Unit (ICU) or surgery end date for surgeries that start the day of or the day after ICU admission (or transfer).Measure specifications are in the Public Domain - -LOINC(R) is a registered trademark of the Regenstrief Institute. - -This material contains SNOMED Clinical Terms(R) (SNOMED CT[C]) copyright 2004-2014 International Health Terminology Standards Development Organization. All rights reserved.These performance measures are not clinical guidelines and do not establish a standard of medical care, and have not been tested for all potential applications. The measures and specifications are provided without warranty.ProportionProcessNoneNoneNoneApproximately two-thirds of cases of Deep Vein Thrombosis (DVT) or Pulmonary Emboli (PE) are associated with recent hospitalization. This is consistent with the 2001 report by Agency for Healthcare Research and Quality (Shojania, et al., 2001). AHRQ reports that "the appropriate application of effective preventive measures in hospitals has major potential for improving patient safety, by reducing the incidence of VTE." - -Almost all hospitalized patients have at least one risk factor for Venous Thromboembolism (VTE), and approximately 40% have three or more risk factors. Without thromboprophylaxis, the incidence of objectively confirmed, hospital-acquired DVT is approximately 10% to 40% among medical or general surgical patients and 40% to 60% following major orthopedic surgery (Geerts et al., 2008). - -Commonly, criteria for admission to the Intensive Care Unit (ICU) itself, puts patient's at an increased risk for developing VTE, and subsequent increased risk of morbidity from PE. Some risk factors are related to the acute illness present that allowed for the admission to the ICU unit, and some risk factors may be acquired during the ICU admission due to subsequent medical treatments, for example limitations of mobility, presence of central venous lines or mechanical ventilation and subsequent pharmacological paralysis. Reports of DVT in the population of ICU patients vary in relation to the acuity of the illness in this population. DVT in ICU patients diagnosed with routine venography or Doppler ultrasound found ranges between 10% to 100%. Five studies prospectively screened patients who were not receiving thromboprophylaxis during their ICU stays. The rates of DVT using Fibrinogen Uptake Test, Doppler Ultrasound or venography ranged from 13 to 31% (Geerts et al., 2008). It is essential for all ICUs to assess each patient upon admission to the ICU unit, a change in level of status, for the need for VTE prophylaxis due to the above increased development of risk factors (Geerts, et al., 2004). - -Some select surgeries have previously been monitored in the Surgical Care Improvement Project; since performance on these surgeries has achieved very high levels, they are not included in this measure.Failure to recognize and protect patients at risk for venous thromboembolism (VTE) increases the chances for critically ill hospitalized patients for developing a deep vein thrombosis or dying from a pulmonary emboli. Screening all patients is the only evidence based practice in reducing incidence of disease. All intensive care unit (ICU) patients should be evaluated for primary VTE prophylaxis, and given appropriate prophylaxis when indicated.Improvement noted as an increase in rateGeerts WH, Bergqvist D, Pineo GF, Heit JA, Samama CM, Lassen MR, Colwell CW. Prevention of venous thromboembolism. The Eighth ACCP Conference on antithrombotic and thrombolytic therapy. Chest. 2008; 133:381S-453S.Geerts WH, Pineo GF, Heit JA, et al. Prevention of venous thromboembolism: the Seventh ACCP Conference on Antithrombotic and Thrombolytic Therapy. Chest. 2004 Sep;126(3 Suppl):338S-400S.Guyatt, G.H., Akl, E.A., Crowther, M., Gutterman, D., Schunemann, H. Antithrombotic Therapy and Prevention of Thrombosis, 9th edition: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines. CHEST 2012; 141(2) (Supp):7S-47S.Kearon C, Akl EA, Comerota AJ, Prandoni P, Bounameaux H, Goldhaber SZ, Nelson ME, Wells PS, Gould MK, Dentali F, Crowther M, Kahn SR. Antithrombotic therapy for VTE disease: antithrombotic therapy and prevention of thrombosis, 9th ed: American College of Chest Physicians evidence-based clinical practice guidelines. Chest. 2012 Feb;141(2 Suppl):e419S-94S Shojania KG, Duncan BW, McDonald DM, et al. (Eds.). (2001). Making healthcare safer; A critical analysis of patient safety practices (Evidence Report/Technology Assessment No. 43). Prepared by the University of California at San Francisco-Stanford Evidenced-based Practice Center under Contract no. 290-97-0013 (AHRQ Publication NO.01-E058). Rockville, MD:Agency for Healthcare Research and Quality.NoneThe unit of measurement for this measure is an inpatient episode of care. Each distinct hospitalization should be reported, regardless of whether the same patient is admitted for inpatient care more than once during the measurement period. In addition, the eMeasure logic intends to represent events within or surrounding a single occurrence of an inpatient hospitalization. - -The definition of an ICU for the purpose of the measures noted above is that used by the CDC in the NHSN Patient Safety Project. An intensive care unit can be defined as a nursing care area that provides intensive observation, diagnosis, and therapeutic procedures for adults and/or children who are critically ill. An ICU excludes nursing areas that provide step-down, intermediate care or telemetry only and specialty care areas. - -The construct of Unfractionated Heparin (route: 'Intravenous route') intends to capture continually infused heparin rather than heparin flushes or pushes.NonePatients age 18 and older discharged during the measurement period from hospital inpatient acute care with a length of stay less than or equal to 120 days, without a diagnosis of venous thromboembolism (VTE) or obstetrics.Patients directly admitted or transferred to ICU during the hospitalization.Patients who have a hospital length of stay (LOS) less than 2 days. -Patients with comfort measures documented anytime between arrival and the day after ICU admission or transfer -Patients with comfort measures documented by the day after surgery end date for surgeries that end the day of or the day after hospital admission -Patients with a principal procedure of surgical care improvement Project (SCIP) VTE selected surgeries that end the day of or the day after ICU admission or transfer.Patients who received VTE prophylaxis: - --the day of or the day after ICU admission (or transfer) --the day of or the day after surgery end date for surgeries that end the day of or the day after ICU admission (or transfer) - -Patients who have documentation of a reason why no VTE prophylaxis was given: -- between arrival and ICU admission (for patients directly admitted as inpatients to the ICU) -- the day of or the day after ICU admission (or transfer) -- the day of or the day after surgery end date (for surgeries that end the day of or the day after ICU admission (or transfer)Not ApplicablePatients with ICU LOS less than one day.Not ApplicableNot ApplicableNot ApplicableFor every patient evaluated by this measure also identify payer, race, ethnicity and sex.eMeasure Venous Thromboembolism (eVTE) - -VTE prophylaxis optionsReasons for no VTE prophylaxis \ No newline at end of file diff --git a/test/fixtures/hqmf/simplexml/CMS22v4_SimpleXML.xml b/test/fixtures/hqmf/simplexml/CMS22v4_SimpleXML.xml deleted file mode 100755 index 4c5c5f8d..00000000 --- a/test/fixtures/hqmf/simplexml/CMS22v4_SimpleXML.xml +++ /dev/null @@ -1,55 +0,0 @@ -40280381-4be2-53b3-014b-ebfcb19508cbPreventive Care and Screening: Screening for High Blood Pressure and Follow-Up DocumentedCMS22229a033a94-3d9b-11e1-8634-00237d5bf1744.0.0000000010100001231Centers for Medicare & Medicaid Services (CMS)Quality Insights of PennsylvaniaPercentage of patients aged 18 years and older seen during the reporting period who were screened for high blood pressure AND a recommended follow-up plan is documented based on the current blood pressure (BP) reading as indicatedLimited proprietary coding is contained in the measure specifications for convenience. Users of the proprietary code sets should obtain all necessary licenses from the owners of these code sets. Quality Insights of Pennsylvania disclaims all liability for use or accuracy of any Current Procedural Terminology (CPT [R]) or other coding contained in the specifications. - -CPT (R) contained in the Measure specifications is copyright 2007-2015 American Medical Association. - -LOINC (R) copyright 2004-2014 [2.50] Regenstrief Institute, Inc. This material contains SNOMED Clinical Terms (R) (SNOMED CT [R]) copyright 2004-2014 [2014-09] International Health Terminology Standards Development Organization. All Rights Reserved. - -Due to technical limitations, registered trademarks are indicated by (R) or [R] and unregistered trademarks are indicated by (TM) or [TM].These performance measures are not clinical guidelines and do not establish a standard of medical care, and have not been tested for all potential applications. - -THE MEASURES AND SPECIFICATIONS ARE PROVIDED "AS IS" WITHOUT WARRANTY OF ANY KIND.ProportionProcessNoneNoneNoneHypertension is a prevalent condition that affects approximately 66.9 million people in the United States. It is estimated that about 20-40% of the adult population has hypertension; the majority of people over age 65 have a hypertension diagnosis (Appleton SL, et. al., 2012 and Luehr D, et. al., 2012). Winter (2013) noted that 1 in 3 American adults have hypertension and the lifetime risk of developing hypertension is 90% (Winter KH, et. al., 2013). The African American population or non-Hispanic Blacks, the elderly, diabetics and those with chronic kidney disease are at increased risk of stroke, myocardial infarction and renal disease. Non-Hispanic Blacks have the highest prevalence at 38.6% (Winter KH, et. al., 2013). Hypertension is a major risk factor for ischemic heart disease, left ventricular hypertrophy, renal failure, stroke and dementia (Luehr D, et. al., 2012). - - -Hypertension is the most common reason for adult office visits other than pregnancy. Garrison (2013) stated that in 2007, 42 million ambulatory visits were attributed to hypertension (Garrison GM and Oberhelman S, 2013). It also has the highest utilization of prescription drugs. Numerous resources and treatment options are available, yet only about 40-50% of the hypertensive patients have their blood pressure under control (<140/90) (Appleton SL, et. al., 2012, Luehr D, et. al., 2012). In addition to medication non-compliance, poor outcomes are also attributed to poor adherence to lifestyle changes such as a low-sodium diet, weight loss, increased exercise and limiting alcohol intake. Many adults find it difficult to continue medications and lifestyle changes when they are asymptomatic. Symptoms of elevated blood pressure usually do not occur until secondary problems arise such as with vascular diseases (myocardial infarction, stroke, heart failure and renal insufficiency) (Luehr D, et. al., 2012). - -Appropriate follow-up after blood pressure measurement is a pivotal component in preventing the progression of hypertension and the development of heart disease. Detection of marginally or fully elevated blood pressure by a specialty clinician warrants referral to a provider familiar with the management of hypertension and prehypertension. The 2010 ACCF/AHA Guideline for the Assessment of Cardiovascular Risk in Asymptomatic Adults continues to support using a global risk score such as the Framingham Risk Score, to assess risk of coronary heart disease (CHD) in all asymptomatic adults (Greenland P, et. al., 2010). Lifestyle modifications have demonstrated effectiveness in lowering blood pressure (JNC 7, 2003). The synergistic effect of several lifestyle modifications results in greater benefits than a single modification alone. Baseline diagnostic/laboratory testing establishes if a co-existing underlying condition is the etiology of hypertension and evaluates if end organ damage from hypertension has already occurred. Landmark trials such as ALLHAT have repeatedly proven the efficacy of pharmacologic therapy to control blood pressure and reduce the complications of hypertension. Follow-up intervals based on blood pressure control have been established by the JNC 7 and the USPSTF.The U.S. Preventive Services Task Force (USPSTF) recommends screening for high blood pressure in adults age 18 years and older. This is a grade A recommendation.Higher score indicates better quality.U.S. Preventive Services Task Force (USPSTF) (2007). Screening for high blood pressure: U.S. Preventive Services Task Force reaffirmation recommendation statement. Annals of Internal Medicine; 147(11):783-6U.S. Department of Health and Human Services, National Institutes of Health, National Heart, Lung, and Blood Institute & National High Blood Pressure Education Program (2003). The Seventh Report of the Joint National Committee on the Prevention, Detection, Evaluation, and Treatment of High Blood Pressure (JNC-7). NIH Publication No. 03-5233Garrison GM & Oberhelman S (2013). Screening for hypertension annually compared with current practice. Annals of Family Medicine, 11 (2), 116-121.Luehr D, Woolley T, Burke R, Dohmen F, Hayes R, Johnson M, Kerandi H, Margolis K, Marshall M, O'Connor P, Pereira C, Reddy G, Schlichte A & Schoenleber M (2012). Hypertension diagnosis and treatment; Institute for Clinical Systems Improvement health care guideline. Updated November, 2012.Appleton SL, Neo C, Hill C L, Douglas K A & Adams R J (2012). Untreated hypertension: prevalence and patient factors and beliefs associated with under-treatment in a population sample. Journal of Human Hypertension, advance online publication December 13, 2012.Winter K H, Tuttle L A & Viera A J (2013). Hypertension. Prim Care Clin Office Pract, 40, 179-194.Blood Pressure (BP) Classification: -BP is defined by four (4) BP reading classifications: Normal, Pre-Hypertensive, First Hypertensive, and Second Hypertensive Readings - -Recommended BP Follow-Up: -The Joint National Committee on the Prevention, Detection, Evaluation, and Treatment of High Blood Pressure (JNC 7) recommends BP screening intervals, lifestyle modifications and interventions based on the current BP reading as listed in the "Recommended Blood Pressure Follow-Up Interventions" listed below - -Recommended Lifestyle Modifications: -The JNC 7 report outlines lifestyle modifications which must include one or more of the following as indicated: -* Weight Reduction -* Dietary Approaches to Stop Hypertension (DASH) Eating Plan -* Dietary Sodium Restriction -* Increased Physical Activity -* Moderation in alcohol (ETOH) Consumption - -Second Hypertensive Reading: -Requires a BP reading of Systolic BP >= 140 mmHg OR Diastolic BP >= 90 mmHg during the current encounter AND a most recent BP reading within the last 12 months Systolic BP >= 140 mmHg OR Diastolic BP >= 90 mmHg - -Second Hypertensive Reading BP Interventions: -The JNC 7 report outlines BP follow-up interventions for a second hypertensive BP reading and must include one or more of the following as indicated: -* Anti-Hypertensive Pharmacologic Therapy -* Laboratory Tests -* Electrocardiogram (ECG) - -Recommended Blood Pressure Follow-Up Interventions: -* Normal BP: No follow-up required for Systolic BP < 120 mmHg AND Diastolic BP <80 mmHg -* Pre-Hypertensive BP: Follow-up with rescreen every year with systolic BP of 120-139 mmHg OR diastolic BP of 80-89 mmHg AND recommend lifestyle modifications OR referral to Alternative/Primary Care Provider -* First Hypertensive BP Reading: Patients with one elevated reading of systolic BP >= 140 mmHg OR diastolic BP >= 90 mmHg: - * Follow-up with rescreen > 1 day and < 4 weeks AND recommend lifestyle modifications OR referral to Alternative/Primary Care Provider -* Second Hypertensive BP Reading: Patients with second elevated reading of systolic BP >=140 mmHg OR diastolic BP >= 90 mmHg: - * Follow-up with Recommended lifestyle recommendations AND one or more of the Second Hypertensive Reading Interventions OR referral to Alternative/Primary Care ProviderBoth the systolic and diastolic blood pressure measurements are required for inclusion. If there are multiple blood pressures on the same date of service, use the most recent as the representative blood pressure. - -Eligible professionals who report the measure must perform the blood pressure screening at the time of a qualifying visit by an eligible professional and may not obtain measurements from external sources. - -The intent of this measure is to screen patients for high blood pressure and provide recommended follow-up as indicated. The documented follow-up plan must be related to the current BP reading as indicated, example: "Patient referred to primary care provider for BP management."TBDAll patients aged 18 years and older before the start of the measurement period with at least one eligible encounter during the measurement periodEquals Initial PopulationPatient has an active diagnosis of hypertensionPatients who were screened for high blood pressure AND have a recommended follow-up plan documented, as indicated if the blood pressure is pre-hypertensive or hypertensiveNot ApplicablePatient Reason(s): -Patient refuses to participate (either BP measurement or follow-up) - -OR - -Medical Reason(s): -Patient is in an urgent or emergent medical situation where time is of the essence and to delay treatment would jeopardize the patient's health status. This may include but is not limited to severely elevated BP when immediate medical treatment is indicated.Not ApplicableNot ApplicableNot ApplicableFor every patient evaluated by this measure also identify payer, race, ethnicity and sex.Preventive Care and Screening - - \ No newline at end of file diff --git a/test/fixtures/hqmf/simplexml/CMS26v3_SimpleXML.xml b/test/fixtures/hqmf/simplexml/CMS26v3_SimpleXML.xml deleted file mode 100755 index db5fc856..00000000 --- a/test/fixtures/hqmf/simplexml/CMS26v3_SimpleXML.xml +++ /dev/null @@ -1,42 +0,0 @@ -40280381-4b9a-3825-014b-bd8fa6b2062eHome Management Plan of Care (HMPC) Document Given to Patient/CaregiverCAC-326e1cb05e0-97d5-40fc-b456-15c5dbf443093.0.0000000010100001231The Joint CommissionThe Joint CommissionAn assessment that there is documentation in the medical record that a Home Management Plan of Care (HMPC) document was given to the pediatric asthma patient/caregiver.LOINC(R) is a registered trademark of the Regenstrief Institute. - -This material contains SNOMED Clinical Terms (R) (SNOMED CT(C)) copyright 2004-2014 International Health Terminology Standards Development Organization. All rights reserved.These performance measures are not clinical guidelines and do not establish a standard of medical care, and have not been tested for all potential applications. The measures and specifications are provided without warranty.ProportionProcessNoneNoneNoneAsthma is the most common chronic disease in children and a major cause of morbidity and health care costs nationally (Adams, et al, 2001). In 2005, 5.2% of children with asthma had at least one asthma attack in the previous year (3.8 million children). Nearly two of every three children who currently have asthma had at least one attack in the past 12 months. Chronic asthma in children can account for an annual loss of more than 14 million school days per year, according to the Asthma and Allergy Foundation (Asthma Facts and Figures). - -It is clear from multiple sources of evidence including the National Heart Lung and Blood Institute (NHLBI) Guidelines that actual self-management of asthma by the patient or caregiver leads to more positive outcomes. Appropriate self-management is completely reliant upon patient education. Patient education is more effective when it aims at training self-management skills that will alter behavior (Norris, et al, 2001). - -NHLBI notes that review of asthma management by expert clinicians is necessary but not sufficient to improve outcomes. Active learning, participating and verbalization of understanding are all strategies that a healthcare organization must incorporate with parents or caregivers of asthmatic children in order for them to understand and make the appropriate changes that can impact the disease in the child in question. Education programs have been effective in improving lung function, feelings of self-esteem, and consequently decreased missed days of school in children and adolescents (Phipatanakul, 2004). Acute hospitalization follow up is imperative to a successful discharge from the hospital, providing the caretaker with the resource information needed to contact the follow up facility, medical office or clinic setting (Schatz, et al, 2009). - -Environmental control consists of removal of asthma triggers from the environment. Multiple studies support the positive correlation of household maintenance factors such as control of cockroach dust, and the number of acute asthma attacks in asthmatic children (McConnell, et al, 2005 and Eggleston, et al, 2005). Evidence from Carter et al, (2001) supported by the National Institute of Health (NIH) grant found specifically that reduction in triggers such as household conditions i.e. dust mites, cockroach, cats and presence of molds and fungus, resulted in a decrease in acute care visits and an overall positive outcome of children. - -Rescue action education related to early recognition of symptoms and proper action to control incidence of asthma attacks is noted to have positive outcomes for asthmatic children (Ducharme and Bhogal, 2008).Under-treatment and/or inappropriate treatment of asthma are recognized as major contributors to asthma morbidity and mortality. National guidelines for the diagnosis and management of asthma in children, recommend establishing a plan for maintaining control of asthma and for establishing plans for managing exacerbation.Improvement noted as an increase in rate.Adams RJ, Fuhlbrigge A, Finkelstein JA, Lozano P, Livingston JM, Weiss KB, and Weiss ST (2001). Use of Inhaled Anti-inflammatory Medication in Children with Asthma in Managed Care Settings. Archives of Pediatrics and Adolescent Medicine, 155, 501-507.American College of Chest Physicians (ACCP), 10th Annual ACCP Community Asthma and COPD Coalitions Symposium: A Physician's Perspective. Retrieved on February 17, 2015 from: http://69.36.35.38/accp/perspective/10th_Asthma Asthma Facts and Figures. Retrieved on February 17, 2015 from http://www.aafa.org/display.cfm?id=9&sub=42#_ftn20.Ducharme FM, Bhogal SK. The role of written action plans in childhood asthma. Curr Opin Allergy Clin Immunol. 2008 Apr;8(2):177-88. -Eggleston, P.A., Butz, A., Rand, C., Curtin-Brosnan, J, Kanchanaraksa, S, Swartz, L, Breysse, P, Buckley, T., Diette, G., Merriman, B., Krishnan, J. (2005). Home Environmental Intervention in Inner-City Asthma: A Randomized Controlled Clinical Trial. Ann Allergy Asthma Immunology; 95 p518-524McConnell, R., Milam, J., Richardson, J., Galvan, J., Jones, C., Thorne, P.S., and Berhane, K. (2005). Educational Intervention to Control Cockroach allergen Exposure in The homes of Hispanic Children in Los Angeles; Results of the La Casa Study. Clinical Exp Allergy; 35, p426-433National Asthma Education and Prevention Program, http://www.nhlbi.nih.gov/about/org/naepp.National Heart Lung and Blood Institute (NHLBI). Guidelines for the Diagnosis and Management of Asthma (EPR-3). Retrieved on February 17, 2015 from: http://www.nhlbi.nih.gov/health-pro/guidelines/current/asthma-guidelines.Phipatanakul, W. (2004). Effects of Educational Interventions for Self-Management of Asthma in Children and Adolsecents:Systematic Review and Meta-Analysis. Pediatrics; 114; 530. Schatz, M, Rachelefsky, G, Krishnan, J.A. (2009). Follow-up after Acute Asthma Episodes. What Improves Future Outcomes. Proc Am Thorac Soc; Vol 6 p 386-393.Zemek, R.L., Bhogal, S.K., Ducharme, F. M. (2008). Systematic Review of Randomized Controlled Trials Examining Written Action Plans in Children: What is the Plan? (Reprinted) Arch Pediatr Adolesc Med/ vol 162 No 2. Retrieved on February 17, 2015 from http://archpedi.jamanetwork.com/article.aspx?articleid=379087.NoneThe home management plan of care document should be a separate and patient-specific written instruction. The document must be present in the form of an explicit and separate document specific to the patient rather than components or segments of the plan spread across discharge instruction sheets, discharge orders, education sheets, or other instruction sheets. - -The home management plan of care is represented in the eMeasure logic by a LOINC code for an asthma action plan document. This form, or equivalent, contains most of the components required for the home management plan of care, including information on: -* Methods and timing of rescue actions: the home management plan of care addresses what to do if asthma symptoms worsen after discharge, including all of the following: 1) When to take action, i.e., assessment of severity (eg, peak flow meter reading, signs and symptoms to watch for); 2) What specific steps to take, i.e., initial treatment instructions (eg, inhaled relievers up to three treatments of 2-4 puffs by MDI at 20-minute intervals or single nebulizer treatment); 3) Contact information to be used, when an asthma attack occurs or is about to occur. -* Appropriate use of long-term asthma medications (controllers), including the medication name, dose, frequency, and method of administration. -* Appropriate use of rescue, quick-relief, or short acting medications of choice to quickly relieve asthma exacerbations (relievers), including the medication name, dose, frequency, and method of administration. -* Environmental control and control of other triggers: information on avoidance or mitigation of environmental and other triggers. - -In addition to the information outlined in the asthma action plan form (or equivalent document), the home management plan of care is required to include information regarding arrangements for referral or follow-up care with a healthcare provider, namely: -* If an appointment for referral or follow-up care with a healthcare provider has been made, the home management plan of care is required to include the provider/clinic/office name, as well as the date and time of the appointment. -* If an appointment for referral of follow-up care with a healthcare provider has NOT been made, the home management plan of care is required to include information for the patient/caregiver to be able to make arrangements for follow-up care, i.e., provider/clinic/office name, telephone number and time frame for appointment for follow-up care (eg, 7-10 days). - -The home management plan of care can only be considered to comply with the criteria outlined in the measure logic if it meets the requirements outlined above and is appropriately filled-out with information specific to the patient. - -Patient refusal includes refusal by a caregiver. The caregiver is defined as the patient's family or any other person (eg, home health, VNA provider, prison official or other law enforcement personnel) who will be responsible for care of the patient after discharge. - -The "Discharge To Home Or Police Custody" value set also intends to capture the following discharge disposition values: -* Assisted Living Facilities -* Court/Law Enforcement - includes detention facilities, jails, and prison -* Home - includes board and care, foster or residential care, group or personal care homes, and homeless shelters -* Home with Home Health Services -* Outpatient Services including outpatient procedures at another hospital, Outpatient Chemical Dependency Programs and Partial Hospitalization. - -The unit of measurement for this measure is an inpatient episode of care. Each distinct hospitalization should be reported, regardless of whether the same patient is admitted for inpatient care more than once during the measurement period. In addition, the eMeasure logic intends to represent events within or surrounding a single occurrence of an inpatient hospitalization.TBDPediatric asthma inpatients with an age of 2 through 17 years, and length of stay less than or equal to 120 days.Pediatric asthma inpatients with an age of 2 through 17 years, length of stay less than or equal to 120 days, and discharged to home or police custody.NonePediatric asthma inpatients with documentation that they or their caregivers were given a written Home Management Plan of Care (HMPC) document that addresses all of the following: -1. Arrangements for follow-up care -2. Environmental control and control of other triggers -3. Method and timing of rescue actions -4. Use of controllers -5. Use of relieversNot applicableNoneNot applicableNot applicableNot applicableFor every patient evaluated by this measure also identify payer, race, ethnicity and sex.eMeasure Children's Asthma Care (eCAC) - - \ No newline at end of file diff --git a/test/fixtures/hqmf/simplexml/CMS2v5_SimpleXML.xml b/test/fixtures/hqmf/simplexml/CMS2v5_SimpleXML.xml deleted file mode 100755 index 2cd4afce..00000000 --- a/test/fixtures/hqmf/simplexml/CMS2v5_SimpleXML.xml +++ /dev/null @@ -1,73 +0,0 @@ -40280381-4b9a-3825-014b-c11ae59d069bPreventive Care and Screening: Screening for Clinical Depression and Follow-Up PlanCMS229a031e24-3d9b-11e1-8634-00237d5bf1745.0.0000000010100001231Centers for Medicare & Medicaid Services (CMS)Quality Insights of PennsylvaniaNational Quality ForumPercentage of patients aged 12 years and older screened for clinical depression on the date of the encounter using an age appropriate standardized depression screening tool AND if positive, a follow-up plan is documented on the date of the positive screen.Limited proprietary coding is contained in the measure specifications for convenience. Users of the proprietary code sets should obtain all necessary licenses from the owners of these code sets. Quality Insights of Pennsylvania disclaims all liability for use or accuracy of any Current Procedural Terminology (CPT [R]) or other coding contained in the specifications. - -CPT (R) contained in the Measure specifications is copyright 2007- 2015American Medical Association. - -LOINC (R) copyright 2004-2014 [2.50] Regenstrief Institute, Inc. This material contains SNOMED Clinical Terms (R) (SNOMED CT [R]) copyright 2004-2014 [2014-09] International Health Terminology Standards Development Organization. All Rights Reserved. - -Due to technical limitations, registered trademarks are indicated by (R) or [R] and unregistered trademarks are indicated by (TM) or [TM].These performance measures are not clinical guidelines and do not establish a standard of medical care, and have not been tested for all potential applications. - -THE MEASURES AND SPECIFICATIONS ARE PROVIDED "AS IS" WITHOUT WARRANTY OF ANY KIND.ProportionProcessNoneNoneNoneThe World Health Organization (WHO), as seen in Pratt & Brody (2008), found that major depression was the leading cause of disability worldwide. Depression causes suffering, decreases quality of life, and causes impairment in social and occupational functioning. It is associated with increased health care costs as well as with higher rates of many chronic medical conditions. Studies have shown that a higher number of depression symptoms are associated with poor health and impaired functioning, whether or not the criteria for a diagnosis of major depression are met. Persons 40-59 years of age had higher rates of depression than any other age group. Persons 12-17, 18-39 and 60 years of age and older had similar rates of depression. Depression was more common in females than in males. Non-Hispanic Black persons had higher rates of depression than non-Hispanic White persons. In the 18-39 and 40-59 age groups, those with income below the federal poverty level had higher rates of depression than those with higher income. Among persons 12-17 and 60 years of age and older, rates of depression did not vary significantly by poverty status. - -Overall, approximately 80% of persons with depression reported some level of difficulty in functioning because of their depressive symptoms. In addition, 35% of males and 22% of females with depression reported that their depressive symptoms make it very or extremely difficult for them to work, get things done at home, or get along with other people. More than one-half of all persons with mild depressive symptoms also reported some difficulty in daily functioning attributable to their symptoms. - -15-20 percent of adults older than age 65 in the United States have experienced depression (Geriatric Mental Health Foundation, 2008). 7 million adults aged 65 years and older are affected by depression (Steinman, 2007). Chronically ill Medicare beneficiaries with accompanying depression have significantly higher health care costs than those with chronic diseases alone (Unutzer, 2009). People aged 65 years and older accounted for 16 percent of suicide deaths in 2004 (Centers for Disease Control and Prevention, 2007). - -The negative outcomes associated with early onset depression, make it crucial to identify and treat depression in its early stages. As reported in Borner et al. (2010), a study conducted by the World Health Organization (WHO) reported that in North America, primary care and family physicians are likely to provide the first line of treatment for depressive disorders. Others consistently report a 10% prevalence rate of depression in primary care patients. But studies have shown that primary care physicians fail to recognize up to 50% of depressed patients, purportedly because of time constraints and a lack of brief, sensitive, easy-to administer psychiatric screening instruments. Coyle et al. (2003), suggested that the picture is more grim for adolescents, and that more than 70% of children and adolescents suffering from serious mood disorders, go unrecognized or inadequately treated. Healthy People 2020 recommends routine screening for mental health problems as a part of primary care for both children and adults (U.S. Department of Health and Human Services, 2014). - -Major depressive disorder (MDD) is a debilitating condition that has been increasingly recognized among youth, particularly adolescents. The prevalence of current or recent depression among children is 3% and among adolescents is 6%. The lifetime prevalence of MDD among adolescents may be as high as 20%. Adolescent-onset MDD is associated with an increased risk of death by suicide, suicide attempts, and recurrence of major depression by young adulthood. MDD is also associated with early pregnancy, decreased school performance, and impaired work, social, and family functioning during young adulthood (Williams et al., 2009). Every fifth adolescent may have a history of depression by age 18. The increase in the onset of depression occurs around puberty. According to Zalsman et al. (2006), as reported in Borner et al. (2010), depression ranks among the most commonly reported mental health problems in adolescent girls. - -The economic burden of depression is substantial for individuals as well as society. Costs to an individual may include suffering, possible side effects from treatment, fees for mental health and medical visits and medications, time away from work and lost wages, transportation, and reduced quality of personal relationships. Costs to society may include loss of life, reduced productivity (because of both diminished capacity while at work and absenteeism from work), and increased costs of mental health and medical care. In 2000, the United States spent an estimated $83.1 billion in direct and indirect costs of depression (USPSTF, 2009).Adolescent Recommendation (12-18 years): - -The USPSTF recommends screening of adolescents (12-18 years of age), for major depressive disorder (MDD) when systems are in place to ensure accurate diagnosis, psychotherapy (cognitive-behavioral or interpersonal), and follow-up (AHRQ, 2010, p.141). - -Clinicians and health care systems should try to consistently screen adolescents, ages 12-18, for major depressive disorder, but only when systems are in place to ensure accurate diagnosis, careful selection of treatment, and close follow-up (ICSI, 2013, p. 16). - - - -Adult Recommendation (18 years and older): - -The USPSTF recommends screening adults for depression when staff-assisted depression care supports are in place to assure accurate diagnosis, effective treatment, and follow-up (AHRQ, 2010, p.136). - -A system that has embedded the elements of best practice and has capacity to effectively manage the volume, should consider routine screening of all patients based on the recommendations of the U.S. Preventive Services Task Force (ICSI, 2013, p. 7). Clinicians should use a standardized instrument to screen for depression if it is suspected, based on risk factors or presentation. Clinicians should assess and treat for depression in patients with some comorbidities. Clinicians should acknowledge the impact of culture and cultural differences on physician and mental health. Clinicians should screen and monitor depression in pregnant and post-partum women (ICSI, 2013, p. 4).Higher score indicates better quality.Pratt L.A, Brody DJ.(2008). Depression in the United States household population, 2005-2006. U.S. Department of Health and Human Services, Centers for Disease Control and Prevention National Center for Health Statistics. NCHS Data Brief No.7, 1-8. Borner I, Braunstein JW, St. Victor, R, Pollack J (2010). Evaluation of a 2-question screening tool for detecting depression in adolescents in Primary Care. Clinical Pediatrics, 49, 947-995. doi: 10.1177/0009922810370203 Coyle J T, Pine D.S, Charney D S, Lewis L, Nemeroff C B, Carlson G A, Joshi P T (2003). Depression and bipolar support alliance consensus development panel. Depression and bipolar support alliance consensus statement on the unmet needs in diagnosis and treatment of mood disorders in children and adolescents. Journal of the American Academy of Child and Adolescent Psychiatry, 42, 1494-1503.U.S. Department of Health and Human Services (2014). Healthy People 2020. Washington, DC: U.S. Department of Health and Human Services. Retrieved from: http://www.healthypeople.gov/2020/topicsobjectives2020/objectiveslist.aspx?topicId=28Williams SB. O'Connor EA, Eder M, Whitlock EP (2009). Screening for Child and Adolescent Depression in Primary Care Setting: A Systematic Evidence Review for the US Preventive Services Task Force. Pediatrics, 123, e716-e735. doi:10.1542/peds.2008-2415Zalsman G, Brent DA & Weersing VR (2006). Depressive disorders in childhood and adolescence: an overview: epidemiology, clinical manifestation and risk factors. Child Adolesc Psychiatr Clin N Am. 2006;15:827-841 Agency for Healthcare Research and Quality (2010). The Guide to Clinical Preventive Services 2010-2011: Recommendations of the U.S. Preventive Services Task Force. Retrieved from: http://www.ahrq.gov/clinic/pocketgd1011/pocketgd1011.pdfWilkinson J, Bass C, Diem S, Gravley A, Harvey L, Maciosek M, McKeon K, Milteer L, Owens J, Rothe P, Snellman L, Solberg L, Vincent P. Institute for Clinical Systems Improvement. Preventive Services for Children and Adolescents. Updated September 2013. https://www.icsi.org/_asset/x1mnv1/PrevServKids.pdfCenters for Disease Control and Prevention (2007). Web-based injury statistics query and reporting system (WISQARS), National Center for Injury Prevention and Control, 2005. Retrieved from: http://www.cdc.gov/injury/wisqars/index.htmlGeriatric Mental Health Foundation (2008). Depression in late life: not a natural part of aging, 2008. Retrieved from: www.gmhfonline.org/gmhf/consumer/factsheets/depression_latelife.htmlSteinman LE, Frederick JT, Prohaska T, Satariano WA, Dornberg-Lee S, Fisher R, ...Snowden M (2007). Recommendations for treating depression in community-based older adults. American Journal of Preventive Medicine, 33(3), 175-81. Retrieved from: www.ajpm-online.net/article/S0749-3797%2807%2900330-3/abstractUnutzer J, Schoenbaum M, Katon WJ, Fan M, Pincus HA, Hogan D & Taylor J (2009). Health care costs associated with depression in medically ill fee-for-service Medicare participants. Journal of the American Geriatric Society, 57(3), 375-584. Retrieved from www.nimh.nih.gov/science-news/2009/health-care-costs-much-higher-for-older-adults-with-depression-plus-other-medical-conditions.shtmlU.S. Preventive Services Task Force (2009). Screening for Depression in Adults: U.S. Preventive Services Task Force Recommendation Statement. Annal of Internal Medicine, 151 (11), 784-792. Retrieved from: http://annals.org/article.aspx?articleid=745304Mitchell J, Trangle M, Degnan B, Gabert T, Haight B, Kessler D, Mack N, Mallen E, Novak H, Rossmiller D, Setterlund L, Somers K, Valentino N, Vincent S. Institute for Clinical Systems Improvement. Adult Depression in Primary Care. Updated September 2013. https://www.icsi.org/_asset/fnhdm3/Depr.pdfScreening: -Completion of a clinical or diagnostic tool used to identify people at risk of developing or having a certain disease or condition, even in the absence of symptoms. -Standardized Depression Screening Tool - A normalized and validated depression screening tool developed for the patient population in which it is being utilized - -Examples of depression screening tools include but are not limited to: -* Adolescent Screening Tools (12-17 years) - * Patient Health Questionnaire for Adolescents (PHQ-A) - * Beck Depression Inventory-Primary Care Version (BDI-PC) - * Mood Feeling Questionnaire(MFQ) - * Center for Epidemiologic Studies Depression Scale (CES-D) - * PRIME MD-PHQ2 -* Adult Screening Tools (18 years and older) - * Patient Health Questionnaire (PHQ9) - * Beck Depression Inventory (BDI or BDI-II) - * Center for Epidemiologic Studies Depression Scale (CES-D) - * Depression Scale (DEPS) - * Duke Anxiety-Depression Scale (DADS) - * Geriatric Depression Scale (SDS) - * Cornell Scale Screening - * PRIME MD-PHQ2 - -Follow-Up Plan: -Documented follow-up for a positive depression screening must include one or more of the following: - * Additional evaluation for depression - * Suicide Risk Assessment - * Referral to a practitioner who is qualified to diagnose and treat depression - * Pharmacological interventions - * Other interventions or follow-up for the diagnosis or treatment of depressionA clinical depression screen is completed on the date of the encounter using an age appropriate standardized depression screening tool AND if positive, a follow-up plan is documented on the date of the positive screen. -Screening Tools: - * The name of the age appropriate standardized depression screening tool utilized must be documented in the medical record - * The depression screening must be reviewed and addressed in the office of the provider, filing the code, on the date of the encounter - * The screening and encounter must occur on the same date - * Standardized Depression Screening Tools should be normalized and validated for the age appropriate patient population in which they are used and must be documented in the medical record -Follow-Up Plan: - * The follow-up plan must be related to a positive depression screening, example: "Patient referred for psychiatric evaluation due to positive depression screening."TBDAll patients aged 12 years and older before the beginning of the measurement period with at least one eligible encounter during the measurement period.Equals Initial PopulationPatients with an active diagnosis for Depression or a diagnosis of Bipolar DisorderPatients screened for clinical depression on the date of the encounter using an age appropriate standardized tool AND if positive, a follow-up plan is documented on the date of the positive screenNot ApplicablePatient Reason(s) -Patient refuses to participate -OR -Medical Reason(s) -Patient is in an urgent or emergent situation where time is of the essence and to delay treatment would jeopardize the patient's health status -OR -Situations where the patient's functional capacity or motivation to improve may impact the accuracy of results of standardized depression assessment tools. For example: certain court appointed cases or cases of deliriumNot ApplicableNot ApplicableNot ApplicableFor every patient evaluated by this measure also identify payer, race, ethnicity and sex.Preventive Care and Screening - - \ No newline at end of file diff --git a/test/fixtures/hqmf/simplexml/CMS30v5_SimpleXML.xml b/test/fixtures/hqmf/simplexml/CMS30v5_SimpleXML.xml deleted file mode 100755 index e7eb82ae..00000000 --- a/test/fixtures/hqmf/simplexml/CMS30v5_SimpleXML.xml +++ /dev/null @@ -1,21 +0,0 @@ -40280381-4be2-53b3-014b-e6419b2c033eStatin Prescribed at DischargeAMI-1030ebfa203e-acc1-4228-906c-855c4bf113105.0.0000000010100001231Centers for Medicare & Medicaid Services (CMS)Oklahoma Foundation for Medical QualityNational Quality ForumAcute myocardial infarction (AMI) patients who are prescribed a statin medication at hospital discharge.Measure specifications are in the Public Domain - -LOINC(R) is a registered trademark of the Regenstrief Institute. - -This material contains SNOMED Clinical Terms (R) (SNOMED CT(C)) copyright 2004-2014 International Health Terminology Standards Development Organization. All rights reserved.These performance measures are not clinical guidelines and do not establish a standard of medical care, and have not been tested for all potential applications. The measures and specifications are provided without warranty. CMS has contracted with Mathematica Policy Research and its subcontractors, Lantana and Telligen, for the continued maintenance of this electronic measure.ProportionProcessNoneNoneNoneSeveral randomized clinical trials have proven the benefits of statin drugs (also known as HMG Co-A reductase inhibitors) in reducing the risk of death and recurrent cardiovascular events in a broad range of patients with established cardiovascular disease, including those with prior myocardial infarction (4S, 1994; Sacks, 1996; LIPID Study Group, 1998; and MRC/BHF Heart Protection Study, 2002). Current ACC/AHA guidelines place a strong emphasis on the initiation or maintenance of statin drugs for patients hospitalized with AMI, particularly those with LDL-cholesterol levels above 100 mg/dL (Smith, 2011; Anderson, 2007; and O'Gara, 2013). As a result of the strength of the evidence and guideline support, the ACC/AHA have developed a performance measure to assess this aspect of care for patients with acute myocardial infarction (Krumholz, 2008). Because statins are generally well-tolerated, most patients with AMI are appropriate candidates for this therapy.Several randomized clinical trials have proven the benefits of statin drugs (also known as HMG Co-A reductase inhibitors) in reducing the risk of death and recurrent cardiovascular events in a broad range of patients with established cardiovascular disease, including those with prior myocardial infarction.Improvement noted as an increase in rateAnderson JL, Adams CD, Antman EM, Bridges CR, Califf RM, Casey DE Jr, et al. ACC/AHA 2007 guidelines for the management of patients with unstable angina/non-ST-elevation myocardial infarction: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Revise the 2002 Guidelines for the Management of Patients With Unstable Angina/Non-ST-Elevation Myocardial Infarction): developed in collaboration with the American College of Emergency Physicians, American College of Physicians, Society for Academic Emergency Medicine, Society for Cardiovascular Angiography and Interventions, and Society of Thoracic Surgeons. J Am Coll Cardiol. 2007;50:e1-157. - -Krumholz HM, Anderson JL, Bachelder BL, Fesmire FM, Fihn SD, Foody JM, et al. ACC/AHA 2008 performance measures for adults with ST-elevation and non-ST-elevation myocardial infarction: a report of the American College of Cardiology/American Heart Association Task Force on Performance Measures (Writing Committee to Develop Performance Measures for ST-Elevation and Non-ST-Elevation Myocardial Infarction). J Am Coll Cardiol. 2008;52:2046-99.The Long-Term Intervention with Pravastatin in Ischaemic Disease (LIPID) Study Group. Prevention of cardiovascular events and death with pravastatin in patients with coronary heart disease and a broad range of initial cholesterol levels. N Engl J Med. 1998;339:1349-57. -MRC/BHF Heart Protection Study of cholesterol lowering with simvastatin in 20,536 high-risk individuals: a randomised placebo-controlled trial. Lancet. 2002;360:7-22.O'Gara PT, Kushner FG, Ascheim DD, Casey DE, Jr, Chung MK, de Lemos JA, et al. 2013 ACCF/AHA guideline for the management of ST-elevation myocardial infarction: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines. J Am Coll Cardiol 2013;61:485-510. -Randomised trial of cholesterol lowering in 4444 patients with coronary heart disease: the Scandinavian Simvastatin Survival Study (4S). Lancet. 1994;344:1383-9.Sacks FM, Pfeffer MA, Moye LA, et al, for the Cholesterol and Recurrent Events Trial investigators. The effect of pravastatin on coronary events after myocardial infarction in patients with average cholesterol levels. N Engl J Med. 1996;335:1001-9. -Smith SC Jr, Benjamin EJ, Bonow RO, Braun LT, Creager MA, et al. AHA/ACCF secondary prevention and risk reduction therapy for patients with coronary and other atherosclerotic vascular disease: 2011 update: a guideline from the American Heart Association and American College of Cardiology Foundation. Circulation. 2011;124:2458-2473. -NoneExclusion element guidance: -Medical or patient reasons for not performing a test or giving a medication are categories for valid medical or patient reasons that are not specifically listed in the exclusion section of the measure. Each is expected to be captured and made available for measurement or clinical decision support within the EHR workflow but the exact method or location of capture is a local or vendor decision.TBDPatients age 18 and older at the time of hospital admission with a principal diagnosis of Acute Myocardial Infarction (AMI) with hospital stays <= 120 days during the measurement year.All patients in the Initial Population* Patients with Comfort Measures documented -* Patients discharged to another hospital -* Patients who left against medical advice -* Patients who expired -* Patients discharged to home for hospice care -* Patients discharged to a health care facility for hospice careAMI patients who are prescribed a statin medication at hospital discharge.NonePatients with LDL of less than 100 mg/dL within the first 24 hours after hospital arrival or 30 days prior to hospital arrival. - -Or patients with a documented Reason for Not Prescribing Statin Medication at Discharge. This includes patients with a statin allergy, the administration of statin medications are on HOLD, or a medical or patient reason for not prescribing a statin.Not applicableNot applicableNot applicableFor every patient evaluated by this measure also identify payer, race, ethnicity, and sex.Acute Myocardial Infarction (AMI) - - \ No newline at end of file diff --git a/test/fixtures/hqmf/simplexml/CMS31v4_SimpleXML.xml b/test/fixtures/hqmf/simplexml/CMS31v4_SimpleXML.xml deleted file mode 100755 index cac8af15..00000000 --- a/test/fixtures/hqmf/simplexml/CMS31v4_SimpleXML.xml +++ /dev/null @@ -1,3 +0,0 @@ -40280381-4c18-79df-014c-2864b0a404c5Hearing Screening Prior To Hospital DischargeNQF1354310924fbae-3fdb-4d0a-aab7-9f354e699fde4.0.0000000010100001231CDC National Center on Birth Defects and Developmental DisabilitiesCDC Early Hearing Detection and Intervention ProgramNational Quality ForumThis measure assesses the proportion of births that have been screened for hearing loss before hospital discharge.NoneThese performance measures are not clinical guidelines and do not establish a standard of medical care, and have not been tested for all potential applications. The measures and specifications are provided without warranty. CMS has contracted with Mathematica Policy Research and its subcontractors, Lantana and Telligen, for the continued maintenance of this electronic measure.ProportionProcessNoneNoneNoneBirthing facility staff should review the effectiveness and timeliness of screening relative to nursery discharge. Benchmarks set within the EHCP may trigger hospital or jurisdictional compliance activities, such as re-writing of procedural guidelines or re-training of screening staff.NoneImprovement noted as an increase in rate.HRSA Title V Block Grant MCHB Performance Measure: Percentage of newborns who have been screened for hearing before hospital discharge.U.S. Preventive Services Task Force (http://www.ahrq.gov/clinic/uspstf/uspsnbhr.htm) Year 2007 Position Statement: Principles and Guidelines for Early Hearing Detection and Intervention Programs. Joint Committee on Infant Hearing. Pediatrics 2007;120;898-921 (http://pediatrics.aappublications.org/cgi/content/full/120/4/898?ijkey=oj9BAleq21OlA&keytype=ref&siteid=aapjournals)HRSA Title V Block Grant MCHB Performance Measure: Percentage of newborns who have been screened for hearing before hospital discharge.NoneThe measurement period is one calendar year but the reporting period is jurisdictionally defined.TBDLive birth encounters at a hospital or birthing facility where the newborn was discharged during the measurement period.Denominator is equal to the Initial Population.Live birth encounters where the patient expires prior to discharge and has not received hearing screening for the left or right ear.Live birth encounters during the measurement period where a patient born at the facility is screened for hearing loss prior to discharge or not screened due to medical reasons.Not applicableNoneNot applicableNot applicableNot applicableFor every patient evaluated by this measure also identify payer, race, ethnicity and sex.Early Hearing Detection and Intervention (EHDI) - - \ No newline at end of file diff --git a/test/fixtures/hqmf/simplexml/CMS32v5_SimpleXML.xml b/test/fixtures/hqmf/simplexml/CMS32v5_SimpleXML.xml deleted file mode 100755 index 197cd79b..00000000 --- a/test/fixtures/hqmf/simplexml/CMS32v5_SimpleXML.xml +++ /dev/null @@ -1,14 +0,0 @@ -40280381-4c18-79df-014c-291ef3f90654Median Time from ED Arrival to ED Departure for Discharged ED PatientsED-3323fd13096-2c8f-40b5-9297-b714e8de91335.0.0000000010100001231Centers for Medicare & Medicaid Services (CMS)Oklahoma Foundation for Medical QualityNational Quality ForumMedian elapsed time from emergency department arrival to emergency room departure for patients discharged from the emergency department.Measure specifications are in the Public Domain - -LOINC(R) is a registered trademark of the Regenstrief Institute. - -This material contains SNOMED Clinical Terms(R) (SNOMED CT(C)) copyright 2004-2014 International Health Terminology Standards Development Organization. All rights reserved.These performance measures are not clinical guidelines and do not establish a standard of medical care, and have not been tested for all potential applications. The measures and specifications are provided without warranty. CMS has contracted with Mathematica Policy Research and its subcontractors, Lantana and Telligen, for the continued maintenance of this electronic measure.Continuous VariableProcessReport total score and the following strata: -Stratum 1 - all patients with principal diagnosis consistent with mental disorders; -Stratum 2 - all patients transferred to another acute care hospital; and -Stratum 3 - all patients other than those included in strata 2 and 3.NoneCalculate the ED encounter duration at the facility in minutes for each ED encounter in the measure population; report the median time for all calculations performed. The specification provides elements from the clinical electronic record required to calculate for each ED encounter, i.e., the length of time the patient was in the Emergency Department, also stated as: the Datetime difference between the Emergency Department facility location departure time and the Emergency Department facility location arrival time. The calculation requires the median across all ED encounter durations.In recent times, EDs have experienced significant overcrowding. Although once only a problem in large, urban, teaching hospitals, the phenomenon has spread to other suburban and rural healthcare organizations. According to a 2002 national U.S. survey, more than 90 percent of large hospitals report EDs operating "at" or "over" capacity. Overcrowding and heavy emergency resource demand have led to a number of problems, including ambulance refusals, prolonged patient waiting times, increased suffering for those who wait, rushed and unpleasant treatment environments, and potentially poor patient outcomes. Approximately one third of hospitals in the U.S. report increases in ambulance diversion in a given year, whereas up to half report crowded conditions in the ED. In a recent national survey, 40 percent of hospital leaders viewed ED crowding as a symptom of workforce shortages. ED crowding may result in delays in the administration of medication such as antibiotics for pneumonia and has been associated with perceptions of compromised emergency care. For patients with non-ST-segment-elevation myocardial infarction, long ED stays were associated with decreased use of guideline-recommended therapies and a higher risk of recurrent myocardial infarction. When EDs are overwhelmed, their ability to respond to community emergencies and disasters may be compromised.Reducing the time patients remain in the emergency department (ED) can improve access to treatment and increase quality of care. Reducing this time potentially improves access to care specific to the patient condition and increases the capability to provide additional treatment.Improvement noted as a decrease in the median valueDiercks DB, et al. Prolonged emergency department stays of non-ST-segment-elevation myocardial infarction patients are associated with worse adherence to the American College of Cardiology/American Heart Association guidelines for management and increased adverse events. Ann Emerg Med.2007;50:489-96.Derlet RW, Richards JR. Emergency department overcrowding in Florida, New York, and Texas. South Med J. 2002;95:846-9.Derlet RW, Richards JR. Overcrowding in the nation's emergency departments: complex causes and disturbing effects. Ann Emerg Med. 2000; 35:63-8.Fatovich DM, Hirsch RL. Entry overload, emergency department overcrowding, and ambulance bypass. Emerg Med J. 2003; 20:406-9.Hwang U, Richardson LD, Sonuyi TO, Morrison RS. The effect of emergency department crowding on the management of pain in older adults with hip fracture. J Am Geriatr Soc. 2006; 54:270-5.Institute of Medicine of the National Academies. Future of emergency care: Hospital-based emergency care at the breaking point. The National Academies Press 2006.Kyriacou DN, Ricketts V, Dyne PL, McCollough MD, Talan DA. A 5-year time study analysis of emergency department patient care efficiency. Ann Emerg Med. 1999;34:326-35Pines JM, et al. ED crowding is associated with variable perceptions of care compromise. Acad Emerg Med. 2007;14:1176-81.Pines JM, et al. Emergency department crowding is associated with poor care for patients with severe pain. Ann Emerg Med. 2008;51:6-7.Schull MJ, et al. Emergency department crowding and thrombolysis delays in acute myocardial infarction. Ann Emerg Med. 2004;44:577-85.Siegel B, et al. Enhancing work flow to reduce crowding. Jt Comm J Qual Patient Saf. 2007;33(11 Suppl):57-67.Trzeciak S, Rivers EP. Emergency department overcrowding in the United States: an emerging threat to patient safety and public health. Emerg Med J. 2003;20:402-5.Wilper AP, Woolhandler S, Lasser KE, McCormick D, Cutrona SL, Bor DH, Himmelstein DU. Waits to see an emergency department physician: U.S. trends and predictors, 1997-2004. Health Aff (Millwood). 2008;27:w84-95.NoneThis measure uses a continuous variable. The specification provides elements from the clinical electronic record required to calculate for each ED encounter, i.e., the length of time the patient was in the Emergency Department, also stated as: the Emergency Department departure time minus the Emergency Department arrival time. The calculation requires the median of all ED encounter durations. This measure specification defines how to determine an individual Emergency Department stay. Reporting requires the median of all patient stays ([Encounter: encounter ED].departuredatetime - [Encounter: encounter ED].arrivaldatetime). - -For each population, results should be reported without stratification and then with each stratum applied. For this measure, the number of encounters that fall into the Initial Population are reported without stratification, then reported according to the defined stratification. The number of encounters that fall into the Measure Population are reported without stratification, then reported according to the defined stratification. The computed continuous variable defined by the Measure Observation is reported for the Measure Population also, then reported according to the defined stratification. - -The measurement period is one calendar year but the reporting period is 3 months as a calendar quarter; Q1 = Jan - Mar, Q2 = Apr - Jun, Q3 = Jul - Sep, Q4 is Oct - Dec.TBDEmergency department encounters discharged during the measurement period.Not applicableNot applicableNot applicableNot applicableNot applicableEmergency department encounters discharged during the measurement period.Emergency department encounters where the patient expired during the encounter. Median elapsed time (in minutes) from emergency department arrival to emergency room departure for patients discharged from the emergency department.For every patient evaluated by this measure also identify payer, race, ethnicity and sex.Emergency Department - - \ No newline at end of file diff --git a/test/fixtures/hqmf/simplexml/CMS50v4_SimpleXML.xml b/test/fixtures/hqmf/simplexml/CMS50v4_SimpleXML.xml deleted file mode 100755 index e31962cd..00000000 --- a/test/fixtures/hqmf/simplexml/CMS50v4_SimpleXML.xml +++ /dev/null @@ -1,22 +0,0 @@ -40280381-4c5d-0de2-014c-70a4a2690d14Closing the Referral Loop: Receipt of Specialist ReportClosing the referral loop50f58fc0d6-edf5-416a-8d29-79afbfd24dea4.0.0000000010100001231Centers for Medicare & Medicaid Services (CMS)National Committee for Quality AssurancePercentage of patients with referrals, regardless of age, for which the referring provider receives a report from the provider to whom the patient was referred.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 CPT or other codes contained in the specifications. - -CPT(R) contained in the Measure specifications is copyright 2004-2014 American Medical Association. LOINC(R) copyright 2004-2014 Regenstrief Institute, Inc. This material contains SNOMED Clinical Terms(R) (SNOMED CT[R]) copyright 2004-2014 International Health Terminology Standards Development Organisation.These performance Measures are not clinical guidelines and do not establish a standard of medical care, and have not been tested for all potential applications. - -THE MEASURES 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].ProportionProcessNoneNoneNoneProblems in the outpatient referral and consultation process have been documented, including lack of timeliness of information and inadequate provision of information between the specialist and the requesting physician (Gandhi, 2000; Forrest, 2000; Stille, 2005). In a study of physician satisfaction with the outpatient referral process, Gandhi et al. (2000) found that 68% of specialists reported receiving no information from the primary care provider prior to referral visits, and 25% of primary care providers had still not received any information from specialists 4 weeks after referral visits. In another study of 963 referrals (Forrest, 2000), pediatricians scheduled appointments with specialists for only 39% and sent patient information to the specialists in only 51% of the time. - -In a 2006 report to Congress, MedPAC found that care coordination programs improved quality of care for patients, reduced hospitalizations, and improved adherence to evidence-based care guidelines, especially among patients with diabetes and CHD. Associations with cost-savings were less clear; this was attributed to how well the intervention group was chosen and defined, as well as the intervention put in place. Additionally, cost-savings were usually calculated in the short-term, while some argue that the greatest cost-savings accrue over time (MedPAC, 2006). - -Improved mechanisms for information exchange could facilitate communication between providers, whether for time-limited referrals or consultations, on-going co-management, or during care transitions. For example, a study by Branger et al. (1999) found that an electronic communication network that linked the computer-based patient records of physicians who had shared care of patients with diabetes significantly increased frequency of communications between physicians and availability of important clinical data. There was a 3-fold increase in the likelihood that the specialist provided written communication of results if the primary care physician scheduled appointments and sent patient information to the specialist (Forrest, 2000). - -Care coordination is a focal point in the current health care reform and our nation's ambulatory health information technology (HIT) framework. The National Priorities Partnership recently highlighted care coordination as one of the most critical areas for development of quality measurement and improvement (NPP, 2008).NoneA higher score indicates better qualityBranger, P. J., Van't Hooft, A., Van Der Wouden, J. C., Moorman, P. W., and Van Bemmel, J. H. (1999). Shared care for diabetes: supporting communication between primary and secondary care. International Journal of Medical Informatics 53(2-3), 133-142. -Forrest, C. B., Glade, G. B., Baker, A. E., Bocian, A., Von Schrader, S., and Starfield, B. (2000). Coordination of specialty referrals and physician satisfaction with referral care. Archives of Pediatrics and Adolescent Medicine 154(5), 499-506. -Gandhi, T. K., Sittig, D. F., Franklin, M., Sussman, A. J., Fairchild, D. G., and Bates, D. W. (2000). Communication breakdown in the outpatient referral process. Journal of General Internal Medicine 15(9), 626-631. -Medicare Payment Advisory Commission (MedPAC) Report to the Congress: Medicare Payment Policy.March, 2006. Retrieved September 22, 2009 from http://www.medpac.gov/documents/Mar06_EntireReport.pdf. -National Priorities Partnership. National Priorities and Goals: Aligning Our Efforts to Transform America's Healthcare. Washington, DC: National Quality Forum; 2008. -Stille, C. J., Jerant, A., Bell, D., Meltzer, D., and Elmore, J. G. (2005). Coordinating care across diseases, settings, and clinicians: a key role for the generalist in practice. Annals of Internal Medicine 142(8), 700-708.Referral: A request from one physician or other eligible provider to another practitioner for evaluation, treatment, or co-management of a patient's condition. This term encompasses referral and consultation as defined by Centers for Medicare and Medicaid Services.The provider to whom the patient was referred should be the same provider that sends the report. - -If there are multiple referrals for a patient during the measurement period, use the first referral.TBDNumber of patients, regardless of age, who were referred by one provider to another provider, and who had a visit during the measurement period.Equals Initial PopulationNoneNumber of patients with a referral, for which the referring provider received a report from the provider to whom the patient was referred.Not ApplicableNoneNot ApplicableNot ApplicableNot ApplicableFor every patient evaluated by this measure also identify payer, race, ethnicity and sex.Not Applicable - - \ No newline at end of file diff --git a/test/fixtures/hqmf/simplexml/CMS52v4_SimpleXML.xml b/test/fixtures/hqmf/simplexml/CMS52v4_SimpleXML.xml deleted file mode 100755 index 4434e21c..00000000 --- a/test/fixtures/hqmf/simplexml/CMS52v4_SimpleXML.xml +++ /dev/null @@ -1,30 +0,0 @@ -40280381-4de7-db4d-014d-e8404b8a0178HIV/AIDS: Pneumocystis Jiroveci Pneumonia (PCP) ProphylaxisHIV AIDS Pneumocystis jiroveci521cdd20de-5de9-4759-8a93-31f1f8baaaa24.1.0000000010100001231National Committee for Quality AssuranceNational Committee for Quality AssuranceAmerican Medical Association-convened Physician Consortium for Performance Improvement(R) (AMA-PCPI)National Quality ForumPercentage of patients aged 6 weeks and older with a diagnosis of HIV/AIDS who were prescribed Pneumocystis jiroveci pneumonia (PCP) prophylaxisCopyright 2014 National Committee for Quality Assurance (NCQA) and American Medical Association. All Rights Reserved.Physician Performance Measures (Measures) and related data specifications have been developed by the American Medical Association (AMA) - convened Physician Consortium for Performance Improvement(R) (PCPI(R)) and the National Committee for Quality Assurance (NCQA). These Measures are not clinical guidelines and do not establish a standard of medical care, and have not been tested for all potential applications. The Measures, while copyrighted, can be reproduced and distributed, without modification, for noncommercial purposes, eg, use by health care providers in connection with their practices. Commercial use is defined as the sale, license, or distribution of the Measures for commercial gain, or incorporation of the Measures into a product or service that is sold, licensed or distributed for commercial gain. Commercial uses of the Measures require a license agreement between the user and the AMA, (on behalf of the PCPI) or NCQA. Neither the AMA, PCPI, NCQA nor its members shall be responsible for any use of the Measures. - -THE MEASURES AND SPECIFICATIONS ARE PROVIDED "AS IS" WITHOUT WARRANTY OF ANY KIND. - -Limited proprietary coding is contained in the Measure specifications for convenience. Users of the proprietary code sets should obtain all necessary licenses from the owners of these code sets. The AMA, PCPI, NCQA and its members disclaim all liability for use or accuracy of any Current Procedural Terminology (CPT[R]) or other coding contained in the specifications. - -CPT(R) contained in the Measure specifications is copyright 2004-2014 American Medical Association. LOINC(R) copyright 2004-2014 Regenstrief Institute, Inc. This material contains SNOMED Clinical Terms(R) (SNOMED CT[R]) copyright 2004-2014 International Health Terminology Standards Development Organisation. ICD-10 copyright 2014 World Health Organization. All Rights Reserved. - -Due to technical limitations, registered trademarks are indicated by (R) or [R] and unregistered trademarks are indicated by (TM) or [TM].ProportionProcessNoneNoneNoneAlthough advances in the management of HIV and AIDS diseases have been made, Pneumocystis carinii pneumonia (PCP) remains an important complication and cause of morbidity. Without PCP prophylaxis, patients with HIV/AIDS are at increased risk of developing PCP, especially when CD4 cell counts fall 200mm3-250mm3 (Kaplan, 1998; Phair, 1990). PCP prophylaxis is very effective and has been demonstrated to prolong life. - -Data from Kaiser Permanente suggests that a gap exists between what is recommended for patients with HIV infection, and what is actually performed. According to 2005-2006 data from Kaiser Permanente California (both Northern and Southern), Georgia, and Oregon, only 71% of HIV-infected persons with a CD4<200mm3 received PCP prophylaxis (personal communication, 2007).HIV-infected adults and adolescents, including pregnant women and those on HAART, should receive chemoprophylaxis against PCP if they have a CD4+T lymphocyte count of <200/mL or a history of oropharyngeal candidiasis. (USPH/IDSA, 2002)A higher score indicates better qualityKaplan JE, Hanson DL, Navin TR, Jones JL. Risk factors for primary Pneumocystis carinii pneumonia in human immunodeficiency virus--infected adolescents and adults in the United States: reassessment of indications for chemoprophylaxis. The Journal of Infectious Diseases. 1998;178:1126-32. Personal communication. Michael Horberg, MD, Director, HIV/AIDS Policy, Quality Improvement, Research, The Permanente Federation. 2007 Nov 6. -Phair J, Munoz A, Detels R, Kaslow R, Rinaldo C, Saah A. The risk of Pneumocystis carinii pneumonia among men infected with human immunodeficiency virus type 1. Multicenter AIDS Cohort Study Group. NEJM. 1990 Jan 18;322:161-65. NoneDenominator 1: The CD4 count below 200 cells/mm3 must occur during the first nine months of the year. - -Denominator 2: The CD4 count below 500 cells/mm3 or the CD4 percentage below 15% must occur during the first nine months of the year. - -Once all denominators and numerators are calculated, a total rate should be calculated using the sum of the three denominators and the sum of the three numerators.TBDDenominator 1: All patients aged 6 years and older with a diagnosis of HIV/AIDS and a CD4 count below 200 cells/mm3 who had at least two visits during the measurement year, with at least 90 days in between each visit - -Denominator 2: All patients aged 1-5 years of age with a diagnosis of HIV/AIDS and a CD4 count below 500 cells/mm3 or a CD4 percentage below 15% who had at least two visits during the measurement year, with at least 90 days in between each visit - -Denominator 3: All patients aged 6 weeks to 12 months with a diagnosis of HIV who had at least two visits during the measurement year, with at least 90 days in between each visitEquals Initial PopulationNoneNumerator 1: Patients who were prescribed pneumocystis jiroveci pneumonia (PCP) prophylaxis within 3 months of CD4 count below 200 cells/mm3 - -Numerator 2: Patients who were prescribed pneumocystis jiroveci pneumonia (PCP) prophylaxis within 3 months of CD4 count below 500 cells/ mm3 or a CD4 percentage below 15% - -Numerator 3: Patients who were prescribed Pneumocystis jiroveci pneumonia (PCP) prophylaxis at the time of diagnosis of HIVNot ApplicableNumerator 1: Patient did not receive PCP prophylaxis because there was a CD4 count above 200 cells/mm3 during the three months after a CD4 count below 200 cells/mm3 - -Numerator 2: Patient did not receive PCP prophylaxis because there was a CD4 count above 500 cells/mm3 or CD4 percentage above 15% during the three months after a CD4 count below 500 cells/mm3 or CD4 percentage below 15% - -Numerator 3: NoneNot ApplicableNot ApplicableNot ApplicableFor every patient evaluated by this measure also identify payer, race, ethnicity, and sex.Not Applicable - - \ No newline at end of file diff --git a/test/fixtures/hqmf/simplexml/CMS53v4_SimpleXML.xml b/test/fixtures/hqmf/simplexml/CMS53v4_SimpleXML.xml deleted file mode 100755 index f01d6b6d..00000000 --- a/test/fixtures/hqmf/simplexml/CMS53v4_SimpleXML.xml +++ /dev/null @@ -1,31 +0,0 @@ -40280381-4be2-53b3-014b-ea9da2df05bbPrimary PCI Received Within 90 Minutes of Hospital ArrivalAMI-8a5384b9d0b5-0caf-4e41-b345-3492a23c2e9f4.0.0000000010100001231Centers for Medicare & Medicaid Services (CMS)Oklahoma Foundation for Medical QualityNational Quality ForumAcute myocardial infarction (AMI) patients with ST-segment elevation on the ECG closest to arrival time receiving primary PCI during the hospital stay with a time from hospital arrival to PCI of 90 minutes or less.Measure specifications are in the Public Domain. - -This material contains SNOMED Clinical Terms (R) (SNOMED CT(C)) copyright 2004-2014 International Health Terminology Standards Development Organization. All rights reserved. - -LOINC (R) is a registered trademark of the Regenstrief Institute.These performance measures are not clinical guidelines and do not establish a standard of medical care, and have not been tested for all potential applications. The measures and specifications are provided without warranty. MS has contracted with Mathematica Policy Research and its subcontractors, Lantana and Telligen, for the continued maintenance of this electronic measure.ProportionProcessNoneNoneNoneThe early use of primary angioplasty in patients with ST-segment myocardial infarction (STEMI) results in a significant reduction in mortality and morbidity. The earlier primary coronary intervention is provided, the more effective it is (Brodie, 1998 and DeLuca, 2004). National guidelines recommend the prompt initiation of PCI in patients presenting with ST-elevation myocardial infarction (O'Gara, 2013; Antman and Levine 2011).National guidelines recommend the prompt initiation of PCI in patients presenting with ST-elevation myocardial infarctionImprovement noted as an increase in rateBrodie BR, Stuckey TD, Wall TC, Kissling G, Hansen CJ, Muncy DB, et al. Importance of time to reperfusion for 30-day and late survival and recovery of left ventricular function after primary angioplasty for acute myocardial infarction. J Am Coll Cardiol. 1998;32:1312-9.DeLuca G, Suryapranata H, Ottervanger JP, Antman EM. Time delay to treatment and mortality in primary angioplasty for acute myocardial infarction: every minute of delay counts. Circulation 2004;109(10):1223-1225. -Krumholz HM, Anderson JL, Bachelder BL, Fesmire FM, Fihn SD, Foody JM, et al. ACC/AHA 2008 performance measures for adults with ST-elevation and non-ST-elevation myocardial infarction: a report of the American College of Cardiology/American Heart Association Task Force on Performance Measures (Writing Committee to Develop Performance Measures for ST-Elevation and Non-ST-Elevation Myocardial Infarction). J Am Coll Cardiol. 2008;52:2046-99.Levine GN, Bates ER, Blankenship JC, Bailey SR, Bittl JA, Cercek B, et al. 2011 ACCF/AHA/SCAI guideline for percutaneous coronary intervention: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines and the Society for Cardiovascular Angiography and Interventions. J Am Coll Cardiol. 2011;58:e44-122.O'Gara PT, Kushner FG, Ascheim DD, Casey DE, Jr, Chung MK, de Lemos JA, et al. 2013 ACCF/AHA guideline for the management of ST-elevation myocardial infarction: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines. J Am Coll Cardiol 2013;61:485-510.NoneTo identify the ECG closest to hospital arrival, the denominator will identify the most recent ECG performed that starts less than 1 hour prior to the emergency department (ED) or inpatient encounter OR the first ECG performed starts after the ED or inpatient encounter started. - -For the denominator data element "Diagnostic Study, Performed : Electrocardiogram (ECG) (result: NSTEMI)" EHR implementations will need to develop mechanisms to capture ECG findings to support denominator criteria for this measure. The measure specification indicates allowable findings. The source of the ECG results should be a physician/APN/PA (rather than the ECG machine's computerized results). - -Numerator element guidance: -This measure expects a PCI procedure within 90 minutes of hospital arrival. Those patients receiving PCI procedures greater than 90 minutes after arrival may be excluded from the denominator only if there is a documented reason for a delay or documented occurrence of intubation, cardiopulmonary arrest or mechanical circulatory assist device placement within the first 90 minutes after arrival. Patients receiving PCI procedures greater than 90 minutes after arrival and with no reason provided are not compliant with the numerator criteria and will remain in the denominator. - -Denominator and Numerator element guidance: -For the denominator and numerator data element "Occurrence A of Procedure, Performed: PCI" and time of start, EHR implementations will need to develop mechanisms to capture the time the balloon was inflated, the time the stent was deployed, or the time a thrombectomy device was used to treat the lesion, whichever is earliest. - -Exclusion element guidance: -Transfers from another hospital are excluded since care may have been delivered in the other setting. Transfers from those hospitals are considered exclusions regardless of whether the receiving hospital has the same or different hospital unique identifier as the transferring hospital. - -PCI procedures analyzed in this measure must be primary procedures. Primary includes emergent or urgent PCI procedures and not those described by the physician/APN/PA anywhere in the record as elective, not emergent, not immediate, not primary, not urgent, or secondary. - -From a clinical standpoint, Primary PCI is loosely defined as percutaneous coronary intervention performed in the acute setting in patients with ST segment elevation MI which is intended to restore perfusion in the infarct-related artery. In randomized trials and observational studies, this therapy is associated with significant reductions in the risks of adverse events, including death, in selected patients with STEMI. - -Exception element guidance: -Medical or patient reasons for not performing a procedure or giving a medication are categories for valid medical or patient reasons that are not specifically listed in the exclusion section of the measure. Each is expected to be captured and made available for measurement or clinical decision support within the EHR workflow but the exact method or location of capture is a local or vendor decision. - -Denominator, Numerator, Exclusion and Exception element guidance: -The criteria indicate scenarios in which the patient is admitted to the hospital directly or the patient is admitted from the Emergency Department (ED). The calculation is to indicate the timing from arrival at the facility to the occurrence of an event.TBDPatients age 18 and older at the time of hospital admission or ED visit with a principal diagnosis of Acute Myocardial Infarction (AMI) with hospital stays <= 120 days during the measurement year. Initial Population and an ECG (result: Acute or Evolving MI) closest to inpatient admission and a primary PCI procedure.Patients received as a transfer from an inpatient or outpatient department of another hospital. -Patients received as a transfer from the emergency/observation department of another hospital. -Patients received as a transfer from an ambulatory surgery center.AMI patients whose time from hospital arrival to primary PCI is 90 minutes or less.Not applicablePatients who have a specified medical diagnosis or procedure performed are the exception.Not applicableNot ApplicableNot applicableFor every patient evaluated by this measure also identify payer, race, ethnicity, and sex.Acute Myocardial Infarction (AMI) - - \ No newline at end of file diff --git a/test/fixtures/hqmf/simplexml/CMS55v4_SimpleXML.xml b/test/fixtures/hqmf/simplexml/CMS55v4_SimpleXML.xml deleted file mode 100755 index 17d4dce8..00000000 --- a/test/fixtures/hqmf/simplexml/CMS55v4_SimpleXML.xml +++ /dev/null @@ -1,16 +0,0 @@ -40280381-4c18-79df-014c-2414260502adMedian Time from ED Arrival to ED Departure for Admitted ED PatientsMedian ED Time559a033274-3d9b-11e1-8634-00237d5bf1744.0.0000000010100001231Centers for Medicare & Medicaid Services (CMS)Oklahoma Foundation for Medical QualityNational Quality ForumMedian time from emergency department admission to time of discharge from the emergency room for patients admitted to the facility from the emergency department.Measure specifications are in the Public Domain - -LOINC(R) is a registered trademark of the Regenstrief Institute. - -This material contains SNOMED Clinical Terms(R) (SNOMED CT(C)) copyright 2004-2014 International Health Terminology Standards Development Organization. All rights reserved.These performance measures are not clinical guidelines and do not establish a standard of medical care, and have not been tested for all potential applications. The measures and specifications are provided without warranty. - -CMS has contracted with Mathematica Policy Research and its subcontractors, Lantana and Telligen, for the continued maintenance of this electronic measure.Continuous VariableProcessReport total score and the following strata: -Stratum 1 - all patients seen in the ED and admitted as an inpatient who do not have a principal diagnosis consistent with psychiatric/mental health disorders -Stratum 2 - all patients seen in the ED and admitted as an inpatient who have a principal diagnosis consistent with psychiatric/mental health disordersNoneCalculate the ED encounter duration in minutes for each ED encounter in the measure population; report the median time for all calculations performed. The specification provides elements from the clinical electronic record required to calculate for each ED encounter, i.e., the length of time the patient was in the Emergency Department, also stated as: the Datetime difference between the Emergency Department discharge time and the Emergency Department admission time. The calculation requires the median across all ED encounter durations.In recent times, EDs have experienced significant overcrowding. Although once only a problem in large, urban, teaching hospitals, the phenomenon has spread to other suburban and rural healthcare organizations. According to a 2002 national U.S. survey, more than 90% of large hospitals report EDs operating "at" or "over" capacity. Approximately one third of hospitals in the US report increases in ambulance diversion in a given year, whereas up to half report crowded conditions in the ED. In a recent national survey, 40% of hospital leaders viewed ED crowding as a symptom of workforce shortages. ED crowding may result in delays in the administration of medication such as antibiotics for pneumonia and has been associated with perceptions of compromised emergency care. For patients with non-ST-segment-elevation myocardial infarction, long ED stays were associated with decreased use of guideline-recommended therapies and a higher risk of recurrent myocardial infarction. Overcrowding and heavy emergency resource demand have led to a number of problems, including ambulance refusals, prolonged patient waiting times, increased suffering for those who wait, rushed and unpleasant treatment environments, and potentially poor patient outcomes. When EDs are overwhelmed, their ability to respond to community emergencies and disasters may be compromised.Reducing the time patients remain in the emergency department (ED) can improve access to treatment and increase quality of care. Reducing this time potentially improves access to care specific to the patient condition and increases the capability to provide additional treatment.Improvement noted as a decrease in the median valueDiercks DB, et al. Prolonged emergency department stays of non-ST-segment-elevation myocardial infarction patients are associated with worse adherence to the American College of Cardiology/American Heart Association guidelines for management and increased adverse events. Ann Emerg Med. 2007;50:489-96.Derlet RW, Richards JR. Emergency department overcrowding in Florida, New York, and Texas. South Med J. 2002;95:846-9.Derlet RW, Richards JR. Overcrowding in the nation's emergency departments: complex causes and disturbing effects. Ann Emerg Med. 2000;35:63-8.Fatovich DM, Hirsch RL. Entry overload, emergency department overcrowding, and ambulance bypass. Emerg Med J. 2003;20:406-9. -Hwang U, Richardson LD, Sonuyi TO, Morrison RS. The effect of emergency department crowding on the management of pain in older adults with hip fracture. J Am Geriatr Soc. 2006;54:270-5.Institute of Medicine of the National Academies. Future of emergency care: Hospital-based emergency care at the breaking point. The National Academies Press 2006.Kyriacou DN, Ricketts V, Dyne PL, McCollough MD, Talan DA. A 5-year time study analysis of emergency department patient care efficiency. Ann Emerg Med. 1999;34:326-35.Pines JM, et al. ED crowding is associated with variable perceptions of care compromise. Acad Emerg Med. 2007;14:1176-81.Pines JM, et al. Emergency department crowding is associated with poor care for patients with severe pain. Ann Emerg Med. 2008;51:6-7.Schull MJ, et al. Emergency department crowding and thrombolysis delays in acute myocardial infarction. Ann Emerg Med. 2004;44:577-85.Siegel B, et al. Enhancing work flow to reduce crowding. Jt Comm J Qual Patient Saf. 2007;33(11 Suppl):57-67.Trzeciak S, Rivers EP. Emergency department overcrowding in the United States: an emerging threat to patient safety and public health. Emerg Med J. 2003;20:402-5.Wilper AP, Woolhandler S, Lasser KE, McCormick D, Cutrona SL, Bor DH, Himmelstein DU. Waits to see an emergency department physician: U.S. trends and predictors, 1997-2004. Health Aff (Millwood). 2008;27:w84-95.NoneThis measure specification defines how to determine the duration of an individual Emergency Department encounter. Reporting requires the median of all ED encounter durations defined as [Encounter: encounter ED] discharge date and time minus [Encounter: encounter ED] ED admission date and time. - -Calculate the ED time in minutes for each person in the measure population; report the median time for all calculations performed. The specification provides elements from the clinical electronic record required to calculate for each ED encounter, i.e., the length of time the patient was in the Emergency Department, also stated as: the Datetime difference between the Emergency Department discharge time and the Emergency Department admission time. The calculation requires the median across all ED encounter durations. - -For each population, results should be reported without stratification and then with each stratum applied. For this measure, the number of encounters that fall into the Initial Population are reported without stratification, then reported according to the defined stratification. The number of encounters that fall into the Measure Population are reported without stratification, then reported according to the defined stratification. The computed continuous variable defined by the Measure Observation is reported for the Measure Population also, then reported according to the defined stratification.TBDInpatient Encounters ending during the measurement period with Length of Stay (Discharge Date minus Admission Date) less than or equal to 120 days.Not ApplicableNot ApplicableNot ApplicableNot ApplicableNot ApplicableInpatient Encounters preceded by an emergency department visit.Not ApplicableTime (in minutes) from ED admission to ED discharge for patients admitted to the facility from the emergency department.For every patient evaluated by this measure, also identify payer, race, ethnicity and sex.Emergency Department - - \ No newline at end of file diff --git a/test/fixtures/hqmf/simplexml/CMS56v4_SimpleXML.xml b/test/fixtures/hqmf/simplexml/CMS56v4_SimpleXML.xml deleted file mode 100755 index 8afa27ef..00000000 --- a/test/fixtures/hqmf/simplexml/CMS56v4_SimpleXML.xml +++ /dev/null @@ -1,11 +0,0 @@ -40280381-4be2-53b3-014b-e5f6100801edFunctional Status Assessment for Hip ReplacementFunctional Status Assessment Hip562f291003-3f2f-48af-bef9-e5aacb95ac3e4.0.0000000010100001231Centers for Medicare & Medicaid Services (CMS)National Committee for Quality AssurancePercentage of patients aged 18 years and older with primary total hip arthroplasty (THA) who completed baseline and follow-up (patient-reported) functional status assessmentsLimited proprietary coding is contained in the Measure specifications for user convenience. Users of proprietary code sets should obtain all necessary licenses from the owners of the code sets. NCQA disclaims all liability for use or accuracy of any CPT or other codes contained in the specifications. - -CPT(R) contained in the Measure specifications is copyright 2004-2014 American Medical Association. LOINC(R) copyright 2004-2014 Regenstrief Institute, Inc. This material contains SNOMED Clinical Terms(R) (SNOMED CT[R]) copyright 2004-2014 International Health Terminology Standards Development Organisation.These performance Measures are not clinical guidelines and do not establish a standard of medical care, and have not been tested for all potential applications. - -THE MEASURES 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].ProportionProcessNoneNoneNoneMeasuring functional status for patient undergoing total hip replacement permits longitudinal assessment - from the patient's perspective - of the impact of surgical intervention on pain, physical function, as well as health-related quality of life (Rothrock 2010).Clinicians should ask patients to report on functional status during at least two points in time while undergoing treatment: before surgery and after a period of post-surgical recovery.A higher score indicates better qualityBachmeier CJ, March LM, Cross MJ, Lapsley HM, Tribe KL, Courtenay BG et al. A comparison of outcomes in osteoarthritis patient undergoing total hip and knee replacement surgery. Osteoarthritis Cartilage 2001; 9:137-146.Rose M, Bjorner JB, Becker J, Fries JF, Ware JE. Evaluation of a preliminary physical function item bank supported expected advantages of the Patient-Reported Outcomes Measurement Information System (PROMIS). J Clin Epidemiol 2008; 61:17-33.Rothrock NE, Hays RD, Spritzer K, Yount SE, Riley W, Cella D. Relative to the general US population, chronic diseases are associated with poorer health-related quality of life as measured by the Patient-Reported Outcomes Measurement Information System (PROMIS). J Clin Epidemiol 2010; 63(11):1195-204.Selim AJ, Berlowitz D, Kazis LE, Rogers W, Wright SM, Qian SX, Rohendler JA, Spiro A, Miller D, Selim BJ, Fincke BG. Comparison of Health Outcomes for Male Seniors in the Veterans Health Administration and Medicare Advantage Plans. Health Services Research 2010; 45(2): 376-396.NoneA Functional Status Assessment (FSA) is based on administration of a validated instrument to eligible patients that asks patients to answer questions related to various domains including: pain, physical function, emotional well-being, health-related quality of life, symptom acuity. - -The use of patient-reported outcomes data in eMeasures - such as this measure of functional status - demonstrates the need for the Quality Reporting Data Architecture (QRDA) to support a data attribute that indicates that the patient provided the information.TBDAdults aged 18 and older who had a primary total hip arthroplasty (THA) within the 12 month period that begins 180 days before the start of the measurement period and ends 185 days after the start of the measurement period and who had an outpatient encounter not more than 180 days prior to procedure, and at least 60 days and not more than 180 days after THA procedure.Equals Initial PopulationPatients with multiple trauma at the time of the total hip arthroplasty or patients with severe cognitive impairmentPatients with patient reported functional status assessment results (eg, VR-12, VR-36,PROMIS-10-Global Health, PROMIS-29, HOOS) not more than 180 days prior to the primary THA procedure, and at least 60 days and not more than 180 days after THA procedure.Not ApplicableNoneNot ApplicableNot ApplicableNot ApplicableFor every patient evaluated by this measure also identify payer, race, ethnicity, and sex.Not Applicable - - \ No newline at end of file diff --git a/test/fixtures/hqmf/simplexml/CMS60v4_SimpleXML.xml b/test/fixtures/hqmf/simplexml/CMS60v4_SimpleXML.xml deleted file mode 100755 index c57f8a73..00000000 --- a/test/fixtures/hqmf/simplexml/CMS60v4_SimpleXML.xml +++ /dev/null @@ -1,24 +0,0 @@ -40280381-4be2-53b3-014b-eb39a1a60681Fibrinolytic Therapy Received Within 30 Minutes of Hospital ArrivalFibrinolytic Therapy60909cf4b4-7a85-4abf-a1c7-cb597ed1c0b64.0.0000000010100001231Centers for Medicare & Medicaid Services (CMS)Oklahoma Foundation for Medical QualityNational Quality ForumAcute myocardial infarction (AMI) patients with ST-segment elevation on the ECG closest to arrival time receiving fibrinolytic therapy during the hospital stay and having a time from hospital arrival to fibrinolysis of 30 minutes or less.Measure specifications are in the Public Domain. - -LOINC (R) is a registered trademark of the Regenstrief Institute. - -This material contains SNOMED Clinical Terms (R) (SNOMED CT(C)) copyright 2004-2014 International Health Terminology Standards Development Organization. All rights reserved.These performance measures are not clinical guidelines and do not establish a standard of medical care, and have not been tested for all potential applications. The measures and specifications are provided without warranty. CMS has contracted with Mathematica Policy Research and its subcontractors, Lantana and Telligen, for the continued maintenance of this electronic measure.ProportionProcessNoneNoneNoneTime to fibrinolytic therapy is a strong predictor of outcome in patients with an acute myocardial infarction. Nearly 2 lives per 1000 patients are lost per hour of delay (Fibrinolytic Therapy Trialists' Collaborative Group, 1994). National guidelines recommend that fibrinolytic therapy be given within 30 minutes of hospital arrival in patients with ST-elevation myocardial infarction (O'Gara, 2013).National guidelines recommend that fibrinolytic therapy be given within 30 minutes of hospital arrival in patients with ST-elevation myocardial infarction.Improvement noted as an increase in rateAntman EM, Anbe DT, Armstrong PW, Bates ER, Green LA, Hand M, et al. ACC/AHA guidelines for the management of patients with ST-elevation myocardial infarction: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Committee to Revise the 1999 Guidelines for the Management of Patients With Acute Myocardial Infarction). 2004.Fibrinolytic Therapy Trialists (FTT) Collaborative Group. Indications for fibrinolytic therapy in suspected acute myocardial infarction: collaborative overview of early mortality and major morbidity results from all randomized trials of more than 1000 patients. Lancet. 1994;343:311-22.Krumholz HM, Anderson JL, Bachelder BL, Fesmire FM, Fihn SD, Foody JM, et al. ACC/AHA 2008 performance measures for adults with ST-elevation and non-ST-elevation myocardial infarction: a report of the American College of Cardiology/American Heart Association Task Force on Performance Measures (Writing Committee to Develop Performance Measures for ST-Elevation and Non-ST-Elevation Myocardial Infarction). J Am Coll Cardiol. 2008;52:2046-99.O'Gara PT, Kushner FG, Ascheim DD, Casey DE, Jr, Chung MK, de Lemos JA, et al. 2013 ACCF/AHA guideline for the management of ST-elevation myocardial infarction: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines. J Am Coll Cardiol 2013;61:485-510.NoneTo identify the ECG closest to the hospital arrival, the denominator will identify the most recent ECG performed that starts less than 1 hour prior to the emergency department (ED) or inpatient encounter OR the first ECG performed that starts after the ED or inpatient encounter started. - -Denominator element guidance: -For the denominator data element "Diagnostic Study, Performed: Electrocardiogram (ECG) (result: Acute or Evolving MI)". EHR implementations will need to develop mechanisms to capture ECG findings to support denominator criteria for this measure. The measure specification indicates allowable findings. The source of the ECG results should be a physician/APN/PA (rather than the ECG machine's computerized results). - -Numerator element guidance: -This measure expects fibrinolytic therapy within 30 minutes of hospital arrival. Those patients receiving fibrinolysis greater than 30 minutes after arrival may be excluded from the denominator only if there is a documented reason for a delay or documented occurrence of intubation, cardiopulmonary arrest or mechanical circulatory assist device placement within the first 30 minutes after arrival. Patients receiving fibrinolysis greater than 30 minutes after arrival and with no reason provided are not compliant with the numerator criteria and will remain in the denominator. - -Exclusion element guidance: -Transfers from another hospital are excluded since care may have been delivered in the other setting. Transfers from those hospitals are considered exclusions regardless of whether the receiving hospital has the same or different hospital unique identifier as the transferring hospital. - -Exception element guidance: -Medical or patient reasons for not performing a procedure or giving a medication are categories for valid medical or patient reasons that are not specifically listed in the exclusion section of the measure. Each is expected to be captured and made available for measurement or clinical decision support within the EHR workflow but the exact method or location of capture is a local or vendor decision. - -Denominator, Numerator, Exclusion and Exception element guidance: -The criteria indicate scenarios in which the patient is admitted to the hospital directly or the patient is admitted from the Emergency Department (ED). The calculation is to indicate the timing from arrival at the facility to the occurrence of an event.TBDPatients age 18 and older at the time of ED visit or hospital admission with a principal diagnosis of Acute Myocardial Infarction (AMI) with hospital stays <= 120 days during the measurement year. Includes Initial Population, and patients with an ECG result of acute or evolving MI, who received fibrinolytic therapy 360 minutes starting after the hospital arrival.Patients received as a transfer from an inpatient or outpatient department of another hospital. -Patients received as a transfer from the emergency/observation department of another hospital. -Patients received as a transfer from an ambulatory surgery center.AMI patients whose time from hospital arrival to fibrinolysis is 30 minutes or less.Not ApplicablePatients who did not receive fibrinolytic therapy within 30 minutes and had a documented reason for delay in fibrinolytic therapy. Or who had one of the following procedures performed: Aortic balloon pump insertion; Endotracheal Intubation; or Ventricular Assist Device placement.Not ApplicableNot ApplicableNot ApplicableFor every patient evaluated by this measure also identify payer, race, ethnicity and sex.Acute Myocardial Infarction (AMI) - - \ No newline at end of file diff --git a/test/fixtures/hqmf/simplexml/CMS61v5_SimpleXML.xml b/test/fixtures/hqmf/simplexml/CMS61v5_SimpleXML.xml deleted file mode 100755 index eda56bfc..00000000 --- a/test/fixtures/hqmf/simplexml/CMS61v5_SimpleXML.xml +++ /dev/null @@ -1,122 +0,0 @@ -40280381-4de7-db4d-014d-e95f07e30324Preventive Care and Screening: Cholesterol - Fasting Low Density Lipoprotein (LDL-C) Test PerformedCMS61610a7f0278-a05c-40aa-94a4-70ec44f5c5685.1.0000000010100001231Centers for Medicare & Medicaid Services (CMS)Quality Insights of PennsylvaniaPercentage of patients aged 20 through 79 years whose risk factors have been assessed and a fasting LDL-C test has been performed.Limited proprietary coding is contained in the measure specifications for convenience. Users of the proprietary code sets should obtain all necessary licenses from the owners of these code sets. Quality Insights of Pennsylvania disclaims all liability for use or accuracy of any Current Procedural Terminology (CPT [R]) or other coding contained in the specifications. - -CPT (R) contained in the Measure specifications is copyright 2007- 2015 American Medical Association. - -LOINC (R) copyright 2004-2014 [2.50] Regenstrief Institute, Inc. This material contains SNOMED Clinical Terms (R) (SNOMED CT [R]) copyright 2004-2014 [2014-09] International Health Terminology Standards Development Organization. All Rights Reserved. - -Due to technical limitations, registered trademarks are indicated by (R) or [R] and unregistered trademarks are indicated by (TM) or [TM].These performance measures are not clinical guidelines and do not establish a standard of medical care, and have not been tested for all potential applications. - -THE MEASURES AND SPECIFICATIONS ARE PROVIDED "AS IS" WITHOUT WARRANTY OF ANY KIND.ProportionProcessThere are three criteria for this measure based on the patient's risk category. When a patient could be included in multiple risk categories, the "higher" level of risk will be utilized. -1. Highest Level of Risk: Coronary Heart Disease (CHD) or CHD Risk Equivalent OR 10-Year Framingham Risk >20% -2. Moderate Level of Risk: Multiple (2+) Risk Factors OR 10-Year Framingham Risk 10-20% -3. Lowest Level of Risk: 0 or 1 Risk Factor OR 10-Year Framingham Risk <10%NoneThis measure will be calculated for each of the three strata based on risk category for all patients aged 20 through 79 years who were seen by the eligible professional during the measurement period.The Agency for Healthcare Research and Quality (AHRQ) conducts systematic evidence reviews prior to recommendations issued by the U.S. Preventive Services Task Force (USPSTF). In the systematic evidence review, Screening for Lipid Disorders, (Pignone MP, et. al., 2001), "Coronary Heart Disease (CHD) was identified as the leading cause of morbidity and mortality in the United States, causing nearly 500,000 deaths each year and requiring nearly 12 million hospital days of care per year. It is the leading cause of disabled life-years and is second only to injuries as a cause of life-years lost. The age-adjusted annual death rate for CHD is 100 per 100,000 persons overall and 140 per 100,000 persons among African Americans. The lifetime risk of having a CHD event, calculated at age 40, is estimated to be 49% for men and 32% for women in the United States. CHD accounted for $78 billion in health care costs in 1995" (Pignone MP, et. al., 2001) - -In June 2008, Helfand & Carson (2008) provided a paper called "Screening for Lipid Disorders in Adults: Selective Update of 2001; U.S. Preventive Services Task Force Review" to renew Pignone's (2001) earlier evidence. Helfand & Carson (2008) stated: "Based on the National Health and Examination Survey (NHANES) III data in the general US population, 8.9% of men aged 18-35 and 12.3% of women aged 18-45 have a (Total Cholesterol) TC >240 mg/dL. Among men aged 18-35 and women younger than 40 who do not smoke, do not have a history of hypertension, and do not have diabetes mellitus, no combination of ATP-III risk factors (TC up to 310 mg/dL and systolic blood pressure) would result in a predicted 10-year risk of major cardiovascular events greater than 10%. Some men younger than 35 years of age who smoke and those who have diabetes have a 10-year risk that exceeds 10% but these men can be identified for lipid testing based on their history. In NHANES, among all non-diabetic women aged 40-45 years, the probability of being at intermediate or high risk were 1.45% and 0%, respectively; all of these women had a history of hypertension or smoking" (Helfand M & Carson S, 2008, p. 5). - -The risk of CHD is independently related to several potentially modifiable risk factors besides abnormal lipids, including smoking, diabetes, hypertension, and physical inactivity. Recent epidemiologic studies and basic science research expanded knowledge about several new potential CHD risk factors. Use of a Framingham risk-based algorithm that directly incorporates age, the presence and magnitude of other risk factors, and measures of total cholesterol and HDL is the most accurate approach to risk screening. - -"Screening for lipid disorders by measuring cholesterol levels in adult patients is quite feasible for physicians because it involves ordering only a blood test. Providers appear to have achieved high levels of lipid screening based on population-based patient survey data" (Pignone MP, et. al., 2001, p. 34). This systematic review recommends using a supplemental table to improve the feasibility of a risk-based strategy. In the Helfand & Carson (2008) update to Pignone's "Screening for Lipid Disorders" (Pignone MP et. al. 2001), the researchers state: "We did not identify new evidence relevant to the appropriate interval to screen for hyperlipidemia in the general population, or in subgroups of the general population" (Helfand M Carson S, 2008, p. 5). - -The primary recommendation of several advisory groups state that adults should undergo an office-based assessment as the first step to identify patients at a higher CHD risk. The National Cholesterol Education Program Panel III (NCEP-III) has adopted using an adaptation of the risk prediction algorithm originating from the Framingham Heart Study estimating a patient's 10-year risk for developing CHD and has recommended its use as the primary goal of preventive treatment. Stratifying CHD risk includes determining if CHD is present as well as CHD risk equivalents and major CHD risk factors. A history of CHD includes myocardial infarction, myocardial ischemia, angina (stable, unstable), percutaneous transluminal coronary angioplasty & coronary artery bypass surgery. CHD risk equivalents include peripheral artery disease, abdominal aortic aneurysm, thrombotic stroke, transient ischemic attacks, diabetes & Framingham 10-yr CHD risk > 20%. Major CHD risk factors include age, yr (men > 45; women > 55), cigarette smoking, hypertension (BP >140/90 mm Hg) or anti-hypertensive medication, Low HDL-C (<40 mg/dL) & negative risk factor: high HDL-C (>60 mg/dL). The Framingham risk categories include sex, age, systolic blood pressure, smoking status, total cholesterol, and HDL-C levels (NCEP III, 2002). - -Nelson RH (2013) noted that "regardless of the recommendations it is useful to consider how successful the medical community has been in meeting guideline goals... a national survey... showed 67% of ...patients with elevated cholesterol achieved their LDL cholesterol treatment goal". Nelson (2013) also stated "data from the National Health and Nutrition Examination Survey (NHANES) document a steady decline in total cholesterol over several decades, so that in 2002 no more than 17% of US adults had a total cholesterol level of 240 mg/dL or higher. More recent data from an identical survey in 2008 show that the Healthy People 2010 goal of an average cholesterol below 200 mg/dL in all adults ages 20 to 74 was met by both men and women by 2008" (Nelson RH, 2013, p. 202). - -"Based on data from the 2005-2008 NHANES, an estimated 71 million (35.5%) U.S. adults aged>=20 years had high LDL-C, but only 34 million (48.1%) were treated and 23 million (32.2%) had their LDL-C controlled....The prevalence of LDL-C control was lowest among persons who reported receiving medical care less than twice in the previous year (11.7%, being uninsured (13.5%), being Mexican American (20.3%) or having income below the poverty level (21.9%)" (Kuklina EV, et. al., 2011, p. 109).Routine cholesterol testing should begin in young adulthood (>= 20 years of age). When LDL cholesterol concentrations range from 100-129 mg/dL, young adults should be encouraged to modify life habits to minimize long-term risk. In those with borderline high LDL cholesterol (130-159 mg/dL), clinical attention through therapeutic lifestyle changes is needed both to lower LDL cholesterol and to minimize other risk factors. If LDL cholesterol is high (160-189 mg/dL), more intensive clinical intervention should be initiated, with emphasis on therapeutic lifestyle changes. - -However, if LDL cholesterol remains elevated despite therapeutic lifestyle changes, particularly when LDL cholesterol is >= 190 mg/dL, consideration should be given to long-term management with LDL-lowering drugs. - -ATP III recognizes that detection of cholesterol disorders and other coronary heart disease (CHD) risk factors occurs primarily through clinical case finding. Risk factors can be detected and evaluated as part of a person's work-up for any medical problem. Alternatively, public screening programs can identify risk factors, provided that affected individuals are appropriately referred for physician attention. The identification of cholesterol disorders in the setting of a medical examination has the advantage that other cardiovascular risk factors including prior CHD, PVD, stroke, age, sex, family history, cigarette smoking, high blood pressure, diabetes mellitus, obesity, physical inactivity co-morbidities, and other factors can be assessed and considered prior to treatment. - -National Cholesterol Education Program -National Heart, Lung, and Blood Institute -National Institutes of Health -NIH Publication No. 02-5215 -September 2002 - -Wilkinson (2012) states that screening "...must be recommended for men over age 34 and women over age 44 every five years in the "Preventative Services for Adults, Institute for Clinical Systems Improvement (ICSI) Guideline (Wilkinson J, et. al., 2012, p. 20). Varbo (2013) also agreed that "LDL cholesterol is well documented as a causal risk factor for ischemic heart disease" (Varbo A, et. al., 2013, p. 435). - -The U.S. Preventive Services Task Force (USPSTF), 2008 strongly recommends screening men aged 35 and older for lipid disorders (Helfand M & Carson S, 2008, p. 40). - -The USPSTF recommends screening men aged 20 to 35 for lipid disorders if they are at increased risk for coronary heart disease (Helfand M & Carson S, 2008). - -The USPSTF strongly recommends screening women aged 45 and older for lipid disorders if they are at increased risk for coronary heart disease (Helfand M & Carson S, 2008). - -The USPSTF recommends screening women aged 20 to 45 for lipid disorders if they are at increased risk for coronary heart disease (Helfand M & Carson S, 2008). - -The USPSTF makes no recommendation for or against routine screening for lipid disorders in men aged 20 to 35, or in women aged 20 and older who are not at increased risk for coronary heart disease (Helfand M & Carson S, 2008). - -Nelson (2013) agrees that the recommendations of the USPSTF, published in 2008, remain current and viable in 2013 (Nelson RH, 2013). - -The National Strategy for Quality Improvement in Health Care for 2011 has identified the promotion of the most effective prevention and treatment practices for the leading causes of mortality, starting with cardiovascular disease as one of its' national priorities. These priorities are based on the most recent research as well as stakeholder input. Opportunities for success include increase blood pressure control in adults, reduced high cholesterol levels in adults, and decrease smoking among adults and adolescents. Illustrative measures include: - -* Percentage of patients ages 18 years and older with ischemic vascular disease whose most recent blood pressure during the measurement year is <140/90 mm Hg -* Percentage of patients with ischemic vascular disease whose most recent low-density cholesterol is <100 -* Percentage of patients who received evidence-based smoking cessation services (eg, medications) - -The U.S. Department of Health and Human Service's Healthy People 2020 has set a target of 82.1% for HDS-6: Increase the proportion of adults who have had their blood cholesterol checked within the preceding 5 years (a 10% improvement over the next decade).Higher score indicates better quality.Health & Human Services. (2011). The National Strategy for Quality Improvement in Health Care for 2011 -Pignone MP, Phillips CJ, Lannon CM, Mulrow CD, Teutsch SM, Lohr KN, Whitener BL (2001). Screening for lipid disorders. Rockville (MD): Agency for Healthcare Research and Quality (AHRQ) (Systematic evidence review; no. 4). Retrieved from http://guideline.gov/content.aspx?id=12634&search=screening+for+lipid+disorders+in+adultsU. S. Department of Health and Human Services, (2002). Third Report of the National Cholesterol Educational Program Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (Adults Treatment Panel III) Final Report, NIH Publication No. 02-5215Helfand M, Carson S (2008). Screening for lipid disorders in adults: selective update of 2001 U.S. Preventive Services Task Force Review (USPSTF). Evidence Synthesis No. 49. Rockville, MD: Agency for Healthcare Research and Quality (AHRQ). AHRQ Publication no. 08-05114-EF-1. Retrieved: http://www.ahrq.gov/downloads/pub/prevent/pdfser/lipides.pdf.Agency for Healthcare Research and Quality (AHRQ) (2012). The Guide to Clinical Preventive Services 2012: Recommendations of the U.S. Preventive Services Task Force (USPSTF) U.S. Department of Health and Human Services, Agency for Healthcare Research and Quality. AHRQ Pub. No.12-05154: ISBN 978-58763-421-5.Kuklina EV, Shaw M, Hong Y (2011). Division for Heart Disease and Stroke Prevention, National Center for Chronic Disease Prevention and Health Promotion (CDC). Vital signs: prevalence, treatment, and control of high levels of low-density lipoprotein cholesterol; United States, 1999-2002 and 2005-2008. Morbidity and Mortality Weekly Report (MMWR), 60(4), February 4, 2011; 109-114.Nelson RH (2013). Hyperlipidemia as a Risk Factor for Cardiovascular Disease. Prim Care Clin Office Pract 40:195-211.Wilkinson J, Bass C, Diem S, Gravley A, Harvey L, Hayes R, Johnson K, Maciosek M, McKeon K, Milteer L, Morgan J, Rothe P, Snellman L, Solberg L, Storlie C, Vincent P (2012). Institute for Clinical Systems Improvement (ICSI). Preventive Services for Adults Updated September 2012. Retrieved: http://bit.ly.PrevServAdults091.Varbo A, Benn M, Tybjaerg-Hansen A, Jorgensen AB, Frikke-Schmidt R, Nordestgaard BG (2013). Remnant cholesterol as a causal risk factor for ischemic heart disease. Journal of the American College of Cardiology, 61(4):427-436.CHD: -History of CHD includes: -* Myocardial Infarction -* Myocardial Ischemia -* Angina (stable, unstable) -* Percutaneous Transluminal Coronary Angioplasty -* Coronary Artery Bypass Surgery. - -CHD Risk Equivalent: -A CHD risk equivalent is a condition that carries an absolute risk for developing new CHD equal to the risk for having recurrent CHD events in persons with established CHD including: - * Atherosclerotic disease - o Peripheral arterial disease (PAD) - o Carotid artery disease - o Abdominal aortic aneurysm (AAA) - o Stroke -* Diabetes - o Type 1 - o Type 2 -* Framingham 10-yr CHD risk > 20% - -Major CHD Risk Factors: - * Cigarette smoking - * Active diagnosis of hypertension or on antihypertensive medication - * Low HDL cholesterol (HDL-C) (<40 mg/dL) - * Family history of premature CHD - o CHD in male first-degree relative <55 years - OR - o CHD in female first-degree relative <65 years - * Age (men >= 45 years; women >=55 years) - - -10 year Framingham Risk Score: -The Framingham Risk Score will be calculated based on the patient data below and will follow the Adult Treatment Panel (ATP) III Guidelines. (see appendix for calculation unless automatically calculated by EHR) - * Sex - * Age - * Total Cholesterol - Fasting - * HDL Cholesterol - Fasting - * Systolic Blood Pressure (treated or untreated) - * Smoking Status (Cigarette Smoking) - -Most Recent LDL-C Test: A LDL-C test performed or LDL-C result verified by another providerThis is part of a two-part measure which is paired with CMS 64 Preventive Care and Screening: Cholesterol - Risk-Stratified Fasting LDL-C. If the fasting LDL-C test is performed, measure CMS 64 should also be reported. - -To be eligible for performance calculations, patients must have at least one face-to-face visit with the eligible professional during the measurement period. To meet the numerator criteria for this measure, the patient will have one fasting LDL-C performed during the same measurement period with the exception of patients with 0 or 1 risk factors who may have a fasting LDL-C performed up to four (4) years prior to the current measurement periodTBDAll patients 20 through 79 years of age before the beginning of the measurement periodDenominator 1: (High Risk) -All patients aged 20 through 79 years who have CHD or CHD Risk Equivalent OR 10-Year Framingham Risk > 20% - -Denominator 2 : (Moderate Risk) -All patients aged 20 through 79 years who have 2 or more Major CHD Risk Factors OR 10-Year Framingham Risk 10-20% - -Denominator 3 : (Low Risk) -All patients aged 20 through 79 years who have 0 or 1 Major CHD Risk Factors OR 10-Year Framingham Risk <10% -** For Denominator 2 and Denominator 3, Fasting HDL-C > or equal to 60 mg/dL subtracts 1 risk from the above (This is a negative risk factor.)Patients who have an active diagnosis of pregnancy -OR -Patients who are receiving palliative careNumerator 1: (High Risk) -Patients who had a fasting LDL-C test performed or a calculated LDL-C during the measurement period - -Numerator 2 : (Moderate Risk) -Patients who had a fasting LDL-C test performed or a calculated LDL-C during the measurement period - -Numerator 3 : (Low Risk) -Patients who had a fasting LDL-C test performed or a calculated LDL-C during the measurement period or up to four (4) years prior to the current measurement periodNot ApplicablePatient Reason(s): - -Patient Refusal - -A fasting LDL-C test is not performed during the measurement period for a valid patient reason.Not ApplicableNot ApplicableNot ApplicableFor every patient evaluated by this measure also identify payer, race, ethnicity and sex.Preventive Care and Screening - - \ No newline at end of file diff --git a/test/fixtures/hqmf/simplexml/CMS62v4_SimpleXML.xml b/test/fixtures/hqmf/simplexml/CMS62v4_SimpleXML.xml deleted file mode 100755 index 4ff1fb5b..00000000 --- a/test/fixtures/hqmf/simplexml/CMS62v4_SimpleXML.xml +++ /dev/null @@ -1,11 +0,0 @@ -40280381-4b9a-3825-014b-cbbddd080b57HIV/AIDS: Medical VisitHIV/AIDS Medical Visit62f70b2984-af4a-4072-ae0d-cec677a7ff8f4.0.0000000010100001231National Committee for Quality AssuranceNational Committee for Quality AssuranceAmerican Medical Association-convened Physician Consortium for Performance Improvement(R) (AMA-PCPI)Percentage of patients, regardless of age, with a diagnosis of HIV/AIDS with at least two medical visits during the measurement year with a minimum of 90 days between each visitCopyright 2014 National Committee for Quality Assurance (NCQA) and American Medical Association. All Rights Reserved.Physician Performance Measures (Measures) and related data specifications have been developed by the American Medical Association (AMA) - convened Physician Consortium for Performance Improvement(R) (PCPI[R]) and the National Committee for Quality Assurance (NCQA). These Measures are not clinical guidelines and do not establish a standard of medical care, and have not been tested for all potential applications. The Measures, while copyrighted, can be reproduced and distributed, without modification, for noncommercial purposes, eg, use by health care providers in connection with their practices. Commercial use is defined as the sale, license, or distribution of the Measures for commercial gain, or incorporation of the Measures into a product or service that is sold, licensed or distributed for commercial gain. Commercial uses of the Measures require a license agreement between the user and the AMA, (on behalf of the PCPI) or NCQA. Neither the AMA, PCPI, NCQA nor its members shall be responsible for any use of the Measures. - -THE MEASURES AND SPECIFICATIONS ARE PROVIDED "AS IS" WITHOUT WARRANTY OF ANY KIND. - -Limited proprietary coding is contained in the Measure specifications for convenience. Users of the proprietary code sets should obtain all necessary licenses from the owners of these code sets. The AMA, PCPI, NCQA and its members disclaim all liability for use or accuracy of any Current Procedural Terminology (CPT[R]) or other coding contained in the specifications. - -CPT(R) contained in the Measure specifications is copyright 2004-2014 American Medical Association. LOINC(R) copyright 2004-2014 Regenstrief Institute, Inc. This material contains SNOMED Clinical Terms(R) (SNOMED CT[R]) copyright 2004-2014 International Health Terminology Standards Development Organisation. ICD-10 copyright 2014 World Health Organization. All Rights Reserved. - -Due to technical limitations, registered trademarks are indicated by (R) or [R] and unregistered trademarks are indicated by (TM) or [TM].ProportionProcessNoneNoneNoneIn general, patients with early-stage disease are seen at 3-month intervals to undergo routine medical evaluation and monitoring of CD4 cell count, viral load, and CBC. During the initial evaluation more frequent visits are common because there is so much information to transmit. Visits should also be more frequent when therapy is introduced and when the CD4 cell count is <200/mm3 because complications are more likely. (Bartlett, 2004)Clinicians should schedule routine monitoring visits at least every 4 months for all HIV-infected patients who are clinically stable. (NYSDOH, 2004)A higher score indicates better qualityBartlett JG, Cheever LW, Johnson MP, Paauw DS [eds]. A Guide to Primary Care of People with HIV/AIDS. Rockville (MD): US Department of Health and Human Services, Health Resources and Services Administration, HIV/AIDS Bureau; 2004. 167 p. ftp://ftp.hrsa.gov/hab/PCARE04.pdf [Accessed February 19, 2015] New York State Department of Health. Primary care approach to the HIV-infected patient. New York (NY): New York State Department of Health; 2004. 18 p. http://www.hivguidelines.org/Content.aspx?pageID=257 [Accessed August 24, 2007] NoneA medical visit is any visit with a health care professional who provides routine primary care for the patient with HIV/AIDS (may be but is not limited to a primary care clinician, ob/gyn, pediatrician, infectious disease specialist).TBDAll patients, regardless of age, with a diagnosis of HIV/AIDS seen within a 12 month periodEquals Initial PopulationNonePatients with at least two medical visits during the measurement year with a minimum of 90 days between each visitNot ApplicableNoneNot ApplicableNot ApplicableNot ApplicableFor every patient evaluated by this measure also identify payer, race, ethnicity, and sex.Not Applicable - - \ No newline at end of file diff --git a/test/fixtures/hqmf/simplexml/CMS64v5_SimpleXML.xml b/test/fixtures/hqmf/simplexml/CMS64v5_SimpleXML.xml deleted file mode 100755 index 8a32a3f0..00000000 --- a/test/fixtures/hqmf/simplexml/CMS64v5_SimpleXML.xml +++ /dev/null @@ -1,128 +0,0 @@ -40280381-4de7-db4d-014d-e9482dd402edPreventive Care and Screening: Risk-Stratified Cholesterol -Fasting Low Density Lipoprotein (LDL-C)CMS64640336a17b-7c2a-48fc-a657-e9b04269a4cc5.1.0000000010100001231Centers for Medicare & Medicaid Services (CMS)Quality Insights of PennsylvaniaPercentage of patients aged 20 through 79 years who had a fasting LDL-C test performed and whose risk-stratified fasting LDL-C is at or below the recommended LDL-C goal.Limited proprietary coding is contained in the measure specifications for convenience. Users of the proprietary code sets should obtain all necessary licenses from the owners of these code sets. Quality Insights of Pennsylvania disclaims all liability for use or accuracy of any Current Procedural Terminology (CPT [R]) or other coding contained in the specifications. - -CPT (R) contained in the Measure specifications is copyright 2007- 2015 American Medical Association. - -LOINC (R) copyright 2004-2014 [2.50] Regenstrief Institute, Inc. This material contains SNOMED Clinical Terms (R) (SNOMED CT [R]) copyright 2004-2014 [2014-09] International Health Terminology Standards Development Organization. All Rights Reserved. - -Due to technical limitations, registered trademarks are indicated by (R) or [R] and unregistered trademarks are indicated by (TM) or [TM].These performance measures are not clinical guidelines and do not establish a standard of medical care, and have not been tested for all potential applications. - -THE MEASURES AND SPECIFICATIONS ARE PROVIDED "AS IS" WITHOUT WARRANTY OF ANY KIND.ProportionProcessThere are three criteria for this measure based on the patient's risk category. When a patient could be included in multiple risk categories, the "higher" level of risk will be utilized. -1. Highest Level of Risk: Coronary Heart Disease (CHD) or CHD Risk Equivalent OR 10 year Framingham risk > 20% - -2. Moderate Level of Risk: Multiple (2+) Risk Factors OR 10 year Framingham risk 10-20% - -3. Lowest Level of Risk: 0 or 1 Risk Factor OR 10 year Framingham risk < 10%NoneThis measure will be calculated for each of the three strata based on risk category for all patients aged 20 through 79 years who were seen by the eligible professional during the measurement period.The Agency for Healthcare Research and Quality (AHRQ) conducts systematic evidence reviews prior to recommendations issued by the U.S. Preventive Services Task Force (USPSTF). In the systematic evidence review, "Screening for Lipid Disorders" by, (Pignone MP et al. 2001), "Coronary Heart Disease (CHD) was identified as the leading cause of morbidity and mortality in the United States, causing nearly 500,000 deaths each year and requiring nearly 12 million hospital days of care per year. It is the leading cause of disabled life-years and is second only to injuries as a cause of life-years lost. The age -adjusted annual death rate for CHD is 100 per 100,000 persons overall and 140 per 100,000 persons among African Americans. The lifetime risk of having a CHD event, calculated at age 40, is estimated to be 49% for men and 32% for women in the United States. CHD accounted for $78 billion in health care costs in 1995" (Pignone MP, et. al. 2001, p. 1). - -In June 2008, Helfand & Carson (2008) provided a paper called "Screening for Lipid Disorders in Adults: Selective Update of 2001; U.S. Preventive Services Task Force Review" to renew Pignone's (2001) earlier evidence. Helfand & Carson (2008) stated: "Based on the National Health and Examination Survey (NHANES) III data in the general US population, 8.9% of men aged 18-35 and 12.3% of women aged 18-45 have a Total Cholesterol( TC) >240 mg/dL. Among men aged 18-35 and women younger than 40 who do not smoke, do not have a history of hypertension, and do not have diabetes mellitus, no combination of ATP-III risk factors (TC up to 310 mg/dL and systolic blood pressure) would result in a predicted 10-year risk of major cardiovascular events greater than 10%. Some men younger than 35 years of age who smoke and those who have diabetes have a 10-year risk that exceeds 10% but these men can be identified for lipid testing based on their history. In NHANES, among all non-diabetic women aged 40-45 years, the probability of being at intermediate or high risk were 1.45% and 0%, respectively; all of these women had a history of hypertension or smoking" (Helfand M & Carson S, 2008, p. 5). - -The risk of CHD is independently related to several potentially modifiable risk factors besides abnormal lipids, including smoking, diabetes, hypertension, and physical inactivity. Recent epidemiologic studies and basic science research expanded knowledge about several new potential CHD risk factors. Use of a Framingham risk-based algorithm that directly incorporates age, the presence and magnitude of other risk factors, and measures of total cholesterol and HDL is the most accurate approach. "Screening for lipid disorders by measuring cholesterol levels in adult patients is quite feasible for physicians because it involves ordering only a blood test. - -Providers appear to have achieved high levels of lipid screening based on population-based patient survey data." (Pignone MP, et. al., 2001, p. 34).AHRQ, 2001) This systematic review recommends using a supplemental table to improve the feasibility of a risk-based strategy. In the Helfand & Carson (2008) update to Pignone's "Screening for Lipid Disorders" (Pignone MP, 2001), the researchers state: "We did not identify new evidence relevant to the -appropriate interval to screen for hyperlipidemia in the general population or in subgroups of the general population" (Helfand M & Carson S, 2008, p. 5). - -The primary recommendation of several advisory groups bodies state that adults should undergo an office-based assessment as the first step to identify patients at a higher CHD risk. The National Cholesterol Education Program Panel III (NCEP- III) has adopted using an adaptation of the risk prediction algorithm originating from the Framingham Heart Study estimating a patient's 10-year risk for developing CHD and has recommended its' use as the primary goal of preventive treatment. Stratifying CHD risk includes determining if CHD is present as well as CHD risk equivalents and major CHD risk factors. A history of CHD includes myocardial infarction, myocardial ischemia, angina (stable, unstable), percutaneous transluminal coronary angioplasty & coronary artery bypass surgery. CHD risk equivalents include peripheral artery disease, abdominal aortic aneurysm, thrombotic stroke, transient ischemic attacks, diabetes & Framingham 10-yr CHD risk > 20%. Major CHD risk factors include age, yr (men >45; women >55), cigarette smoking, hypertension (BP >140/90 mm Hg) or anti- hypertensive medication, Low HDL-C (<40 mg/dL) & negative risk factor: high HDL-C (>60 mg/dL). The Framingham risk categories include sex, age, systolic blood pressure, smoking status, total cholesterol, and HDL-C levels (NCEP III, 2002). - -Nelson RH (2013) noted that "regardless of the recommendations it is useful to consider how successful the medical community has been in meeting guideline goals...a national survey...showed 67% of ...patients with elevated cholesterol achieved their LDL cholesterol treatment goal". Nelson (2013) also stated "data from the National Health and Nutrition Examination Survey (NHANES) documents a steady decline in total cholesterol over several decades, so that in 2002 no more than 17% of US adults had a total cholesterol level of 240 mg/dL or higher. More recent data from an identical survey in 2008 show that the Healthy People 2010 goal of an average cholesterol below 200 mg/dL in all adults ages 20 to 74 was met by both men and women by 2008" (Nelson RH, 2013, p. 202). - -"Based on data from the 2005-2008 NHANES, an estimated 71 million (35.5%) U.S. adults aged>=20 years had high LDL-C, but only 34 million (48.1%) were treated and 23 million (32.2%) had their LDL-C controlled....The prevalence of LDL-C control was lowest among persons who reported receiving medical care less than twice in the previous year (11.7%, being uninsured (13.5%), being Mexican American (20.3%) or having income below the poverty level (21.9%)" (Kuklina EV, et. al., 2011, p. 109).Routine cholesterol testing should begin in young adulthood (>= 20 years of age). When LDL cholesterol concentrations range from 100-129 mg/dL, young adults should be encouraged to modify life habits to minimize long-term risk. In those with borderline high LDL cholesterol (130-159 mg/dL), clinical attention through therapeutic lifestyle changes is needed both to lower LDL cholesterol and to minimize other risk factors. If LDL cholesterol is high (160-189 mg/dL), more intensive clinical intervention should be initiated, with emphasis on therapeutic lifestyle changes. - -However, if LDL cholesterol remains elevated despite therapeutic lifestyle changes, particularly when LDL cholesterol is >= 190 mg/dL, consideration should be given to long-term management with LDL-lowering drugs. - -ATP III recognizes that detection of cholesterol disorders and other coronary heart disease (CHD) risk factors occurs primarily through clinical case finding. Risk factors can be detected and evaluated as part of a person's work-up for any medical problem. Alternatively, public screening programs can identify risk factors, provided that affected individuals are appropriately referred for physician attention. The identification of cholesterol disorders in the setting of a medical examination has the advantage that other cardiovascular risk factors-including prior CHD, PVD, stroke, age, sex, family history, cigarette smoking, high blood pressure, diabetes mellitus, obesity, physical inactivity- co-morbidities, and other factors can be assessed and considered prior to treatment. - -National Cholesterol Education Program, -National Heart, Lung, and Blood Institute, -National Institutes of Health, - NIH Publication No. 02-5215, -September 2002 - -Wilkinson J (2012) states that screening "must be recommended for men over age 34 and women over age 44 every five years in the "Preventative Services for Adults, Institute for Clinical Systems Improvement (ICSI) Guideline (Wilkinson J, et. al. 2012, p.20). Varbo (2013) also agreed that "LDL cholesterol is well documented as a causal risk factor for ischemic heart disease" (Varbo A, et. al., 2013, p. 435). - -The U.S. Preventive Services Task Force (USPSTF), 2008 strongly recommends screening men aged 35 and older for lipid disorders (Helfand M & Carson S, 2008, p. 40). - -The USPSTF recommends screening men aged 20 to 35 for lipid disorders if they are at increased risk for coronary heart disease (Helfand M & Carson S, 2008). - -The USPSTF strongly recommends screening women aged 45 and older for lipid disorders if they are at increased risk for coronary heart disease (Helfand M & Carson S, 2008). - -The USPSTF recommends screening women aged 20 to 45 for lipid disorders if they are at increased risk for coronary heart disease (Helfand M & Carson S, 2008). - -The USPSTF makes no recommendation for or against routine screening for lipid disorders in men aged 20 to 35, or in women aged 20 and older who are not at increased risk for coronary heart disease (Helfand M & Carson S, 2008). - -Nelson (2013) agrees that the recommendations of the USPSTF, published in 2008, remain current and viable in 2013 (Nelson RH, 2013). -The National Strategy for Quality Improvement in Health Care for 2011 has identified the promotion of the most effective prevention and treatment practices for the leading causes of mortality, starting with cardiovascular disease as one of its' national priorities. These priorities are based on the most recent research as well as stakeholder input. Opportunities for success include increase blood pressure control in adults, reduced high cholesterol levels in adults, and decrease smoking among adults and adolescents. Illustrative measures include: -* Percentage of patients ages 18 years and older with ischemic vascular disease whose most recent blood pressure during the measurement year is <140/90 mm Hg -* Percentage of patients with ischemic vascular disease whose most recent low-density cholesterol is <100 -* Percentage of patients who received evidence-based smoking cessation services (eg, medications) - -The U.S. Department of Health and Human Service's Healthy People 2020 has set a target of 82.1% for HDS-6: Increase the proportion of adults who have had their blood cholesterol checked within the preceding 5 years (a 10% improvement over the next decade).Higher score indicates better quality.Helfand M, Carson S (2008). Screening for lipid disorders in adults: selective update of 2001 U.S. Preventive Services Task Force Review. Evidence Synthesis No. 49. Rockville, MD: Agency for Healthcare Research and Quality. AHRQ Publication no. 08-05114-EF-1. Retrieved from http://www.ahrq.gov/downloads/pub/prevent/pdfser/lipides.pdf.U. S. Department of Health and Human Services, (2002). Third Report of the National Cholesterol Educational Program Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (Adults Treatment Panel III) Final Report, NIH Publication No. 02-5215Agency for Healthcare Research and Quality (AHRQ) (2012). The Guide to Clinical Preventive Services 2012: Recommendations of the U.S. Preventive Services Task Force (USPSTF) U.S. Department of Health and Human Services, Agency for Healthcare Research and Quality. AHRQ Pub. No.12-05154: ISBN 978-58763-421-5.Kuklina EV, Shaw M, Hong Y (2011). Division for Heart Disease and Stroke Prevention, National Center for Chronic Disease Prevention and Health Promotion (CDC). Vital signs: prevalence, treatment, and control of high levels of low-density lipoprotein cholesterol; United States, 1999-2002 and 2005-2008. Morbidity and Mortality Weekly Report (MMWR), 60(4), February 4, 2011; 109-114.Nelson RH (2013). Hyperlipidemia as a Risk Factor for Cardiovascular Disease. Prim Care Clin Office Pract 40:195-211. Wilkinson J, Bass C, Diem S, Gravley A, Harvey L, Hayes R, Johnson K, Maciosek M, McKeon K, Milteer L, Morgan J, Rothe P, Snellman L, Solberg L, Storlie C, Vincent P (2012). Institute for Clinical Systems Improvement. -Preventive Services for Adults Updated September 2012. Retrieved: http://bit.ly.PrevServAdults091 -Varbo A, Benn M, Tybjaerg-Hansen A, Jorgensen AB, Frikke-Schmidt R, Nordestgaard BG (2013). Remnant cholesterol as a causal risk factor for ischemic heart disease. Journal of the American College of Cardiology, 61(4):427-436.Health & Human Services. (2011). The National Strategy for Quality Improvement in Health Care for 2011Pignone MP, Phillips CJ, Lannon CM, Mulrow CD, Teutsch SM, Lohr KN, Whitener BL (2001). Screening for lipid disorders. Rockville (MD): Agency for Healthcare Research and Quality (AHRQ) (Systematic evidence review; no. 4). Retrieved from http://guideline.gov/content.aspx?id=12634&search=screening+for+lipid+disorders+in+adultsCHD: -History of CHD includes: -* Myocardial Infarction -* Myocardial Ischemia -* Angina (stable, unstable) -* Percutaneous Transluminal Coronary Angioplasty -* Coronary Artery Bypass Surgery - -CHD Risk Equivalent: -A CHD risk equivalent is a condition that carries an absolute risk for developing new CHD equal to the risk for having recurrent CHD events in persons with established CHD including: -* Atherosclerotic disease -* Peripheral arterial disease (PAD) -* Carotid artery disease -* Abdominal aortic aneurysm (AAA) -* Stroke -* Diabetes - o Type 1 - o Type 2 -* Framingham 10-yr CHD risk > 20% - -Major CHD Risk Factors: -* Cigarette smoking -* Active diagnosis of hypertension or on antihypertensive medication -* Low HDL cholesterol (HDL-C) (<40 mg/dL) -* Family history of premature CHD -* CHD in male first-degree relative <55 years -OR -* CHD in female first-degree relative <65 years -* Age (men >=45 years; women >=55 years) - -Most Recent LDL-C Test: -A LDL-C test performed or LDL-C result verified by another provider. - -10-year Framingham risk: -The Framingham Risk Score will be calculated based on the patient data below and will follow the Adult Treatment Panel (ATP) III Guidelines. (see appendix for calculation unless automatically calculated by EHR) -* Sex -* Age -* Total cholesterol - Fasting -* HDL cholesterol - Fasting -* Systolic blood pressure (treated or untreated) -* Smoking status (Cigarette smoking) - -Calculated LDL-C* results: -Are acceptable if the other elements (TRIGLYCERIDES, TOTAL CHOLESTEROL, and HIGH DENSITY LIPOPROTEIN (HDL-C) listed below are submitted AND the triglyceride value is <= 400 mg/dL. -* Calculated LDL value = [TOTAL CHOLESTEROL value - HIGH DENSITY LIPOPROTEIN (HDL-C) value - (TRIGLYCERIDE value/5)] -Risk Level Recommended LDL-C Goal: -CHD and CHD Risk Equivalent: <100 mg/dL -Multiple (2+) Risk Factors: <130 mg/dL -0-1 Risk Factor : <160 mg/dL -* LDL-C goal for multiple-risk-factor persons with 10-year risk >20 percent = <100 mg/dLThis is a two -part measure which is paired with CMS 61: Preventive Care and Screening: Cholesterol - Fasting Low Density Lipoprotein (LDL-C) Test Performed. If the fasting LDL-C results are documented this measure CMS 64 should also be reported. - -To be eligible for performance calculations, patients must have at least one face-to -face visit with the eligible professional during the measurement period and have one fasting LDL-C performed during the same measurement period with the exception of patients with 0 or 1 risk factors who may have an fasting LDL-C performed up to four (4) years prior to the current measurement period. To meet the numerator criteria for this measure, the patient's fasting LDL-C (low density lipoprotein) meets or exceeds the recommended LDL-C goal.TBDAll patients 20 through 79 years of age before the beginning of the measurement periodDenominator 1: (High Risk) -All patients aged 20 through 79 years who had a fasting LDL-C or a calculated LDL-C test performed during the measurement period and have CHD or CHD Risk Equivalent OR 10 year Framingham risk > 20% - -Denominator 2: (Moderate Risk) -All patients aged 20 through 79 years who had a fasting LDL-C or a calculated LDL-C test performed during the measurement period and have 2 or more Major CHD Risk Factors OR 10 year Framingham Risk 10-20%. - -Denominator 3: (Low Risk) -All patients aged 20 through 79 years who had a fasting LDL-C or a calculated LDL-C test performed up to 4 years prior to the current measurement period and have 0 or 1 Major CHD Risk Factors OR 10 year Framingham risk <10%. - -** For Denominator 2 and Denominator 3, HDL-C > or equal to 60 mg/dL subtracts 1 risk from the above (This is a negative risk factor.)Patients who have an active diagnosis of pregnancy -OR -Patients who are receiving palliative careNumerator 1: -Patients whose most recent fasting LDL-C test result is in good control, defined as <100 mg/dL -Numerator 2: -Patients whose most recent fasting LDL-C test result is in good control, defined as <130 mg/dL -Numerator 3: -Patients whose most recent fasting LDL-C test result is in good control, defined as <160 mg/dLNot ApplicableNoneNot ApplicableNot ApplicableNot ApplicableFor every patient evaluated by this measure also identify payer, race, ethnicity and sex.Preventive Care and Screening - - \ No newline at end of file diff --git a/test/fixtures/hqmf/simplexml/CMS65v5_SimpleXML.xml b/test/fixtures/hqmf/simplexml/CMS65v5_SimpleXML.xml deleted file mode 100755 index 77e3d0de..00000000 --- a/test/fixtures/hqmf/simplexml/CMS65v5_SimpleXML.xml +++ /dev/null @@ -1,30 +0,0 @@ -40280381-4cc2-8ffd-014c-c7a21fda042cHypertension: Improvement in Blood PressureHypertension Improvement in BP651d8363ce-a529-490b-8c98-9b54aa75da065.1.0000000010100001231Centers for Medicare & Medicaid Services (CMS)National Committee for Quality AssurancePercentage of patients aged 18-85 years of age with a diagnosis of hypertension whose blood pressure improved during the measurement period.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. - -CPT(R) contained in the Measure specifications is copyright 2004-2014 American Medical Association. LOINC(R) copyright 2004-2014 Regenstrief Institute, Inc. This material contains SNOMED Clinical Terms(R) (SNOMED CT(R)) copyright 2004-2014 International Health Terminology Standards Development Organisation. ICD-10 copyright 2014 World Health Organization. All Rights Reserved.These performance Measures are not clinical guidelines and do not establish a standard of medical care, and have not been tested for all potential applications. - -THE MEASURES 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].ProportionOutcomeTBDNoneNoneHigh blood pressure is one of the most common risk factors for cardiovascular disease and stroke. Less than half of those with hypertension have their condition controlled. Uncontrolled and untreated hypertension was associated with increased risk of total and cardiovascular mortality among the general hypertensive population. Health-care system improvements, including use of electronic health records with registry and clinical decision support functions, could facilitate better treatment and follow-up management, and improve patient-physician interaction. - -Epidemiological studies and randomized trials have repeatedly demonstrated that the relative risk of cardiovascular disease increases continuously with increasing levels of BP. The benefit of lowering a high blood pressure is to reduce the risk of developing a cardiovascular disease in the future. For example, it is estimated that reducing a high diastolic blood pressure by 6 mm Hg reduces your relative risk of having a stroke in the future by about 35-40%, and reduces your relative risk of developing heart disease by about 20-25%. Larger reductions in blood pressure provide greater benefits.The Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure (JNC 7): Treating systolic blood pressure and diastolic blood pressure to targets that are <140/90 mmHg is associated with a decrease in cardiovascular disease complicationsA higher score indicates better qualityPrevention, Detection, Evaluation, and Treatment of High Blood Pressure - The Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure. NIH Publication No.03 - 5233 December 2003 -MacMahon S, Peto R, Cutler J, Collins R, Sorlie P, Neaton J, Abbott R, Godwin J, Dyer A, Stamler J. Blood pressure, stroke, and coronary heart disease, part 1: prolonged differences in blood pressure: prospective observational studies corrected for the regression dilution bias. Lancet. 1990;335:765-774.[Medline] [Order article via Infotrieve]Kannel WB, Belanger AJ. Epidemiology of heart failure. Am Heart J. 1991;121:951-957.[Medline] [Order article via Infotrieve]Klag MJ, Whelton PK, Randall BL, Neaton JD, Brancati FL, Ford CE, Shulman NB, Stamler J. Blood pressure and end-stage renal disease in men. N Engl J Med. 1996;334:13-18.[Medline] [Order article via Infotrieve]He J, Whelton PK. Elevated systolic blood pressure and risk of cardiovascular and renal disease: an overview of evidence from observational epidemiologic studies and randomized controlled trials. Am Heart J.. 1999;138:S211-S219.Collins R, Peto R, MacMahon S, Hebert P, Fiebach NH, Eberlein KA, Godwin J, Qizilbash N, Taylor JO, Hennekens CH. Blood pressure, stroke, and coronary heart disease, part 2: short-term reductions in blood pressure: overview of randomized drug trials in their epidemiological context. Lancet. 1990;335:827-838.http://www.patient.co.uk/health/High-Blood-Pressure-(Hypertension).htmAdequate control: a systolic blood pressure < 140 mmHg. - -Uncontrolled blood pressure: a systolic blood pressure >= 140 mmHg. - -Uncontrolled baseline blood pressure: systolic blood pressure >= 140 mmHg that is taken during the first outpatient encounter of the measurement year in which the patient has an active diagnosis of hypertension. This must occur during the first six months of the year. If the patient with hypertension has uncontrolled blood pressure during the first outpatient encounter of the measurement year, then include the patient in the initial patient population of the measure. - -Follow-up blood pressure: systolic blood pressure taken during the first outpatient encounter during the measurement year that occurs at least six months after the baseline blood pressure. - -Improvement in blood pressure: the follow-up blood pressure is at least 10 mmHg less than the baseline systolic blood pressure.Blood pressure readings must be taken while the patient is sitting. If multiple measurements occur on the same date, the last systolic and diastolic readings should be used. - -"Occurrence A of Physical Exam, Performed: Systolic Blood Pressure (result)" represents the baseline blood pressure, which must occur prior to "Occurrence B of Physical Exam, Performed: Systolic Blood Pressure (result)", which represents the follow-up blood pressure. - -To calculate the "Physical Exam, Performed: Delta systolic blood pressure (result)" data element, subtract the value of "Occurrence B of Physical Exam, Performed: Systolic Blood Pressure (result)" from the value of "Occurrence A of Physical Exam, Performed: Systolic Blood Pressure (result)". - -The data element "Physical Exam, Performed: Delta systolic blood pressure (result)" is intended to represent the result of the mathematic comparison between systolic blood pressures taken during two separate visits. This is a calculation artifact, and there's no requirement to document the delta data element in the medical record.TBDAll patients aged 18-85 years of age, who had at least one outpatient visit in the first six months of the measurement year, who have a diagnosis of essential hypertension documented during that outpatient visit, and who have uncontrolled baseline blood pressure at the time of that visitEquals Initial PopulationExclude from the denominator all patients with evidence of end-stage renal disease (ESRD) on or prior to December 31 of the measurement year. Documentation of dialysis or kidney transplant also meets the criteria for evidence of ESRD. - -Exclude from the denominator all patients with a diagnosis of pregnancy during the measurement year.Patients whose follow-up blood pressure is at least 10 mmHg less than their baseline blood pressure or is adequately controlled. - -If a follow-up blood pressure reading is not recorded during the measurement year, the patient's blood pressure is assumed "not improved."Not ApplicableNoneNot ApplicableNot ApplicableNot ApplicableFor every patient evaluated by this measure also identify payer, race, ethnicity and sex.Not Applicable - - \ No newline at end of file diff --git a/test/fixtures/hqmf/simplexml/CMS66v4_SimpleXML.xml b/test/fixtures/hqmf/simplexml/CMS66v4_SimpleXML.xml deleted file mode 100755 index 7d666c13..00000000 --- a/test/fixtures/hqmf/simplexml/CMS66v4_SimpleXML.xml +++ /dev/null @@ -1,11 +0,0 @@ -40280381-4b9a-3825-014b-e06944e51139Functional Status Assessment for Knee ReplacementFSA for Knee Replacement66be8d9655-1194-46ef-b43e-4b1d0c36ab714.0.0000000010100001231Centers for Medicare & Medicaid Services (CMS)National Committee for Quality AssurancePercentage of patients aged 18 years and older with primary total knee arthroplasty (TKA) who completed baseline and follow-up (patient-reported) functional status assessments.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 CPT or other codes contained in the specifications. - -CPT(R) contained in the Measure specifications is copyright 2004-2014 American Medical Association. LOINC(R) copyright 2004-2014 Regenstrief Institute, Inc. This material contains SNOMED Clinical Terms(R) (SNOMED CT[R]) copyright 2004-2014 International Health Terminology Standards Development Organisation.These performance Measures are not clinical guidelines and do not establish a standard of medical care, and have not been tested for all potential applications. - -THE MEASURES 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].ProportionProcessNoneNoneNoneMeasuring functional status for patient undergoing total knee replacement permits longitudinal assessment - from the patient's perspective - of the impact of surgical intervention on pain, physical function, as well as health-related quality of life (Rothrock 2010).Clinicians should ask patients to report on functional status during at least two points in time while undergoing treatment: before surgery and after a period of post-surgical recovery.A higher score indicates better qualityBachmeier CJ, March LM, Cross MJ, Lapsley HM, Tribe KL, Courtenay BG et al. A comparison of outcomes in osteoarthritis patient undergoing total hip and knee replacement surgery. Osteoarthritis Cartilage, 9 (2001), pp. 137-146.Escobar A, Quintana JM, Bilbao A, Arostegui I, Lafuente I, Vidauretta I. Responsiveness and clinically important differences for the WOMAC and SF-36 after total knee replacement. Osteoathritis Cartilage, 15 (2007), pp.273-280.Rose M, Bjorner JB, Becker J, Fries JF, Ware JE. Evaluation of a preliminary physical function item bank supported expected advantages of the Patient-Reported Outcomes Measurement Information System (PROMIS). J Clin Epidemiol 2008; 61:17-33.Rothrock NE, Hays RD, Spritzer K, Yount SE, Riley W, Cella D. Relative to the general US population, chronic diseases are associated with poorer health-related quality of life as measured by the Patient-Reported Outcomes Measurement Information System (PROMIS). J Clin Epidemiol 2010; 63(11):1195-204.Selim AJ, Berlowitz D, Kazis LE, Rogers W, Wright SM, Qian SX, Rohendler JA, Spiro A, Miller D, Selim BJ, Fincke BG. Comparison of Health Outcomes for Male Seniors in the Veterans Health Administration and Medicare Advantage Plans. Health Services Research 2010; 45(2): 376-396.NoneA Functional Status Assessment (FSA) is based on administration of a validated instrument to eligible patients that asks patients to answer questions related to various domains including: pain, physical function, emotional well-being, health-related quality of life, symptom acuity. - -The use of patient-reported outcomes data in eMeasures - such as this measure of functional status - demonstrates the need for the Quality Reporting Data Architecture (QRDA) to support a data attribute that indicates that the patient provided the information.TBDAdults aged 18 and older who had a primary total knee arthroplasty (TKA) within the 12 month period that begins 180 days before the start of the measurement period and ends 185 days after the start of the measurement period and who had an outpatient encounter not more than 180 days prior to procedure, and at least 60 days and not more than 180 days after TKA procedure.Equals initial populationPatients with multiple traumas at the time of the total knee arthroplasty or patients with severe cognitive impairmentPatients with patient reported functional status assessment results (eg, VR-12, VR-36, PROMIS-10 Global Health, PROMIS-29, KOOS) not more than 180 days prior to the primary TKA procedure, and at least 60 days and not more than 180 days after TKA procedureNot applicableNoneNot ApplicableNot ApplicableNot ApplicableFor every patient evaluated by this measure also identify payer, race, ethnicity, and sex.TBD - - \ No newline at end of file diff --git a/test/fixtures/hqmf/simplexml/CMS68v5_SimpleXML.xml b/test/fixtures/hqmf/simplexml/CMS68v5_SimpleXML.xml deleted file mode 100755 index 53d8574b..00000000 --- a/test/fixtures/hqmf/simplexml/CMS68v5_SimpleXML.xml +++ /dev/null @@ -1,48 +0,0 @@ -40280381-4be2-53b3-014c-040de60d10e1Documentation of Current Medications in the Medical RecordCMS68689a032d9c-3d9b-11e1-8634-00237d5bf1745.0.0000000010100001231Centers for Medicare & Medicaid Services (CMS)Quality Insights of PennsylvaniaNational Quality ForumPercentage of visits for patients aged 18 years and older for which the eligible professional attests to documenting a list of current medications using all immediate resources available on the date of the encounter. This list must include ALL known prescriptions, over-the-counters, herbals, and vitamin/mineral/dietary (nutritional) supplements AND must contain the medications' name, dosage, frequency and route of administration.Limited proprietary coding is contained in the measure specifications for convenience. Users of the proprietary code sets should obtain all necessary licenses from the owners of these code sets. Quality Insights of Pennsylvania disclaims all liability for use or accuracy of any Current Procedural Terminology (CPT [R]) or other coding contained in the specifications. - -CPT (R) contained in the Measure specifications is copyright 2007-2015 American Medical Association. - -LOINC (R) copyright 2004-2014 [2.50] Regenstrief Institute, Inc. This material contains SNOMED Clinical Terms (R) (SNOMED CT [R]) copyright 2004-2014 [2014-09] International Health Terminology Standards Development Organization. All Rights Reserved. - -Due to technical limitations, registered trademarks are indicated by (R) or [R] and unregistered trademarks are indicated by (TM) or [TM].These performance measures are not clinical guidelines and do not establish a standard of medical care, and have not been tested for all potential applications. - -THE MEASURES AND SPECIFICATIONS ARE PROVIDED "AS IS" WITHOUT WARRANTY OF ANY KIND.ProportionProcessNoneNoneNoneIn the American Medical Association's (AMA) Physician's Role in Medication Reconciliation (2007), critical patient information, including medical and medication histories, current medications the patient is receiving and taking, and sources of medications, is essential to the delivery of safe medical care. However, interruptions in the continuity of care and information gaps in patient health records are common and significantly affect patient outcomes. Consequently, clinical judgments may be based on incomplete, inaccurate, poorly documented or unavailable information about the patient and his or her medication. - -As identified by The Agency for Healthcare Research and Quality in the National Healthcare Disparities report (2013), "different providers may prescribe medications for the same patient. Patients are responsible for keeping track of all their medications, but medication information can be confusing, especially for patients on multiple medications. When care is not well coordinated and some providers do not know about all of a patient's medications, patients are at greater risk for adverse events related to drug interactions, overdosing, or underdosing." - -In addition, providers need to periodically review all of a patient's medications to ensure that they are taking what is needed and only what is needed. Medication reconciliation has been shown to reduce both medication errors and adverse drug events (Whittington & Cohen, 2004). - -Medication safety efforts have primarily focused on hospitals; however, the majority of health care services are provided in the outpatient setting where two-thirds of physician visits result in writing at least one prescription (Stock et al., 2009). Chronically ill patients are increasingly being treated as outpatients, many of whom take multiple medications requiring close monitoring (Nassaralla et al., 2007). - -Adverse drug events (ADE) prove to be more fatal in outpatient settings (1 of 131 outpatient deaths) than in hospitals (1 of 854 inpatient deaths) (Nassaralla et al., 2007). According to the first study to utilize nationally-representative data to examine annual rates of ADEs in the ambulatory care setting "Adverse Drug events in U.S. Adult Ambulatory Medical Care," ADE rates increase with age, adults 25-44 years old had a rate of 1.3 per 10,000 person per year, those 45-64 had a rate of 2.2 per 10,000 per year, and those 65 years and older had the highest rate, at 3.8 ADEs per 10,000 persons per year. This study estimates that 13.5 million ADE related visits occurred between 2005-2007, estimating that approximately 4.5 million ambulatory ADE visits occur each year. These 4.5 million visits are associated with approximately 400,000 hospitalizations annually. According to the Institute of Medicine (IOM), in the US, as many as 98,000 deaths per year are attributable to preventable adverse events that occur in the hospitals setting with annual costs of between $17 billion and $29 billion. (Sarkar et al., 2011) - -Additionally, findings of The Commonwealth Fund (2010) studies identified 11% to 28% of the 4.3 million visit related ADEs (VADE) in 2001 might have been prevented with improved systems of care and better patient education, yielding an estimate of 473,000 to 1.2 million potentially preventable VADEs annually and potential cost-savings of $946 million to $2.4 billion. - -According to the AMA's published report, The Physician's Role in Medication Reconciliation, the rate of medication errors during hospitalization was estimated to be 52 per 100 admissions, or 70 per 1,000 patient days in 2005. Emerging research suggests the scope of medication-related errors in ambulatory settings is as extensive as or more extensive than during hospitalization. Ambulatory visits result in a prescription for medication 50 to 70% of the time. One study estimated the rate of ADEs in the ambulatory setting to be 27 per 100 patients. It is estimated that between 2004 and 2005, in the United States 701,547 patients were treated for ADEs in emergency departments and 117,318 patients were hospitalized for injuries caused by an ADE. Individuals aged 65 years and older are more likely than any other population group to require treatment in the emergency department for ADEs. (AMA, 2007). - -A Systematic Review on "Prevalence of Adverse Drug Events in Ambulatory Care" finds that "In the ambulatory care setting, adverse drug events (ADEs) have been reported to occur at a rate of 25%. Approximately 39% of these ADEs were preventable. Since many ADEs are associated with medication errors, and thus potentially preventable, understanding the nature of medication errors in ambulatory care settings can direct attention toward improvement of medication safety in ambulatory care." Data extracted and synthesized across studies indicated the median preventable ADE rates in ambulatory care-based studies were 16.5%. (Tache et al., 2011). - -The Agency for Healthcare Research and Quality's (AHRQ) National's Healthcare Disparities Report (2011) identified the rate of adverse drug events (ADE) among Medicare beneficiaries in ambulatory settings 50 per 1,000 person-years. In 2005, AHRQ reported data on adults age 65 and over who received potentially inappropriate prescription medicines in the calendar year, by race, ethnicity, income, education, insurance status, and sex. The disparities were identified as follows: older Asians were more likely than older Whites to have inappropriate drug use (20.3% compared with 17.3%); Older Hispanics were less likely than older non-Hispanic Whites to have inappropriate drug use (13.5% compared with 17.6%); Older women were more likely than older men to have inappropriate drug use (20.2% compared with 14.3%); there were no statistically significant differences by income or education. - -Weeks et al. (2010) noted fragmented medication records across the health care continuum, inaccurate reporting of medication regimens by patients, and provider failure to acquire all of the necessary elements of medication information from the patient or record, present significant obstacles to obtaining an accurate medication list in the ambulatory care setting. Because these obstacles require solutions demonstrating improvements in access to information and communication, the Institute of Medicine and others have encouraged the incorporation of IT solutions in the medication reconciliation process. In a survey administered to office-based physicians with high rates of EMR use, Weeks et al. found there is an opportunity for universal medication lists utilizing health IT.The Joint Commission's 2015 Ambulatory Care National Patient Safety Goals guide providers to maintain and communicate accurate patient medication information. Specifically, the section "Use Medicines Safely NPSG.03.06.01" states the following: "Maintain and communicate accurate patient medication information. The types of information that clinicians use to reconcile medications include (among others) medication name, dose, frequency, route, and purpose. Organizations should identify the information that needs to be collected to reconcile current and newly ordered medications and to safely prescribe medications in the future." (Joint Commission, 2015, retrieved at: http://www.jointcommission.org/assets/1/6/2015_NPSG_AHC1.PDF). - -The National Quality Forum's 2010 update of the Safe Practices for Better Healthcare, states healthcare organizations must develop, reconcile, and communicate an accurate patient medication list throughout the continuum of care. Improving the safety of healthcare delivery saves lives, helps avoid unnecessary complications, and increases the confidence that receiving medical care actually makes patients better, not worse. Every healthcare stakeholder group should insist that provider organizations demonstrate their commitment to reducing healthcare error and improving safety by putting into place evidence-based safe practices. - -The AMA's published report, The Physician's Role in Medication Reconciliation, identified the best practice medication reconciliation team as one that is multidisciplinary and--in all settings of care--will include physicians, pharmacists, nurses, ancillary health care professionals and clerical staff. The team's variable requisite knowledge, skills, experiences, and perspectives are needed to make medication reconciliation work as safely and smoothly as possible. Team members may have access to vital information or data needed to optimize medication safety. Because physicians are ultimately responsible for the medication reconciliation process and subsequently accountable for medication management, physician leadership and involvement in all phases of developing and initiating a medication reconciliation process or model is important to its success.Higher score indicates better quality.American Medical Association (2007). The physician's role in medication reconciliation: Issues, strategies and safety principles. Retrieved from http://www.ama-assn.org/resources/doc/cqi/med-rec-monograph.pdfAgency for Healthcare Research and Quality (2013). National Healthcare Disparities Report 2013. Retrieved from http://www.ahrq.gov/research/findings/nhqrdr/nhdr13/2013nhdr.pdfStock, R., Scott, J., & Gurtel, S. (2009). Using an Electronic Prescribing System to Ensure Accurate Medication Lists in a Large Multidisciplinary Medical Group. The Joint Commission Journal on Quality and Patient Safety; 35(5), 271-277.Nassaralla, C.L., Naessens, J.M., Chaudhry, R., et al. (2007). Implementation of a medication reconciliation process in an ambulatory internal medicine clinic. Quality and Safety in Health Care 2007; (16), 90-94.Sarkar, U., Lopez, A., Maselli, J.H., Gonzalez, R. (2011). Adverse Drug Events in U.S. Adult Ambulatory Medical Care. Health Services Reserach, 46(5), 1517-1533.The Commonwealth Fund (2010). Adverse Drug Events: Ambulatory Care Visits for Treatment. Retrieved from http://www.commonwealthfund.org/Performance-Snapshots/Medication-Mistakes-and-Adverse-Drug-Events/Adverse-Drug-Events--Ambulatory-Care-Visits-for-Treatment.aspxAgency for Healthcare Research and Quality (2011). National Healthcare Disparities Report 2011. Retrieved from http://www.ahrq.gov/research/findings/nhqrdr/nhqr11/chap3.html - -Weeks, D.L., Corbette, C.F., Stream, G. (2010). Beliefs of Ambulatory Care Physicians about Accuracy of Patient Medication Records and Technology-Enhanced Solutions to Improve Accuracy. Journal for Healthcare Quality; 32(5), 12-21.The Joint Commission (2015). Ambulatory Care National Patient Safety Goals. Retrieved from http://www.jointcommission.org/assets/1/6/2015_NPSG_AHC1.PDFNational Quality Forum (2010). Safe Practices for Better Healthcare - 2010 Update. Retrieved from http://www.qualityforum.org/Projects/Safe_Practices_2010.aspxTache, S.V., Sonnichsen, A., & Ashcroft, D.M. (2011). Prevalence of Adverse Drug Events in Ambulatory Care: A Systematic Review. The Annals of Pharmacotherapy, 45(7-8), 977-989. doi: 10.1345/aph.1P627.Current Medications: -Medications the patient is presently taking including all prescriptions, over-the-counters, herbals and vitamin/mineral/dietary (nutritional) supplements with each medication's name, dosage, frequency and administered route. - -Route: -Documentation of the way the medication enters the body (some examples include but are not limited to: oral, sublingual, subcutaneous injections, and/or topical)This measure is to be reported for every encounter during the measurement period. - -Eligible professionals reporting this measure may document medication information received from the patient, authorized representative(s), caregiver(s) or other available healthcare resources. - -This list must include all prescriptions, over-the-counter (OTC) products, herbals, vitamins, minerals, dietary (nutritional) supplements AND must contain the medications' name, dosage, frequency and route of administration. - -This measure should also be reported if the eligible professional documented the patient is not currently taking any medications. - -By reporting the action described in this measure, the provider attests to having documented a list of current medications utilizing all immediate resources available at the time of the encounter.TBDAll visits occurring during the 12 month reporting period for patients aged 18 years and older before the start of the measurement periodEquals Initial PopulationNoneEligible professional attests to documenting, updating or reviewing the patient's current medications using all immediate resources available on the date of the encounter. This list must include ALL known prescriptions, over-the-counters, herbals and vitamin/mineral/dietary (nutritional) supplements AND must contain the medications' name, dosages, frequency and route of administrationNot ApplicableMedical Reason: -Patient is in an urgent or emergent medical situation where time is of the essence and to delay treatment would jeopardize the patient's health statusNot ApplicableNot ApplicableNot ApplicableFor every patient evaluated by this measure also identify payer, race, ethnicity and sex.CLINICAL QUALITY MEASURE SET - - \ No newline at end of file diff --git a/test/fixtures/hqmf/simplexml/CMS69v4_SimpleXML.xml b/test/fixtures/hqmf/simplexml/CMS69v4_SimpleXML.xml deleted file mode 100755 index 98f7286c..00000000 --- a/test/fixtures/hqmf/simplexml/CMS69v4_SimpleXML.xml +++ /dev/null @@ -1,71 +0,0 @@ -40280381-4de7-db4d-014d-e8de93d4027dPreventive Care and Screening: Body Mass Index (BMI) Screening and Follow-Up PlanCMS69699a031bb8-3d9b-11e1-8634-00237d5bf1744.1.0000000010100001231Centers for Medicare & Medicaid Services (CMS)Quality Insights of PennsylvaniaNational Quality ForumPercentage of patients aged 18 years and older with a BMI documented during the current encounter or during the previous six months AND with a BMI outside of normal parameters, a follow-up plan is documented during the encounter or during the previous six months of the current encounter - -Normal Parameters: Age 65 years and older BMI => 23 and < 30 kg/m2 - Age 18 - 64 years BMI => 18.5 and < 25 kg/m2Limited proprietary coding is contained in the measure specifications for convenience. Users of the proprietary code sets should obtain all necessary licenses from the owners of these code sets. Quality Insights of Pennsylvania disclaims all liability for use or accuracy of any Current Procedural Terminology (CPT [R]) or other coding contained in the specifications. - -CPT (R) contained in the Measure specifications is copyright 2007- 2015 American Medical Association. - -LOINC (R) copyright 2004-2014 [2.50] Regenstrief Institute, Inc. This material contains SNOMED Clinical Terms (R) (SNOMED CT [R]) copyright 2004-2014 [2014-09] International Health Terminology Standards Development Organization. All Rights Reserved. - -Due to technical limitations, registered trademarks are indicated by (R) or [R] and unregistered trademarks are indicated by (TM) or [TM].These performance measures are not clinical guidelines and do not establish a standard of medical care, and have not been tested for all potential applications. - -THE MEASURES AND SPECIFICATIONS ARE PROVIDED "AS IS" WITHOUT WARRANTY OF ANY KIND.ProportionProcessNoneNoneNoneNormal Parameters for Age 65 Years and Older - -Winter et al. (2014) performed a meta-analysis looking at the relationship between BMI and all-cause mortality among adults 65 and older. They identified a higher risk of mortality among those with a BMI <23 kg/m2 and recommended monitoring weight status in this group to address any modifiable causes of weight loss promptly with due consideration of individual comorbidities. Dahl et al. (2013) reported that old persons (70-79) who were overweight had a lower mortality risk than old persons who were of normal weight, even after controlling for weight change and multimorbidity. The study also shows that persons who increased or decreased in BMI had a greater mortality risk than those who had a stable BMI, particularly those aged 70 to 79. Their results provide support to the belief that the World Health Organization guidelines for BMI are overly restrictive in old age. - -BMI Above Upper Parameters - -Obesity continues to be a costly public health concern in the United States. The Centers for Disease Control and Prevention (CDC, 2010) reported in 2009, no state met the Healthy People 2010 obesity target of 15 percent and the self-reported overall prevalence of obesity among adults had increased 1.1 percentage points in 2007 to 26.7 percent (2010). Ogden, Carroll, Kit and Flegel (2013) reported the prevalence of BMI-defined obesity in adults is high and continues to exceed 30% in most sex-age groups (34.9% overall). They also stated the overall prevalence of obesity did not differ between men and women in 2011-2012; however, among non-Hispanic Black adults, 56.6% of women were obese compared with 37.1% of men. In addition to the continued high prevalence rate for adults in general, Flegel, Carroll, Kit & Ogden (2012) report a significant increase for men and for non-Hispanic Black and Mexican American women over the 12-year period from 1999 through 2010 (2012). Moyer (2012) reported: Obesity is associated with such health problems as an increased risk for coronary artery disease, type 2 diabetes, various types of cancer, gallstones and disability. These comorbid medical conditions are associated with a higher use of health care services and costs among obese patients (p. 373). - -Obesity is also associated with an increased risk of death, particularly in adults younger than age 65 years and has been shown to reduce life expectancy by 6 to 20 years depending on age and race (LeBlanc et al., 2011). Masters et al. (2013) also showed mortality due to obesity varied by race and sex. They estimated adult deaths between 1986 and 2006 associated with overweight and obesity was 5.0% and 15.6% for Black and White men, and 26.8% and 21.7% for Black and White women, respectively. They also found a stronger association than previous research demonstrated between obesity and mortality risk at older ages. - -Finkelstein, Trogdon, Cohen & Dietz (2009) found that in 2006, across all payers, per capita medical spending for the obese is $1,429 higher per year (42 percent) than for someone of normal weight. Using 2008 dollars, this was estimated to be equivalent to $147 billion dollars in medical care costs related to obesity. - -Padula, Allen & Nair (2014) examined data from a commercial claims and encounter database to estimate the cost for obesity and associated comorbidities among working-age adults who had a claim with a primary or secondary diagnosis of obesity in 2006-2007. The mean net expenditure for inpatient and outpatient claims was $1907 per patient per visit. The increase in cost for comorbidities ranged from $527 for obesity with congestive heart failure (CHF) to $15, 733 for the combination of obesity, diabetes mellitus, hypertension and depression. - -In addition to a high prevalence rate of obesity, less than 50% of obese adults in 2010 received advice to exercise or perform physical activity (Barnes & Schoenborn, 2012). - -BMI Below Normal Parameters - -In the National Center of Health Statistics (NCHS) Health E-Stat, Fryer & Ogden (2012) reported that poor nutrition or underlying health conditions can result in underweight. Results from the 2007-2010 National Health and Nutrition Examination Survey (NHANES), using measured heights and weights, indicate an estimated 1.7% of U.S. adults are underweight with women more likely to be underweight than men (2012). - -In a cohort study conducted by Borrell & Lalitha (2014), data from NHANES III (1988-1994) was linked to the National Death Index mortality file with follow-up to 2006, and showed that when compared to their normal weight counterparts (BMI 18.5-25 kg/m2), underweight (BMI <18.5 kg/m2) had significantly higher death rates (Hazard Ratio=2.27; 95% confidence intervals (CI) = 1.78, 2.90). - -Ranhoff, Gjoen & Mowe (2005) recommended using BMI < 23 kg/m2 for the elderly to identify positive results with malnutrition screens and poor nutritional status.Although multiple clinical recommendations addressing obesity have been developed by professional organizations, societies and associations, two recommendations have been identified which exemplify the intent of the measure and address the numerator and denominator. - -The US Preventive Health Services Task Force (USPSTF) recommends that clinicians screen all adults (aged 18 years and older) for obesity. Clinicians should offer or refer patients with a BMI of 30 or higher to intensive, multicomponent behavioral interventions. This is a B recommendation (Moyer, 2012). - -As cited in Wilkinson et al. (2013), the Institute for Clinical Systems Improvement (ICSI) Preventive Services for Adults, Obesity Screening (Level II) Recommendation provides the following guidance: - --Record height, weight and calculate body mass index at least annually - * Clinicians should consider waist circumference measurement to estimate disease risk for patients who have BMI scores indicative of overweight or obesity class I. For adult patients with a BMI of 25 to 34.9 kg/m2, sex-specific waist circumference cutoffs should be used in conjunction with BMI to identify increased disease risk. - --A BMI greater or equal to 30 is defined as obese --A BMI of 25-29 is defined as overweight --Intensive intervention for obese individuals, based on BMI, is recommended by the U.S. Preventive Services to help control weight - -Similarly, the 2013 joint report/guideline from the American Heart Association, American College of Cardiology and the Obesity Society also recommend measuring height and weight and calculating BMI at annual visits or more frequently, using the current cutpoints for overweight (BMI >25.0-29.9 kg/m2) and obesity (BMI >=30 kg/m2) to identify adults who may be at elevated risk of mortality from all causes. They also recommended counseling overweight and obese individuals on their increased risk for CVD, type 2 diabetes, and all-cause mortality, and need for lifestyle changes.Higher score indicates better qualityReference Centers for Disease Control and Prevention (CDC). ( 2010). Vital Signs: State-specific obesity prevalence among adults, - United States, 2009. Morbidity and mortality weekly report, 59. Retrieved from http://www.cdc.gov/mmwr/preview/mmwrhtml/mm59e0803a1.htmFryar, C. D., & Ogden, C. L. (2012). Prevalence of underweight among adults aged 20 and over: United States, 1960-1962 through 2007-2010. National Center for Health Statistics, Division of Health and Nutrition Examination Surveys. Retrieved from http://www.cdc.gov/nchs/data/hestat/underweight_adult_07_10/underweight_adult_07_10.pdfFinkelstein, E.A., Trogdon, J.G., Cohen, J.W., & Dietz, W. (2009). Annual Medical Spending Attributable To Obesity: Payer-And Service-Specific Estimates. Health Affairs, 28(5), w822-w831. doi: 10.1377/hlthaff.28.5.w822Winter, J. E., MacInnis, R.J., Wattanapenpaiboon, N., & Nowson, C.A. (2014). BMI and all-cause mortality in older adults: a meta-analysis. American Journal of Clinical Nutrition, 99, 875-90.Dahl, A. K., Fauth, E.B., Ernsth-Bravell, M., Hassing, L.B., Ram, N. & Gerstof, D. (2013). Body mass index, change in body mass index, and survival in old and very old persons. JAGS, 61, 512-518.Centers for Disease Control and Prevention (CDC). (2010). Vital Signs: State-specific obesity prevalence among adults, - United States, 2009. Morbidity and mortality weekly report, 59. Retrieved from http://www.cdc.gov/mmwr/preview/mmwrhtml/mm59e0803a1.htmOgden, C. L., Carroll, M. D., Kit, B. K., & Flegal, K. M. (2013). Prevalence of obesity among adults: United States, 2011-2012, Centers for Disease Control and Prevention (CDC), National Center for Health Statistics (NCHS) Data Brief, No. 131: Oct 2013. Retrieved from http://www.cdc.gov/nchs/data/databriefs/db131.pdfFlegal, K. M., Carroll, M. D., Kit, B. K., & Ogden, C. L. (2012). Prevalence of obesity and trends in the distribution of body mass index among U. S. adults, 1999-2010. JAMA, 307(5), 491-497.Moyer, V. A. (2012). Screening for and management of obesity in adults: U.S. Preventive Services Task Force Recommendation Statement. Annals of Internal Medicine, 157(5), 373-378. doi:10.7326/0003-4819-157-5-201209040-00475Ranhoff, A.H., Gjoen, A.U. & Mowe, M. (2005). Screening for malnutrition in elderly acute medical patients: The usefulness of MNA-SF. Journal of Nutrition Health and Aging, 9(4), 221-225.Wilkinson, J., Bass, C., Diem, S., Gravley, A., Harvey, L. Hayes, R., Johnson, K., Maciosek, M., McKeon, K., Milteer, L., Morgan, J., Rothe, P., Snellman, L., Solberg, L., Storlie, C., & Vincent, P. (2013). Institute for Clinical Systems Improvement. Preventive Services for Adults. Retrieved from https://www.icsi.org/_asset/gtjr9h/PrevServAdults-Interactive0912.pdf. .LeBlanc, E., O'Connor, E., Whitlock, E.P., Patnode, C., & Kapka T. (2011). Screening for and Management of Obesity and Overweight in Adults. (AHRQ Publication No. 11-05159- EF-1). Evidence Synthesis Number 89. Retrieved from http://www.uspreventiveservicestaskforce.org/uspstf11/obeseadult/obesees.pdfBarnes PM, & Schoenborn CA (2012). Trends in adults receiving a recommendation for exercise or other physical activity from a physician or other health professional. Centers for Disease Control and Prevention (CDC), National Center for Health Statistics (NCHS) Data Brief, No. 86: Feb 2012.Masters, R.K., Reither, E.N., Powers, D.A., Yang, C.Y., Burger, A.E., & Link, B.G. (2013). The impact of obesity on us mortality levels: The importance of age and cohort factors in population estimates. American Journal of Public Health, 103, 1895-1901.Padula, W. V., Allen, R. R. & Nair, K. V. (2014). Determining the cost of obesity and its common comorbidities from a commercial claims database. Clinical Obesity 4, 53-58. doi: 10.1111/cob.12041 Borrell, L.N. & Samuel, L. (2014). Body mass index categories and mortality risk in US adults: The effect of overweight and obesity on advancing death. American Journal of Public Health, 104, 512-519. -Jensen, M.D., Ryan, D.H., Apovian, C.M., Ard, J.D., Comuzzie, A. G., Donato, K.A., ... Yanovski, S.Z. (2013). Practice guidelines and the obesity society report of the american college of cardiology/american heart association task force on 2013 AHA/ACC/TOS guideline for the management of overweight and obesity in adults: A report of the american college of cardiology/american heart association task force on practice guidelines and the obesity society. Circulation. doi: 10.1161/01.cir.0000437739.71477.BMI- Body mass index (BMI) is a number calculated using the Quetelet index: weight divided by height squared (W/H2) and is commonly used to classify weight categories. BMI can be calculated using: - -Metric Units: BMI = Weight (kg) / (Height (m) x Height (m)) -OR -English Units: BMI = Weight (lbs.) / (Height (in) x Height (in)) x 703 - -Follow-Up Plan - Proposed outline of treatment to be conducted as a result of a BMI out of normal parameters. A follow-up plan may include, but is not limited to: documentation of education, referral (for example a registered dietician, nutritionist, occupational therapist, physical therapist, primary care provider, exercise physiologist, mental health professional, or surgeon), pharmacological interventions, dietary supplements, exercise counseling or nutrition counseling.* There is no diagnosis associated with this measure. -* This measure is to be reported a minimum of once per reporting period for patients seen during the reporting period. -* This measure may be reported by eligible professionals who perform the quality actions described in the measure based on the services provided at the time of the qualifying visit and the measure-specific denominator coding. - -BMI Measurement Guidance: -* Height and Weight - An eligible professional or their staff is required to measure both height and weight. Both height and weight must be measured within six months of the current encounter and may be obtained from separate encounters. Self-reported values cannot be used. -* The BMI may be documented in the medical record of the provider or in outside medical records obtained by the provider. -* If the most recent documented BMI is outside of normal parameters, then a follow-up plan is documented during the encounter or during the previous six months of the current encounter. -* The documented follow-up plan must be based on the most recent documented BMI, outside of normal parameters, example: "Patient referred to nutrition counseling for BMI above normal parameters". (See Definitions for examples of a follow-up plan treatments). -* If more than one BMI is reported during the measurement period, the most recent BMI will be used to determine if the performance has been met.TBDThere are two (2) Initial Patient Populations for this measure: - -Initial Patient Population 1: All patients 18 through 64 years on the date of the encounter with at least one eligible encounter during the measurement period. - -Initial Patient Population 2: All patients 65 years of age and older on the date of the encounter with at least one eligible encounter during the measurement period. Equals Initial PopulationInitial Patient Population 1: Patients who are pregnant or encounters where the patient is receiving palliative care, refuses measurement of height and/or weight, the patient is in an urgent or emergent medical situation where time is of the essence and to delay treatment would jeopardize the patient's health status, or there is any other reason documented in the medical record by the provider explaining why BMI measurement was not appropriate. - -Initial Patient Population 2: Encounters where the patient is receiving palliative care, refuses measurement of height and/or weight, the patient is in an urgent or emergent medical situation where time is of the essence and to delay treatment would jeopardize the patient's health status, or there is any other reason documented in the medical record by the provider explaining why BMI measurement was not appropriate.Patients with a documented BMI during the encounter or during the previous six months, AND when the BMI is outside of normal parameters, a follow-up plan is documented during the encounter or during the previous six months of the current encounter.Not ApplicableNoneNot ApplicableNot ApplicableNot ApplicableFor every patient evaluated by this measure also identify payer, race, ethnicity and sex.None - - \ No newline at end of file diff --git a/test/fixtures/hqmf/simplexml/CMS71v5_SimpleXML.xml b/test/fixtures/hqmf/simplexml/CMS71v5_SimpleXML.xml deleted file mode 100755 index 34ff8b9a..00000000 --- a/test/fixtures/hqmf/simplexml/CMS71v5_SimpleXML.xml +++ /dev/null @@ -1,15 +0,0 @@ -40280381-4b9a-3825-014b-db6ef30f0e2dAnticoagulation Therapy for Atrial Fibrillation/FlutterSTK-3 (Stroke)7103876d69-085b-415c-ae9d-9924171040c25.0.0000000010100001231The Joint CommissionThe Joint CommissionNational Quality ForumIschemic stroke patients with atrial fibrillation/flutter who are prescribed anticoagulation therapy at hospital discharge.Measure specifications are in the Public Domain. - -LOINC(R) is a registered trademark of the Regenstrief Institute. - -This material contains SNOMED Clinical Terms(R) (SNOMED CT(C)) copyright 2004-2010 International Health Terminology Standards Development Organization. All rights reserved.These performance measures are not clinical guidelines and do not establish a standard of medical care, and have not been tested for all potential applications. The measures and specifications are provided without warranty.ProportionProcessNoneNoneNoneNonvalvular atrial fibrillation (NVAF) is a common arrhythmia and an important risk factor for stroke. It is one of several conditions and lifestyle factors that have been identified as risk factors for stroke. It has been estimated that over 2 million adults in the United States have NVAF. While the median age of patients with atrial fibrillation is 75 years, the incidence increases with advancing age. For example, The Framingham Heart Study noted a dramatic increase in stroke risk associated with atrial fibrillation with advancing age, from 1.5% for those 50 to 59 years of age to 23.5% for those 80 to 89 years of age. Furthermore, a prior stroke or transient ischemic attack (TIA) are among a limited number of predictors of high stroke risk within the population of patients with atrial fibrillation. Therefore, much emphasis has been placed on identifying methods for preventing recurrent ischemic stroke as well as preventing first stroke. Prevention strategies focus on the modifiable risk factors such as hypertension, smoking, and atrial fibrillation. Analysis of five placebo-controlled clinical trials investigating the efficacy of warfarin in the primary prevention of thromboembolic stroke, found the relative risk of thromboembolic stroke was reduced by 68% for atrial fibrillation patients treated with warfarin. The administration of anticoagulation therapy, unless there are contraindications, is an established effective strategy in preventing recurrent stroke in high stroke risk-atrial fibrillation patients with TIA or prior stroke.The administration of anticoagulation therapy, unless there are contraindications, is an established effective strategy in preventing recurrent stroke in high stroke risk atrial fibrillation patients with TIA or prior stroke.Improvement noted as an increase in rateFurie, K. L., S. E. Kasner, R. J. Adams, G. W. Albers, R. L. Bush, S. C. Fagan, J. L. Halperin, et al. "Guidelines for the Prevention of Stroke in Patients with Stroke or Transient Ischemic Attack: A Guideline for Healthcare Professionals from the American Heart Association/American Stroke Association." [In eng]. Stroke 42, no. 1 (Jan 2011): 227-76.Goldstein, L. B., R. Adams, M. J. Alberts, L. J. Appel, L. M. Brass, C. D. Bushnell, A. Culebras, et al. "Primary Prevention of Ischemic Stroke: A Guideline from the American Heart Association/American Stroke Association Stroke Council: Cosponsored by the Atherosclerotic Peripheral Vascular Disease Interdisciplinary Working Group; Cardiovascular Nursing Council; Clinical Cardiology Council; Nutrition, Physical Activity, and Metabolism Council; and the Quality of Care and Outcomes Research Interdisciplinary Working Group: The American Academy of Neurology Affirms the Value of This Guideline." [In eng]. Stroke 37, no. 6 (Jun 2006): 1583-633.Jauch, E. C., J. L. Saver, H. P. Adams, Jr., A. Bruno, J. J. Connors, B. M. Demaerschalk, P. Khatri, et al. "Guidelines for the Early Management of Patients with Acute Ischemic Stroke: A Guideline for Healthcare Professionals from the American Heart Association/American Stroke Association." [In Eng]. Stroke (Jan 31 2013).Saxena, R., and P. J. Koudstaal. "Anticoagulants for Preventing Stroke in Patients with Nonrheumatic Atrial Fibrillation and a History of Stroke or Transient Ischemic Attack (Review)." Cochrane Database Syst Rev, no. 4 (2011): CD000185.Wann, L. S., A. B. Curtis, K. A. Ellenbogen, N. A. Estes, 3rd, M. D. Ezekowitz, W. M. Jackman, C. T. January, et al. "2011 Accf/Aha/Hrs Focused Update on the Management of Patients with Atrial Fibrillation (Update on Dabigatran): A Report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines." [In eng]. J Am Coll Cardiol 57, no. 11 (Mar 15 2011): 1330-7.NoneThe unit of measurement for this measure is an inpatient episode of care. Each distinct hospitalization should be reported, regardless of whether the same patient is admitted for inpatient care more than once during the measurement period. In addition, the eMeasure logic intends to represent events within or surrounding a single occurrence of an inpatient hospitalization. - -The "Non-elective Inpatient Encounter" value set intends to capture all non-scheduled hospitalizations. This value set is a subset of the "Inpatient encounter" value set, excluding concepts that specifically refer to elective hospital admissions. Non-elective admissions include emergency, urgent and unplanned admissions.TBDPatients age 18 and older discharged from inpatient care (non-elective admissions) with a principal diagnosis of ischemic or hemorrhagic stroke and a length of stay less than or equal to 120 days that ends during the measurement period.Patients with a principal diagnosis of ischemic stroke, history of atrial ablation, and current or history of atrial fibrillation/flutter.Patients with comfort measures documented. -Patients admitted for elective carotid intervention. This exclusion is implicitly modeled by only including non-elective hospitalizations. -Patients discharged to another hospital. -Patients who left against medical advice. -Patients who expired. -Patients discharged to home for hospice care. -Patients discharged to a health care facility for hospice care.Patients prescribed anticoagulation therapy at hospital discharge.Not ApplicablePatients with a documented reason for not prescribing anticoagulation therapy at discharge.Not ApplicableNot ApplicableNot ApplicableFor every patient evaluated by this measure also identify payer, race, ethnicity and sex.eMeasure Stroke (eSTK) - - \ No newline at end of file diff --git a/test/fixtures/hqmf/simplexml/CMS72v4_SimpleXML.xml b/test/fixtures/hqmf/simplexml/CMS72v4_SimpleXML.xml deleted file mode 100755 index 8094fa61..00000000 --- a/test/fixtures/hqmf/simplexml/CMS72v4_SimpleXML.xml +++ /dev/null @@ -1,15 +0,0 @@ -40280381-4c72-51df-014c-8f6fc3510790Antithrombotic Therapy By End of Hospital Day 2SKT-5 (Stroke)7293f3479f-75d8-4731-9a3f-b7749d8bcd374.1.0000000010100001231The Joint CommissionThe Joint CommissionNational Quality ForumIschemic stroke patients administered antithrombotic therapy by the end of hospital day 2.Measure specifications are in the Public Domain - -LOINC(R) is a registered trademark of the Regenstrief Institute. - -This material contains SNOMED Clinical Terms(R) (SNOMED CT(C)) copyright 2004-2014 International Health Terminology Standards Development Organization. All rights reserved.These performance measures are not clinical guidelines and do not establish a standard of medical care, and have not been tested for all potential applications. The measures and specifications are provided without warranty.ProportionProcessNoneNoneNoneThe effectiveness of antithrombotic agents in reducing stroke mortality, stroke-related morbidity and recurrence rates has been studied in several large clinical trials. While the use of these agents for patients with acute ischemic stroke and transient ischemic attacks continues to be the subject of study, substantial evidence is available from completed studies. Data at this time suggest that antithrombotic therapy should be administered within 2 days of symptom onset in acute ischemic stroke patients to reduce stroke mortality and morbidity as long as no contraindications exist. - -Anticoagulants at doses to prevent venous thromboembolism are insufficient antithrombotic therapy to prevent recurrent ischemic stroke or TIA.Antithrombotic therapy should be administered within 2 days of symptom onset in acute ischemic stroke patients to reduce stroke mortality and morbidity as long as no contraindications exist.Improvement noted as an increase in rateAntithrombotic Trialists, Collaboration. "Collaborative Meta-Analysis of Randomised Trials of Antiplatelet Therapy for Prevention of Death, Myocardial Infarction, and Stroke in High Risk Patients." [In eng]. BMJ 324, no. 7329 (Jan 12 2002): 71-86.Chen, Z. M., P. Sandercock, H. C. Pan, C. Counsell, R. Collins, L. S. Liu, J. X. Xie, C. Warlow, and R. Peto. "Indications for Early Aspirin Use in Acute Ischemic Stroke : A Combined Analysis of 40 000 Randomized Patients from the Chinese Acute Stroke Trial and the International Stroke Trial. On Behalf of the Cast and Ist Collaborative Groups." [In eng]. Stroke 31, no. 6 (Jun 2000): 1240-9.Coull, B. M., L. S. Williams, L. B. Goldstein, J. F. Meschia, D. Heitzman, S. Chaturvedi, K. C. Johnston, et al. "Anticoagulants and Antiplatelet Agents in Acute Ischemic Stroke: Report of the Joint Stroke Guideline Development Committee of the American Academy of Neurology and the American Stroke Association (a Division of the American Heart Association)." [In eng]. Stroke 33, no. 7 (Jul 2002): 1934-42.Furie, K. L., S. E. Kasner, R. J. Adams, G. W. Albers, R. L. Bush, S. C. Fagan, J. L. Halperin, et al. "Guidelines for the Prevention of Stroke in Patients with Stroke or Transient Ischemic Attack: A Guideline for Healthcare Professionals from the American Heart Association/American Stroke Association." [In eng]. Stroke 42, no. 1 (Jan 2011): 227-76.Guyatt, G. H., E. A. Akl, M. Crowther, D. D. Gutterman, H. J. Schuunemann, Therapy American College of Chest Physicians Antithrombotic, and Panel Prevention of Thrombosis. "Executive Summary: Antithrombotic Therapy and Prevention of Thrombosis, 9th Ed: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines." [In eng]. Chest 141, no. 2 Suppl (Feb 2012): 7S-47S.Jauch, E. C., J. L. Saver, H. P. Adams, Jr., A. Bruno, J. J. Connors, B. M. Demaerschalk, P. Khatri, et al. "Guidelines for the Early Management of Patients with Acute Ischemic Stroke: A Guideline for Healthcare Professionals from the American Heart Association/American Stroke Association." [In Eng]. Stroke (Jan 31 2013).NoneThe unit of measurement for this measure is an inpatient episode of care. Each distinct hospitalization should be reported, regardless of whether the same patient is admitted for inpatient care more than once during the measurement period. In addition, the eMeasure logic intends to represent events within or surrounding a single occurrence of an inpatient hospitalization. - -The "Non-elective admissions" value set intends to capture all non-scheduled hospitalizations. This value set is a subset of the "Inpatient encounter" value set, excluding concepts that specifically refer to elective hospital admissions. Non-elective admissions include emergency, urgent and unplanned admissions.TBDPatients age 18 and older discharged from inpatient care (non-elective admissions) with a principal diagnosis of ischemic or hemorrhagic stroke and a length of stay less or equal to 120 days.Patients with a principal diagnosis of Ischemic stroke.Patients who have a duration of stay less than 2 days - -Patients with comfort measures documented on day or the day after arrival - -Patients with intra-venous or intra-arterial Thrombolytic (t-PA) Therapy administered within 24 hours prior to arrival or anytime during hospitalization.Patients who had antithrombotic therapy administered the day of or day after hospital arrival.Not ApplicablePatients with a documented reason for not administering antithrombotic therapy the day of or day after hospital arrival.Not ApplicableNot ApplicableNot ApplicableFor every patient evaluated by this measure also identify payer, race, ethnicity and sex.eMeasure Stroke (eSTK) - - \ No newline at end of file diff --git a/test/fixtures/hqmf/simplexml/CMS73v4_SimpleXML.xml b/test/fixtures/hqmf/simplexml/CMS73v4_SimpleXML.xml deleted file mode 100755 index 4cc99169..00000000 --- a/test/fixtures/hqmf/simplexml/CMS73v4_SimpleXML.xml +++ /dev/null @@ -1,26 +0,0 @@ -40280381-4c18-79df-014c-38c6ba7f190bVenous Thromboembolism Patients with Anticoagulation Overlap TherapyVTE 3736f069bb2-b3c4-4bf4-adc5-f6dd424a10b74.0.0000000010100001231The Joint CommissionThe Joint CommissionNational Quality ForumThis measure assesses the number of patients diagnosed with confirmed VTE who received an overlap of parenteral (intravenous [IV] or subcutaneous [subcu]) anticoagulation and warfarin therapy. For patients who received less than five days of overlap therapy, they should be discharged on both medications or have a reason for discontinuation of overlap therapy. Overlap therapy should be administered for at least five days with an international normalized ratio (INR) greater than or equal to 2 prior to discontinuation of the parenteral anticoagulation therapy, discharged on both medications or have a reason for discontinuation of overlap therapy.Measure specifications are in the Public Domain. - -LOINC(R) is a registered trademark of the Regenstrief Institute. - -This material contains SNOMED Clinical Terms (R) (SNOMED CT[C]) copyright 2004-2014 International Health Terminology Standards Development Organization. All rights reserved.These performance measures are not clinical guidelines and do not establish a standard of medical care, and have not been tested for all potential applications. The measures and specifications are provided without warranty.ProportionProcessNoneNoneNoneFor patients who present with a confirmed acute VTE, parenteral anticoagulation is the first line of therapy because of its rapid onset of action (Buller et al., 2004). Warfarin can be initiated on the first day of treatment after the first dose of a parenteral anticoagulant has been given. Because the warfarin has a very slow onset of action, it cannot be used as mono-therapy for acute VTE (Ansell et al., 2008). - -The strong (Level I) recommendations to overlap parenteral anticoagulation with oral warfarin therapy in the initial treatment of VTE events is based in part on the known effect of warfarin on the coagulation cascade (Brandjes, et al.,1992). The early increase in the Pro thrombin time (PT) and INR often reflects the laboratory finding of initial reduction in clotting factors of the extrinsic pathway of coagulation resulting in prolongation of the PT/INR, while the patient is still at risk of thromboembolic events due to persistent levels of coagulation factors of the intrinsic pathway and common pathways of coagulation. - -The recommendation that heparins and warfarin overlap for a five-day period is based on pharmacokinetic, pharmacologic, pathophysiologic, and clinical evidence as noted by Wittkowsky A.K. (2005). All studies support the pharmacokinetic characteristics of warfarin and the time delay in achieving an antithrombotic effect suggesting the need for overlap of heparin during initial warfarin dosing in order to prevent thrombus extension, embolization to the lungs, death due to Pulmonary Emboli (PE), and the development of complications such as recurrent thromboembolic events and the postthrombotic syndrome. Kearon et al, 2008 also denotes current recommendation for treatment of confirmed VTE to begin with oral warfarin therapy, with combination of initial anticoagulation therapy for a minimum of 5 days and until the INR is >2.0 for at least 24 hours, and then a recommended target rate.Overlap therapy of both warfarin and parenteral therapy is the recommended treatment for VTE patients if there are no contraindications. This therapy should take place over five or more days, until an INR greater than or equal to 2.0 is reached prior to discontinuation of parenteral therapy.Improvement noted as an increase in the rateAnsell J, Hirsch J, Hylek E, Jacobson A, Crowther M, Palareti G. Pharmacology and management of the vitamin K antagonists: The Eighth ACCP Conference on Antithrombotic and Thrombolytic Therapy. Chest. 2008 133:160S-198S.Brandjes DP, Heijboer H, Buller HR, et al. Acenocoumarol and heparin compared with acenocoumarol alone in the initial treatment of proximal-vein thrombosis. N Engl J Med. 1992; 327:1485-9.Guyatt, G.H., Akl, E.A., Crowther, M., Gutterman, D., Schunemann, H. Antithromboitic Therapy and Prevention of Thrombosis, 9th edition: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines. CHEST 2012; 141(2) (Supp):7S-47S.Kearon C, Akl EA, Comerota AJ, Prandoni P, Bounameaux H, Goldhaber SZ, Nelson ME, Wells PS, Gould MK, Dentali F, Crowther M, Kahn SR. Antithrombotic therapy for VTE disease: antithrombotic therapy and prevention of thrombosis, 9th ed: American College of Chest Physicians evidence-based clinical practice guidelines. Chest. 2012 Feb;141(2 Suppl):e419S-94S. Wittkowsky AK. Why warfarin and heparin need to overlap when treating acute venous thromboembolism. Dis Mon 2005; 51:112-115.NoneCMS recognizes the difficulty in capturing the VTE confirmed concept required in this measure and suggests eligible hospitals participating in the Medicare & Medicaid EHR Incentive Programs consider selecting alternative electronic clinical quality measures (eCQMs) to meet program requirements for meaningful use. If suitable alternatives are unavailable, CMS will accept a 0 denominator submission for the eCQM version only for this measure. - -The unit of measurement for this measure is an inpatient episode of care. Each distinct hospitalization should be reported, regardless of whether the same patient is admitted for inpatient care more than once during the measurement period. In addition, the eMeasure logic intends to represent events within or surrounding a single occurrence of an inpatient hospitalization.TBDPatients with a diagnosis code for venous thromboembolism (VTE), a patient age greater than or equal to 18 years, and a length of stay less than or equal to 120 days.Patients with confirmed VTE who received warfarin.* Patients with Comfort Measures documented -* Patients discharged to a health care facility for hospice care -* Patients discharged to home for hospice care -* Patients who expired -* Patients who left against medical advice -* Patients discharged to another hospital -* Patients without warfarin therapy during hospitalization -* Patients without VTE confirmed by diagnostic testingPatients who received overlap therapy (warfarin and parenteral anticoagulation): - -* Five or more days, with an INR greater than or equal to 2 prior to discontinuation of parenteral therapy OR -* Five or more days, with an INR less than 2 and discharged on overlap therapy OR -* Less than five days and discharged on overlap therapy OR -* With documentation of reason for discontinuation of parenteral therapy OR -* With documentation of a reason for no overlap therapyNot ApplicableNoneNot ApplicableNot ApplicableNot ApplicableFor every patient evaluated by this measure also identify payer, race, ethnicity and sex.eMeasure Venous Thromboembolism (eVTE) - - \ No newline at end of file diff --git a/test/fixtures/hqmf/simplexml/CMS74v5_SimpleXML.xml b/test/fixtures/hqmf/simplexml/CMS74v5_SimpleXML.xml deleted file mode 100755 index 697a6ef6..00000000 --- a/test/fixtures/hqmf/simplexml/CMS74v5_SimpleXML.xml +++ /dev/null @@ -1,11 +0,0 @@ -40280381-4b9a-3825-014b-c2609c45085dPrimary Caries Prevention Intervention as Offered by Primary Care Providers, including DentistsPrimary Caries Prevention740b81b6ba-3b30-41bf-a2f3-95bdc9f558f25.0.0000000010100001231Centers for Medicare & Medicaid Services (CMS)National Committee for Quality AssurancePercentage of children, age 0-20 years, who received a fluoride varnish application during the measurement period.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 CPT or other codes contained in the specifications. - -CPT(R) contained in the Measure specifications is copyright 2004-2014 American Medical Association. LOINC(R) copyright 2004-2014 Regenstrief Institute, Inc. This material contains SNOMED Clinical Terms(R) (SNOMED CT[R]) copyright 2004-2014 International Health Terminology Standards Development Organisation.These performance Measures are not clinical guidelines and do not establish a standard of medical care, and have not been tested for all potential applications. - -THE MEASURES 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].ProportionProcessPopulation 1: age 0-5 -Population 2: age 6-12 -Population 3: age 13-20NoneNoneThe literature reflects that fluoride varnish when applied to the teeth of high-risk children, reduces, in conjunction with anticipatory guidance provided to the caregiver, the risk of the child developing caries.Fluoride varnish applied every six months is effective in preventing caries in the primary and permanent dentition of children and adolescents. Two or more applications of fluoride varnish per year are effective in preventing caries in high-risk populations (Hutter 2006).A higher score indicates better qualityJA. Wentraub, F. Ramos-Gomez, B. Jue, S. Shain, CI. Hoover, JDB. Featherstone, and SA. Gansky. Fluoride Varnish Efficacy in Prevention ECC. J Dent Res 85(2): 172-176, 2006. Hutter JW, Chan JT, Featherstone JDB, Ismail A, Kingman A, Stamm J, Tinanoff N, Wefel JS, Zero DT. Professionally Applied Topical Fluoride: Evidence-Based Clinical Recommendations. Journal of the American Dental Association, 137(8): 1151-1159, 2006.NoneNoneTBDChildren, age 0-20 years, with a visit during the measurement period.Equals Initial PopulationNoneChildren who receive a fluoride varnish applicationNot ApplicableNoneNot ApplicableNot ApplicableNot ApplicableFor every patient evaluated by this measure also identify payer, race, ethnicity and sex.Not Applicable - - \ No newline at end of file diff --git a/test/fixtures/hqmf/simplexml/CMS75v4_SimpleXML.xml b/test/fixtures/hqmf/simplexml/CMS75v4_SimpleXML.xml deleted file mode 100755 index b3c3be26..00000000 --- a/test/fixtures/hqmf/simplexml/CMS75v4_SimpleXML.xml +++ /dev/null @@ -1,9 +0,0 @@ -40280381-4b9a-3825-014b-c2730e6f088cChildren Who Have Dental Decay or CavitiesChildren Who Have Dental Decay7561947125-4376-4a7b-ab7a-ac2be9bd91384.0.0000000010100001231Centers for Medicare & Medicaid Services (CMS)National Committee for Quality AssurancePercentage of children, age 0-20 years, who have had tooth decay or cavities during the measurement period.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 CPT or other codes contained in the specifications. - -CPT(R) contained in the Measure specifications is copyright 2004-2014 American Medical Association. LOINC(R) copyright 2004-2014 Regenstrief Institute, Inc. This material contains SNOMED Clinical Terms(R) (SNOMED CT[R]) copyright 2004-2014 International Health Terminology Standards Development Organisation.These performance Measures are not clinical guidelines and do not establish a standard of medical care, and have not been tested for all potential applications. - -THE MEASURES 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].ProportionOutcomeNoneNoneNoneDental cavities have been identified as the most common chronic disease for children. Nationally, 19.4% of children have dental decay or cavities.Children who have dental decay or cavities are less likely to be in very good or excellent overall health than children without decay or cavities. Children with decay are also more likely to have other oral health problems such as toothaches, broken teeth, and bleeding gums.A lower score indicates better qualityChild and Adolescent Health Measurement Initiative. 2007 National Survey of Children's Health, Data Resource Center for Child Adolescent Health website. www.nschdata.orgEdelstein BL, Chinn CH. Update on disparities in oral health and access to dental care for America's children. Acad Pediatr.2009;9(6):415-419.Milgrom P, Zero DT, Tanzer JM. An examination of the advances in science and technology of prevention of tooth decay in young children since the Surgeon General's Report on Oral Health. Acad Pediatr. 2009;9(6):404-409.NoneNoneTBDChildren, age 0-20 years, with a visit during the measurement period.Equals Initial PopulationNoneChildren who had cavities or decayed teeth.Not applicableNoneNot applicableNot applicableNot applicableFor every patient evaluated by this measure also identify payer, race, ethnicity and sex.Not applicable - - \ No newline at end of file diff --git a/test/fixtures/hqmf/simplexml/CMS77v4_SimpleXML.xml b/test/fixtures/hqmf/simplexml/CMS77v4_SimpleXML.xml deleted file mode 100755 index 457213c9..00000000 --- a/test/fixtures/hqmf/simplexml/CMS77v4_SimpleXML.xml +++ /dev/null @@ -1,10 +0,0 @@ -40280381-4be2-53b3-014b-ebcbaefc082eHIV/AIDS: RNA Control for Patients with HIVRNA Control for HIV Patients77e0a07809-7b74-473f-bcc4-1891be506aaa4.0.0000000010100001231Centers for Medicare & Medicaid Services (CMS)National Committee for Quality AssurancePercentage of patients aged 13 years and older with a diagnosis of HIV/AIDS, with at least two visits during the measurement year, with at least 90 days between each visit, whose most recent HIV RNA level is <200 copies/mL.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 CPT or other codes contained in the specifications. - -CPT(R) contained in the Measure specifications is copyright 2004-2014 American Medical Association. LOINC(R) copyright 2004-2014 Regenstrief Institute, Inc. This material contains SNOMED Clinical Terms(R) (SNOMED CT[R]) copyright 2004-2014 International Health Terminology Standards Development Organisation.These performance Measures are not clinical guidelines and do not establish a standard of medical care, and have not been tested for all potential applications. - -THE MEASURES 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].ProportionOutcomeNoneNoneNot ApplicableTBDTBDA higher score indicates better qualityNone - NoneNoneTBDAll patients aged 13 years and older with a diagnosis of HIV/AIDS with at least two visits during the measurement year, with at least 90 days between each visit.Equals Initial PopulationNot ApplicablePatients whose most recent HIV RNA level is <200 copies/mL.Not ApplicableNoneNot ApplicableNot ApplicableNot ApplicableFor every patient evaluated by this measure also identify payer, race, ethnicity and sex.Not Applicable - - \ No newline at end of file diff --git a/test/fixtures/hqmf/simplexml/CMS82v3_SimpleXML.xml b/test/fixtures/hqmf/simplexml/CMS82v3_SimpleXML.xml deleted file mode 100755 index 0c6b2a30..00000000 --- a/test/fixtures/hqmf/simplexml/CMS82v3_SimpleXML.xml +++ /dev/null @@ -1,40 +0,0 @@ -40280381-4cc2-8ffd-014c-d82cc95c07ceMaternal Depression ScreeningMaternal Dep Screening828e6c8479-99fd-4949-b0ad-24fa60fe42013.1.0000000010100001231National Committee for Quality AssuranceNational Committee for Quality AssuranceThe percentage of children who turned 6 months of age during the measurement year, who had a face-to-face visit between the clinician and the child during child's first 6 months, and who had a maternal depression screening for the mother at least once between 0 and 6 months of life.Physician Performance Measure (Measures) and related data specifications were developed by the National Committee for Quality Assurance (NCQA). - -The Measures are copyrighted but can be reproduced and distributed, without modification, for noncommercial purposes (eg, use by healthcare providers in connection with their practices). Commercial use is defined as the sale, licensing, or distribution of the Measures for commercial gain, or incorporation of the Measures into a product or service that is sold, licensed or distributed for commercial gain. Commercial use of the Measures requires a license agreement between the user and NCQA. NCQA is not responsible for any use of the Measures. - -(c) 2008-2015 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 CPT or other codes contained in the specifications. - -CPT(R) contained in the Measure specifications is copyright 2004-2014 American Medical Association. LOINC(R) copyright 2004-2014 Regenstrief Institute, Inc. This material contains SNOMED Clinical Terms(R) (SNOMED CT[R]) copyright 2004-2014 International Health Terminology Standards Development Organisation. ICD-10 copyright 2014 World Health Organization. All Rights Reserved.These performance Measures are not clinical guidelines and do not establish a standard of medical care, and have not been tested for all potential applications. - -THE MEASURES 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].ProportionProcessNoneNoneNoneMaternal depression, also known as post-partum depression, is one of the most common perinatal complications; however, the disorder often remains unrecognized, undiagnosed, and untreated (VanLandeghem, 2006). Studies suggest that over 10 percent of mothers experience depression six weeks after giving birth, whether it is minor or major. Three to 25 percent of women experience major depression during the year following childbirth (Gaynes BN, 2005; Kessler RC, 1994). The incidence of depression may be higher in women who already have young children (VanLandeghem, 2006; Gaynes BN, 2005). Maternal depression can greatly affect mothers, their baby, and their family's well-being. It can have lasting effects on a mother's self-esteem and confidence as a mother (Epperson, 1999). - -Screening is important, as mothers with post-partum depression who are not treated can have symptoms that carry over into the second year post-partum. Mothers that have had post-partum depression are also more likely to have a recurrence with subsequent children. (Epperson, 1999). There are effective treatments available, but less than half of post-partum depression cases are ever diagnosed (Gibson, 2010). Less than 50 percent of mothers with an infant child are currently being screened for post-partum depression (Gjerdingen, Crow, McGovern, Miner, Center, 2009). This measure encourages clinicians to screen new mothers for depression.U.S. Preventive Services Task Force (2002) -The USPSTF recommends screening for depression in clinical practices that have systems in place to assure accurate diagnosis, effective treatment, and follow up for the general adult population* -Grade: B Recommendation -*NOTE: This recommendation applies to all adults. - -Bright Futures (2008) -Health care professionals should screen mothers on the following topics: - -Mothers of one week old infants: -Discuss health and depression, family stress, uninvited advice, parent role. -Differentiate between short-term "baby blues" and postpartum depression, and counsel and refer as appropriate: -It may be helpful to advise women that the "postpartum blues" are a different entity from depression. The "blues," with characteristic tearfulness, anxiety and low mood, are relatively common but are transient, peaking at 3-5 days after birth and resolving by 10-14 days. - -Mothers of one month old infants: -Discuss maternal health (postpartum, checkup, depression, substance abuse) - -Mothers of two month old children: -Discuss maternal health (maternal postpartum, checkup and resumption of activities, depression) -Grade: Expert Consensus - -References -U.S. Preventive Services Task Force. Screening for Depression, May 2002. - -Hagan, JF, Shaw JS, Duncan PM, eds. 2008. Bright Futures: Guidelines for Health Supervision of Infants, Children, and Adolescents, Third Edition. Elk Grove, IL: American Academy of PediatricsHigher score indicates better qualityEpperson, C Neill, MD. Postpartum Major Depression: Detection and Treatment. American Family Physician. April 15, 1999.Gaynes BN, G. et al. Perinatal Depression: Prevalence, Screening Accuracy, and Screening Outcomes. Summary, Evidence Report/Technology Assessment No. 119. (Prepared by the RTI-University of North Carolina Evidence based Practice Center under Contract No. 290-02-0016.) AHRQ Publication No. 05-E006-1. Rockville, MD: Agency for Healthcare Research and Quality. February 2005.Gibson J. Screening for Postpartum Depression Not Worth the Time or Money. March 27, 2010.Gjerdingen D, Crow S, McGovern P, Miner M, Center B. Postpartum Depression Screening at Well-Child Visits: Validity of a 2-Question Screen and the PHQ-9. Annals of Family Medicine 7:63-70 (2009).Hagan, JF, Shaw JS, Duncan PM, eds. 2008. Bright Futures: Guidelines for Health Supervision of Infants, Children, and Adolescents, Third Edition. Elk Grove, IL: American Academy of Pediatrics.Kessler RC, McGonagle KA, Zhao S, Nelson CB, Hughes M, Eshleman S, et al. Lifetime and 12-month prevalence of DSM-III-R psychiatric disorders in the United States. Results from the National Comorbidity Survey. Arch Gen Psychiatry 1994;51:8-19.VanLandeghem K. National Academy for State Health Policy. Financing Strategies for Medicaid Reimbursement of Maternal Depression Screening by Pediatric Providers. April 2006.NoneThe eMeasure specifies only patient's record, looking for the newly allocated SNOMED codes that allow providers to record the screening and treatment of the mother, but the endorsed measure relies on notes from the patient's and mother's charts.TBDChildren with a visit who turned 6 months of age in the measurement period.Equals Initial PopulationNoneChildren with documentation of maternal screening or treatment for postpartum depression for the mother.Not ApplicableNoneNot ApplicableNot ApplicableNot ApplicableFor every patient evaluated by this measure also identify payer, race, ethnicity and sex.None - - \ No newline at end of file diff --git a/test/fixtures/hqmf/simplexml/CMS90v5_SimpleXML.xml b/test/fixtures/hqmf/simplexml/CMS90v5_SimpleXML.xml deleted file mode 100755 index 9005f210..00000000 --- a/test/fixtures/hqmf/simplexml/CMS90v5_SimpleXML.xml +++ /dev/null @@ -1,15 +0,0 @@ -40280381-4be2-53b3-014b-e5d4e6160186Functional Status Assessment for Complex Chronic ConditionsFSA for complex chronic cond90bb9b8ef7-0354-40e0-bec7-d6891b7df5195.0.0000000010100001231Centers for Medicare & Medicaid Services (CMS)National Committee for Quality AssurancePercentage of patients aged 65 years and older with heart failure who completed initial and follow-up patient-reported functional status assessmentsLimited proprietary coding is contained in the Measure specifications for user convenience. Users of proprietary code sets should obtain all necessary licenses from the owners of the code sets. NCQA disclaims all liability for use or accuracy of any CPT or other codes contained in the specifications. - -CPT(R) contained in the Measure specifications is copyright 2004-2014 American Medical Association. LOINC(R) copyright 2004-2014 Regenstrief Institute, Inc. This material contains SNOMED Clinical Terms(R) (SNOMED CT[R]) copyright 2004-2014 International Health Terminology Standards Development Organisation.These performance Measures are not clinical guidelines and do not establish a standard of medical care, and have not been tested for all potential applications. - -THE MEASURES 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].ProportionProcessNoneNoneNoneMeasuring functional status for patients with complex chronic illness permits longitudinal assessment - from the patient's perspective - of the effectiveness of symptom management, as well as health-related quality of life (Flynn 2009, Rothrock 2010).Clinicians should ask patients to report on functional status during at least two points in time while undergoing treatment and working with the clinical team to coordinate care. (Selim 2006)A higher score indicates better qualityFlynn KE, Pina IL, Whellan DJ, Lin L, Blumenthal JA, Ellis SJ, Fine LJ, Howlett JG, Keteyian SJ, Kitzman DW, Kraus WE, Miller NH, Schulman KA, Spertus JA, O'Connor CM, Weinfurt KP. Effects of exercise training on health status in patients with chronic heart failure: HF-ACTION randomized controlled trial. JAMA 2009; 301:1451-1459.Rose M, Bjorner JB, Becker J, Fries JF, Ware JE. Evaluation of a preliminary physical function item bank supported expected advantages of the Patient-Reported Outcomes Measurement Information System (PROMIS). J Clin Epidemiol 2008; 61:17-33.Rothrock NE, Hays RD, Spritzer K, Yount SE, Riley W, Cella D. Relative to the general US population, chronic diseases are associated with poorer health-related quality of life as measured by the Patient-Reported Outcomes Measurement Information System (PROMIS). J Clin Epidemiol 2010; 63(11):1195-204.Selim AJ, Berlowitz D, Kazis LE, Rogers W, Wright SM, Qian SX, Rohendler JA, Spiro A, Miller D, Selim BJ, Fincke BG. Comparison of Health Outcomes for Male Seniors in the Veterans Health Administration and Medicare Advantage Plans. Health Services Research 2010; 45(2): 376-396.NoneInitial encounter: The first encounter during the first 185 days of the measurement year. - -Follow-up encounter: The last encounter that is at least 30 days but no more than 180 after the initial encounter. - -A Functional Status Assessment (FSA) is based on administration of a validated instrument to eligible patients that asks patients to answer questions related to various domains including: pain, physical function, emotional well-being, health-related quality of life, symptom acuity. - -The use of patient-reported outcomes data in eMeasures - such as this measure of functional status - demonstrates the need for the Quality Reporting Data Architecture (QRDA) to support a data attribute that indicates that the patient provided the information.TBDAdults aged 65 years and older who had two outpatient encounters during the measurement year and an active diagnosis of heart failure.Equals Initial PopulationPatients with severe cognitive impairment or patients with an active diagnosis of cancerPatients with patient reported functional status assessment results (eg, VR-12; VR-36; MLHF-Q; KCCQ; PROMIS-10 Global Health, PROMIS-29) present in the EHR within two weeks before or during the initial encounter and the follow-up encounter during the measurement year.Not ApplicableNoneNot ApplicableNot ApplicableNot ApplicableFor every patient evaluated by this measure also identify payer, race, ethnicity and sex.None - - \ No newline at end of file diff --git a/test/fixtures/hqmf/simplexml/CMS91v5_SimpleXML.xml b/test/fixtures/hqmf/simplexml/CMS91v5_SimpleXML.xml deleted file mode 100755 index ca83b94f..00000000 --- a/test/fixtures/hqmf/simplexml/CMS91v5_SimpleXML.xml +++ /dev/null @@ -1,24 +0,0 @@ -40280381-4be2-53b3-014b-f0bbf5d70dbbThrombolytic TherapySTK-4912838875a-07b5-4bf0-be04-c3eb99f539755.0.0000000010100001231The Joint CommissionThe Joint CommissionNational Quality ForumAcute ischemic stroke patients who arrive at this hospital within 2 hours of time last known well and for whom t-PA was initiated at this hospital within 3 hours of time last known well.Measure specifications are in the Public Domain. - -LOINC(R) is a registered trademark of the Regenstrief Institute. - -This material contains SNOMED Clinical Terms (R) (SNOMED CT(C)) copyright 2004-2014 International Health Terminology Standards Development Organization. All rights reserved.These performance measures are not clinical guidelines and do not establish a standard of medical care, and have not been tested for all potential applications. The measures and specifications are provided without warranty.ProportionProcessNoneNoneNoneThe administration of thrombolytic agents to carefully screened, eligible patients with acute ischemic stroke has been shown to be beneficial in several clinical trials. These included two positive randomized controlled trials in the United States: The National Institute of Neurological Disorders and Stroke (NINDS) Studies, Part I and Part II. Based on the results of these studies, the Food and Drug Administration (FDA) approved the use of intravenous recombinant tissue plasminogen activator (IV r-tPA or t-PA) for the treatment of acute ischemic stroke when given within 3 hours of stroke symptom onset. A large meta-analysis controlling for factors associated with stroke outcome confirmed the benefit of IV t-PA in patients treated within 3 hours of symptom onset. While controversy still exists among some specialists, the major society practice guidelines developed in the United States all recommend the use of IV t-PA for eligible patients. Physicians with experience and skill in stroke management and the interpretation of CT scans should supervise treatment. - -The European Cooperative Acute Stroke Study (ECASS) III trial indicated that intravenous r-tPA can be given safely to, and can improve outcomes for, carefully selected patients treated 3 to 4.5 hours after stroke; however, as the NINDS investigators concluded, the earlier that IV thrombolytic therapy is initiated, the better the patient outcome. Therefore, the target for IV t-PA initiation remains within 3 hours of time last known well. The administration of IV thrombolytic therapy beyond 3 hours of stroke symptom onset has not been FDA approved.The administration of thrombolytic agents to carefully screened, eligible patients with acute ischemic stroke has been shown to be beneficial in several clinical trials. Intravenous recombinant tissue plasminogen activator (IV r-tPA or t-PA) should be used for the treatment of acute ischemic stroke when given within 3 hours of stroke symptom onset.Improvement is noted as an increase in ratedel Zoppo GJ, Saver JL, Jauch EC, Adams HP. Expansion of the Time Window for Treatment of Acute Ischemic Stroke With Intravenous Tissue Plasminogen Activator: A Science Advisory From the American Heart Association/ American Stroke Association. Stroke. 2009;40:2945-2948.Guyatt, G. H., E. A. Akl, M. Crowther, D. D. Gutterman, H. J. Schuunemann, Therapy American College of Chest Physicians Antithrombotic, and Panel Prevention of Thrombosis. "Executive Summary: Antithrombotic Therapy and Prevention of Thrombosis, 9th Ed: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines." [In eng]. Chest 141, no. 2 Suppl (Feb 2012): 7S-47S.Jauch, E. C., J. L. Saver, H. P. Adams, Jr., A. Bruno, J. J. Connors, B. M. Demaerschalk, P. Khatri, et al. "Guidelines for the Early Management of Patients with Acute Ischemic Stroke: A Guideline for Healthcare Professionals from the American Heart Association/American Stroke Association." [In Eng]. Stroke (Jan 31 2013).Kwiatkowski, T. G., R. B. Libman, M. Frankel, B. C. Tilley, L. B. Morgenstern, M. Lu, J. P. Broderick, et al. "Effects of Tissue Plasminogen Activator for Acute Ischemic Stroke at One Year. National Institute of Neurological Disorders and Stroke Recombinant Tissue Plasminogen Activator Stroke Study Group." [In eng]. N Engl J Med 340, no. 23 (Jun 10 1999): 1781-7.Saposnik, G., J. Fang, M. K. Kapral, J. V. Tu, M. Mamdani, P. Austin, S. C. Johnston, Network Investigators of the Registry of the Canadian Stroke, and Group Stroke Outcomes Research Canada Working. "The Iscore Predicts Effectiveness of Thrombolytic Therapy for Acute Ischemic Stroke." [In eng]. Stroke 43, no. 5 (May 2012): 1315-22."Tissue Plasminogen Activator for Acute Ischemic Stroke. The National Institute of Neurological Disorders and Stroke Rt-Pa Stroke Study Group." [In eng]. N Engl J Med 333, no. 24 (Dec 14 1995): 1581-7.Wardlaw, J. M., V. Murray, E. Berge, and G. J. Del Zoppo. "Thrombolysis for Acute Ischaemic Stroke." [In eng]. Cochrane Database Syst Rev, no. 4 (2009): CD000213.NoneThe unit of measurement for this measure is an inpatient episode of care. Each distinct hospitalization should be reported, regardless of whether the same patient is admitted for inpatient care more than once during the measurement period. In addition, the eMeasure logic intends to represent events within or surrounding a single occurrence of an inpatient hospitalization. - -The "baseline state" value set and its associated effectiveTime intend to capture the date and time prior to hospital arrival at which it was witnessed or reported that the patient was last known to be without the signs and symptoms of the current stroke or at his or her baseline state of health. The time of symptom onset value set and its associated effectiveTime is intended to capture the date and time at which symptoms started if symptom onset was witnessed. Since none of the value sets make any specific reference to stroke, their use is only meaningful in the context of stroke-specific documentation, such as a stroke assessment form or template. - -The "Non-elective Inpatient Encounter" value set intends to capture all non-scheduled hospitalizations. This value set is a subset of the "Inpatient encounter" value set, excluding concepts that specifically refer to elective hospital admissions. Non-elective admissions include emergency, urgent and unplanned admissions.TBDPatients age 18 and older discharged from inpatient care (non-elective admissions) with a principal diagnosis of ischemic or hemorrhagic stroke and a length of stay less than or equal to 120 days.Ischemic stroke patients admitted through the Emergency Department whose time of arrival is within 2 hours (less than or equal to 120 minutes) of the 1) time they were known to be at their baseline state of health; or 2) time of symptom onset if time last known at baseline state is not known.NoneAcute ischemic stroke patients for whom IV thrombolytic therapy was initiated at this hospital within 3 hours (less than or equal to 180 minutes) of when it was witnessed or reported that the patient was last known to be without the signs and symptoms of the current stroke or at his or her baseline state of health.Not Applicable* Patients with comfort measures documented on the day of or the day after arrival -* Patients with intra-venous or intra-arterial Thrombolytic (t-PA) Therapy prior to arrival -* Patients with documentation of a National Institutes for Health Stroke Scale (NIHSS) score of zero in the emergency department -* Patients with Medical Reasons for not initiating IV thrombolytics documented by a physician/APN/PA or pharmacist on the day of or the day after arrival -* Patients with any of the following results within 180 minutes of the 1) time they were known to be at their baseline state of health; or 2) time of symptom onset: - *Prothrombin Time > 15 seconds - *Platelet Count <100,000 - *INR<1.7 - *Partial Thromboplastin Time > 40 seconds - *Systolic Blood Pressure > 185 mmHg - *Diastolic Blood Pressure > 110 mmHg - *Patient refusalNot ApplicableNot ApplicableNot ApplicableFor every patient evaluated by this measure also identify payer, race, ethnicity and sex.eMeasure Stroke (eSTK) - - \ No newline at end of file diff --git a/test/fixtures/hqmf/simplexml/CMS9v4_SimpleXML.xml b/test/fixtures/hqmf/simplexml/CMS9v4_SimpleXML.xml deleted file mode 100755 index caea35f5..00000000 --- a/test/fixtures/hqmf/simplexml/CMS9v4_SimpleXML.xml +++ /dev/null @@ -1,17 +0,0 @@ -40280381-4de7-db4d-014d-e8c552e9025fExclusive Breast Milk FeedingExclusive Breast Milk Feeding97d374c6a-3821-4333-a1bc-4531005d77b84.1.0000000010100001231The Joint CommissionThe Joint CommissionNational Quality ForumPC-05 Exclusive breast milk feeding during the newborn's entire hospitalization. - -PC-05a Exclusive breast milk feeding during the newborn's entire hospitalization considering mother's choice.LOINC(R) is a registered trademark of the Regenstrief Institute. - -This material contains SNOMED Clinical Terms (R) (SNOMED CT[C]) copyright 2004-2014 International Health Terminology Standards Development Organization. All rights reserved.These performance measures are not clinical guidelines and do not establish a standard of medical care, and have not been tested for all potential applications. The measures and specifications are provided without warranty.ProportionProcessNoneNoneNoneExclusive breast milk feeding for the first 6 months of neonatal life has long been the expressed goal of World Health Organization (WHO), Department of Health and Human Services (DHHS), American Academy of Pediatrics (AAP) and American College of Obstetricians and Gynecologists (ACOG). ACOG has recently reiterated its position (ACOG, 2007). A recent Cochrane review substantiates the benefits (Kramer et al., 2002). Much evidence has now focused on the prenatal and intrapartum period as critical for the success of exclusive (or any) BF (Centers for Disease Control and Prevention [CDC], 2007; Petrova et al., 2007; Shealy et al., 2005; Taveras et al., 2004). Exclusive breast milk feeding rate during birth hospital stay has been calculated by the California Department of Public Health for the last several years using newborn genetic disease testing data. Healthy People 2010 and the CDC have also been active in promoting this goal.Exclusive breast milk feeding for the first 6 months of neonatal life can result in numerous long-term health benefits for both mother and newborn and is recommended by a number of national and international organizations. Evidence suggests that the prenatal and intrapartum period is critical for the success of exclusive (or any) breast feeding. Therefore, it is recommended that newborns are fed breast milk only from birth to discharge.Improvement noted as an increase in the rateAmerican Academy of Pediatrics. (2005). Section on Breastfeeding. Policy Statement: -Breastfeeding and the Use of Human Milk. Pediatrics.115:496-506.American College of Obstetricians and Gynecologists. (Feb. 2007). Committee on Obstetric Practice and Committee on Health Care for Underserved Women.Breastfeeding: Maternal and Infant Aspects. ACOG Committee Opinion 361.California Department of Public Health. (2006). Genetic Disease Branch. California In- -Hospital Breastfeeding as Indicated on the Newborn Screening Test Form, Statewide, County and Hospital of Occurrence: Available at: http://www.cdph.ca.gov/data/statistics/Pages/BreastfeedingStatistics.aspx.Centers for Disease Control and Prevention. (Aug 3, 2007). Breastfeeding trends and -updated national health objectives for exclusive breastfeeding--United States birth years 2000-2004. MMWR - Morbidity & Mortality Weekly Report. 56(30):760-3.Centers for Disease Control and Prevention. (2014). Division of Nutrition, Physical Activity and Obesity. Breastfeeding Report Card. Available at: http://www.cdc.gov/breastfeeding/pdf/2014breastfeedingreportcard.pdfIp, S., Chung, M., Raman, G., et al. (2007). Breastfeeding and maternal and infant health outcomes in developed countries. Rockville, MD: US Department of Health and Human Services. Available at: http://www.ahrq.gov/downloads/pub/evidence/pdf/brfout/brfout.pdfKramer, M.S. & Kakuma, R. (2002).Optimal duration of exclusive breastfeeding. [107 refs] Cochrane Database of Systematic Reviews. (1):CD003517.Petrova, A., Hegyi, T., & Mehta, R. (2007). Maternal race/ethnicity and one-month exclusive breastfeeding in association with the in-hospital feeding modality. Breastfeeding Medicine. 2(2):92-8.Shealy, K.R., Li, R., Benton-Davis, S., & Grummer-Strawn, L.M. (2005).The CDC guide to breastfeeding interventions. Atlanta, GA: US Department of Health and Human Services, CDC. Available at: http://www.cdc.gov/breastfeeding/pdf/breastfeeding_interventions.pdf.Taveras, E.M., Li, R., Grummer-Strawn, L., Richardson, M., Marshall, R., Rego, V.H., -Miroshnik, I., & Lieu, T.A. (2004). Opinions and practices of clinicians associated with -continuation of exclusive breastfeeding. Pediatrics. 113(4):e283-90.US Department of Health and Human Services. (2007). Healthy People 2010 Midcourse Review. Washington, DC: US Department of Health and Human Services. Available at: http://www.healthypeople.gov/2010/data/midcourse/?visit=1.World Health Organization. (1991). Indicators for assessing breastfeeding practices. Geneva, Switzerland: World Health Organization. Available at: http://whqlibdoc.who.int/hq/1991/WHO_CDD_SER_91.14.pdf?ua=1.NoneA discharge to a designated cancer center or children's hospital should be captured as a discharge to an acute care facility. - -The unit of measurement for this measure is an inpatient episode of care. Each distinct hospitalization should be reported, regardless of whether the same patient is admitted for inpatient care more than once during the measurement period. In addition, the eMeasure logic intends to represent events within or surrounding a single occurrence of an inpatient hospitalization.TBDSingle term newborns born in the hospital who did not have a diagnosis of galactosemia, were not subject to parenteral nutrition, and had a length of stay less than or equal to 120 days.PC-05 Single term newborns discharged from the hospital. -PC-05a Single term newborns discharged from the hospital.PC-05 Newborns who were admitted to the Neonatal Intensive Care Unit (NICU), who were transferred to an acute care facility, or who expired during the hospitalization. -PC-05a Newborns who were admitted to the Neonatal Intensive Care Unit (NICU), who were transferred to an acute care facility, who expired during the hospitalization, or whose mothers chose not to exclusively breast feed.PC-05 Newborns who were fed breast milk only since birth. -PC-05a Newborns who were fed breast milk only since birth.Not applicableNoneNot applicableNot applicableNot applicableFor every patient evaluated by this measure also identify payer, race, ethnicity and sex.eMeasure Perinatal Care (ePC) - - \ No newline at end of file diff --git a/test/unit/hqmf/2.0/hqmf_vs_simple_test.rb b/test/unit/hqmf/2.0/hqmf_vs_simple_test.rb deleted file mode 100644 index 6cc760a1..00000000 --- a/test/unit/hqmf/2.0/hqmf_vs_simple_test.rb +++ /dev/null @@ -1,390 +0,0 @@ -require 'fileutils' -require 'digest' -require 'simplexml_parser' -require_relative '../../../test_helper' - -# Compares the model generated for HQMF 2.1 to the SimpleXML generated model -class HQMFVsSimpleTest < Minitest::Test - RESULTS_DIR = File.join('tmp', 'hqmf_simple_diffs') - - HQMF_ROOT = File.join(ENV['HQMF_ROOT']) if ENV['HQMF_ROOT'] - HQMF_ROOT ||= File.join('test', 'fixtures', 'hqmf', 'hqmf') - - SIMPLE_XML_ROOT = File.join(ENV['SIMPLE_XML_ROOT']) if ENV['SIMPLE_XML_ROOT'] - SIMPLE_XML_ROOT ||= File.join('test', 'fixtures', 'hqmf', 'simplexml') - - # Create a blank folder for the errors - FileUtils.rm_rf(RESULTS_DIR) if File.directory?(RESULTS_DIR) - FileUtils.mkdir_p RESULTS_DIR - # Automatically generate one test method per measure file - measure_files = File.join(HQMF_ROOT, '*.xml') - - Dir.glob(measure_files).each do |measure_filename| - measure_name = File.basename(measure_filename, '.xml') - #if ["CMS172v5"].index(measure_name) # left in to handle subset testing - define_method("test_#{measure_name}") do - do_roundtrip_test(measure_filename, measure_name) - end - #end - end - - def do_roundtrip_test(measure_filename, measure_name) - hqmf_model, hqmf_json_orig, simple_xml_model, simple_xml_json_orig = generate_models_and_json(measure_filename, measure_name) - # ignore the attributes... these are not that important - hqmf_model.instance_variable_set(:@attributes, []) - simple_xml_model.instance_variable_set(:@attributes, []) - - # make sure we don't have duplicated specific occurrences... we blow away the SO constant, so this is the best we can check - check_for_duplicate_specific_occurrences(hqmf_model) - - # remap values in simple_xml and hqmf_model to resolve ignorable differences - remap_arbitrary_v2_diffs(simple_xml_model, hqmf_model, measure_name) - - # certain measures carry over currently unused by products - individual_measure_corrections(simple_xml_model, hqmf_model, measure_name) - - remap_ids(hqmf_model) - remap_ids(simple_xml_model) - - # empty out the measure period, since they are unlikely be equal - # simple_xml_model.instance_variable_set(:@measure_period, nil) - # hqmf_model.instance_variable_set(:@measure_period, nil) - - # COMPARE - - hqmf_json = JSON.parse(hqmf_model.to_json.to_json, max_nesting: 100) - simple_xml_json = JSON.parse(simple_xml_model.to_json.to_json, max_nesting: 100) - diff = generate_diff_and_save_to_file(measure_name, hqmf_json, simple_xml_json) - print_to_file(measure_name, hqmf_model, simple_xml_model, hqmf_json_orig, simple_xml_json_orig) unless diff.empty? - # TODO: remove this when SimpleXML import is fixed - skip - assert diff.empty?, 'Differences in model between HQMF and SimpleXml.' - end - - # check if there are any source data criteria entries for specific occurrences that share the same constant and SO letter... this indicates a duplicated SO - # this only really happens in HQMF R2 since there is no SDC list so it is possible to duplicate SO when generating. Since the SO constants are cleared for comparison - # this is not caught by the diff testing. - def check_for_duplicate_specific_occurrences(hqmf_model) - by_const_map = {} - hqmf_model.source_data_criteria.each do |dc| - next if dc.specific_occurrence_const.nil? - key = "#{dc.specific_occurrence_const} #{dc.specific_occurrence}" - by_const_map[key] ||= [] - by_const_map[key] << dc - end - duplicated_specifics = by_const_map.values.select {|x| x.length > 1} - throw "Duplicate specific occurrences in source for HQMF " + (duplicated_specifics.map {|x| x.map(&:id).join(',')}.join(',')) if duplicated_specifics.count > 0 - end - - # Initial setup of models and json - def generate_models_and_json(measure_filename, measure_name) - puts ">> #{measure_name}" - # parse the model from the V1 XML - hqmf_model = HQMF::Parser::V2Parser.new.parse(File.open(measure_filename).read) - # rebuild hqmf model so that source data criteria are different objects - hqmf_model = HQMF::Document.from_json(JSON.parse(hqmf_model.to_json.to_json, max_nesting: 100)) - - # Only care about the major hqmf version id for the comparison test - hqmf_model.instance_variable_set(:@hqmf_version_number, hqmf_model.hqmf_version_number.to_i) - - simple_xml = File.join(SIMPLE_XML_ROOT, "#{measure_name}_SimpleXML.xml") - simple_xml_model = SimpleXml::Parser::V1Parser.new.parse(File.read(simple_xml)) - - hqmf_json_orig = JSON.parse(hqmf_model.to_json.to_json, max_nesting: 100) - simple_xml_json_orig = JSON.parse(simple_xml_model.to_json.to_json, max_nesting: 100) - [hqmf_model, hqmf_json_orig, simple_xml_model, simple_xml_json_orig] - end - - # Handle differences between the HQMF 2 parser and SimpleXML that are characteristic of the 2.1 switch - def remap_arbitrary_v2_diffs(simple_xml_model, hqmf_model, measure_name) - # FIXME: (10/19/2015) removes the source data criteria for patient expired from simplexml, which at this time - # does not exist in the HQMF2.1 version or in the human readable version for most measures - unless %w(CMS159v4 CMS160v4 CMS172v5 CMS178v5).index(measure_name) - simple_xml_model.instance_variable_get(:@source_data_criteria).reject! { |sdc| sdc.definition == 'patient_characteristic_expired' } - end - - remap_arbitrary_dc_v2_diff(simple_xml_model) - remap_arbitrary_dc_v2_diff(hqmf_model) - # Remove comments from both sets of populations criteria - simple_xml_model.instance_variable_get(:@population_criteria).each do |pop_crit| - recurively_remove_precondition_comments(pop_crit) - end - - # modify both populations to reduce erroneous error reporting - remap_populations(simple_xml_model, hqmf_model) - end - - # Handle changes that should not affect calculations - def remap_arbitrary_dc_v2_diff(model) - (model.all_data_criteria + model.source_data_criteria).each do |dc| - # title and description for all are technically arbitrary values - dc.instance_variable_set(:@title, '') - dc.instance_variable_set(:@description, '') - - if %w(patient_characteristic_birthdate patient_characteristic_expired).index(dc.definition) - dc.instance_variable_set(:@code_list_id, '') - dc.instance_variable_set(:@inline_code_list, '') - end - - # Ignore STATUS field value from HQMF - # The meaning of status has changed over time. Laboratory test and procedure now use status differently. - # This change is causing superficial discrepencies between the simplexml and hqmf regarding STATUS. - dc.field_values.except!('STATUS') unless dc.field_values.nil? - dc.field_values = nil if !dc.field_values.nil? && dc.field_values.empty? - - # Changes specific occurrence consts to a generalized naming pattern - # The goal is to reduce errors from arbitrary naming patterns that can - # pop up - if dc.specific_occurrence && dc.specific_occurrence_const - dc.instance_variable_set(:@specific_occurrence_const, "Occurrence #{dc.specific_occurrence}") - end - - # ORDINALITY was changed to ORDINAL in the new HQMF, this nullifies that error - if !dc.field_values.nil? && !dc.field_values.empty? - if dc.field_values['ORDINALITY'] - dc.field_values['ORDINAL'] = dc.field_values['ORDINALITY'] - dc.field_values.delete('ORDINALITY') - end - end - - change_field_value_units(dc.value) - end - end - - # Changes the field value units that changed in the newer version - def change_field_value_units(value) - return if value.nil? || value.type != 'IVL_PQ' - # Update units from simple_xml version, mm[Hg], to new mmHg version - if value.low && value.low.unit == 'mm[Hg]' - value.low.instance_variable_set(:@unit, 'mmHg') - end - if value.high && value.high.unit == 'mm[Hg]' - value.high.instance_variable_set(:@unit, 'mmHg') - end - end - - # Manage corrections needed for individual (or groups of) measures - def individual_measure_corrections(simple_xml_model, hqmf_model, measure_name) - # Birthdate is unnecessary on this measure according to human readable, only appear in SimpleXML - if measure_name == 'CMS149v4' - simple_xml_model.instance_variable_get(:@source_data_criteria).reject! { |sdc| sdc.definition == 'patient_characteristic_birthdate' } - end - - # Removes a code_list_id from a qdm variable (it is present in the measure xml) - if ['CMS62v4'].index(measure_name) - hqmf_model.all_data_criteria.select { |dc| dc.id == 'qdm_var_During_2F8D4BA8_BA4E_4DC8_9C35_11D4ADFE3E75' }.each do |dc| - dc.instance_variable_set(:@code_list_id, nil) - end - hqmf_model.source_data_criteria.select { |dc| dc.id == 'qdm_var_During_2F8D4BA8_BA4E_4DC8_9C35_11D4ADFE3E75' }.each do |dc| - dc.instance_variable_set(:@code_list_id, nil) - end - end - - # Handles measures that are "regardless of age" or seems to not refer to Ptient birthdate characteristic - if %w(CMS31v4 CMS32v5 CMS50v4 CMS55v4 CMS62v4 CMS111v4 CMS129v5 CMS157v4 CMS185v4).index(measure_name) - simple_xml_model.source_data_criteria.reject! { |dc| dc.definition == 'patient_characteristic_birthdate' } - end - end - - # Modify the populations to make them similar - def remap_populations(simple_xml_model, hqmf_model) - # The "stratifications" property of populations either does not exist or is not being parsed in SimpleXML, - # or is superfluous in HQMF (they both contain "STRAT"s) - hqmf_model.instance_variable_get(:@populations).map! { |pop| pop.reject { |key, _value| key == 'stratification' } } - - # the population_index and stratification_index were added to support CQL work and do not affect QDM-based measures - hqmf_model.instance_variable_get(:@populations).map! { |pop| pop.reject { |key, _value| key == 'population_index' } } - hqmf_model.instance_variable_get(:@populations).map! { |pop| pop.reject { |key, _value| key == 'stratification_index' } } - - # population titles in HQMF2 can be ignored - hqmf_model.instance_variable_get(:@populations).map! { |pop| pop.reject { |key, _value| key == 'title' } } - simple_xml_model.instance_variable_get(:@populations).map! { |pop| pop.reject { |key, _value| key == 'title' } } - hqmf_populations = hqmf_model.instance_variable_get(:@populations) - reject_unnecessary_population_criteria(simple_xml_model, hqmf_populations) - end - - # Removes populations that may not be necessary, but could appear in the simpel_xml - # (an unneccessary population is one that doesn't have a precondition) - def reject_unnecessary_population_criteria(simple_xml_model, hqmf_populations) - # More restrictive (only checks DENEXCEP) removal of populations in simple_xml - # obtain all denexceps and denex (and only run if they exist) - unnecessary_pop_crit = simple_xml_model.instance_variable_get(:@population_criteria).select { |pc| pc.type =~ /(DENEX|MSRPOPLEX)/ } - unnecessary_pop_crit.each do |pc| - # if HQMF2 version does not have that population - next unless hqmf_populations.reject { |pop| !pop.key?(pc.type) || pop[pc.type] != pc.id }.empty? - # or that population has a precondition - next unless pc.preconditions.empty? - # Then remove DENEXCEP from population criteria and any population - simple_xml_model.instance_variable_get(:@population_criteria) - .delete_at(simple_xml_model.instance_variable_get(:@population_criteria).index { |pc2| pc == pc2 }) - simple_xml_model.instance_variable_get(:@populations).map! { |pop| pop.reject { |_key, value| value == pc.id } } - end - end - - # We shouldn't be comparing comments stored in the formats - def recurively_remove_precondition_comments(precondition) - precondition.instance_variable_set(:@comments, nil) - precondition.preconditions.each do |precon| - recurively_remove_precondition_comments(precon) - end - end - - # Swap id's with the hash id generated by the criteria - def remap_ids(measure_model) - criteria_list = (measure_model.source_data_criteria + measure_model.all_data_criteria) - criteria_map = get_criteria_map(measure_model.source_data_criteria, measure_model.all_data_criteria) - - # Normalize the HQMF model IDS - criteria_list.each do |dc| - dc.id = HashDataCriteria.hash_criteria(dc, criteria_map) - dc.instance_variable_set(:@source_data_criteria, dc.id) - end - - measure_model.all_population_criteria.each do |pc| - remap_preconditions(criteria_map, pc.preconditions) - # We don't care about differences in titles - pc.instance_variable_set(:@title, '') - end - end - - # Creates a map of data criteria ids to the data criteria themselves - def get_criteria_map(source_data_criteria, data_criteria) - criteria_map = {} - # Since the dc has more specifics than the sdc, only use the sdc version if no dc version exists - source_data_criteria.each do |dc| - criteria_map[dc.id] = dc - end - data_criteria.each do |dc| - criteria_map[dc.id] = dc - end - criteria_map - end - - # Swaps the Hash Id with the original data_criteria id - def remap_preconditions(criteria_map, preconditions) - return if preconditions.nil? - preconditions.each do |precondition| - remap_preconditions(criteria_map, precondition.preconditions) - next if precondition.reference.nil? - data_criteria = criteria_map[precondition.reference.id] - precondition.reference.id = data_criteria.id if data_criteria - end - end - - # Generates the diff between the hqmf and simplexml modified json - def generate_diff_and_save_to_file(measure_name, hqmf_json, simple_xml_json) - diff = simple_xml_json.diff_hash(hqmf_json, true, true) - unless diff.empty? - outfile = File.join("#{RESULTS_DIR}", "#{measure_name}_diff.json") - File.open(outfile, 'w') { |f| f.write(JSON.pretty_generate(JSON.parse(diff.to_json))) } - outfile = File.join("#{RESULTS_DIR}", "#{measure_name}_diff_hqmf.json") - File.open(outfile, 'w') { |f| f.write(JSON.pretty_generate(hqmf_json)) } - outfile = File.join("#{RESULTS_DIR}", "#{measure_name}_diff_simplexml.json") - File.open(outfile, 'w') { |f| f.write(JSON.pretty_generate(simple_xml_json)) } - end - diff - end - - # Prints the original json, and the critical differences between the two base models, to files - def print_to_file(measure_name, hqmf_model, simple_xml_model, hqmf_json_orig, simple_xml_json_orig) - outfile = File.join("#{RESULTS_DIR}", "#{measure_name}_orig_hqmf.json") - File.open(outfile, 'w') { |f| f.write(JSON.pretty_generate(hqmf_json_orig)) } - outfile = File.join("#{RESULTS_DIR}", "#{measure_name}_orig_simplexml.json") - File.open(outfile, 'w') { |f| f.write(JSON.pretty_generate(simple_xml_json_orig)) } - - outfile = File.join("#{RESULTS_DIR}", "#{measure_name}_crit_diff.json") - File.open(outfile, 'w') do|f| - f.puts ">>>>>> HQMF ONLY: " - f.puts((hqmf_model.all_data_criteria.collect(&:id) - simple_xml_model.all_data_criteria.collect(&:id)).sort) - f.puts - f.puts ">>>>>> SIMPLE ONLY: " - f.puts((simple_xml_model.all_data_criteria.collect(&:id) - hqmf_model.all_data_criteria.collect(&:id)).sort) - f.puts - f.puts ">>>>>> HQMF ONLY (SOURCE): " - f.puts((hqmf_model.source_data_criteria.collect(&:id) - simple_xml_model.source_data_criteria.collect(&:id)).sort) - f.puts - f.puts ">>>>>> SIMPLE ONLY (SOURCE): " - f.puts((simple_xml_model.source_data_criteria.collect(&:id) - hqmf_model.source_data_criteria.collect(&:id)).sort) - end - end -end - -# Class to handle hashing of data criteria -class HashDataCriteria - # Generate the unique hash for a data criteria - def self.hash_criteria(criteria, criteria_map) - return criteria.id unless criteria_map[criteria.id] - - # generate a SHA256 hash of key fields in the data criteria - # sha256 = Digest::SHA256.new - # uncomment to keep string undigested for comparison - sha256 = '' - - sha256 << "1-#{criteria.code_list_id}:" - sha256 << "2-#{criteria.definition}:" - sha256 << "3-#{criteria.status}:" - sha256 << "4-#{criteria.negation}:" - sha256 << "5-#{criteria.specific_occurrence}:" - - # build hashes of each complex child... these will update refereces to other data criteria as the hash is built - sha256 << "6-#{hash_values(criteria.value)}:" - sha256 << "7-#{hash_children(criteria.children_criteria, criteria_map)}:" - sha256 << "8-#{hash_subsets(criteria.subset_operators)}:" - sha256 << "9-#{hash_temporals(criteria.temporal_references, criteria_map)}:" - sha256 << "10-#{hash_fields(criteria.field_values, criteria_map)}:" - sha256 << "11-#{criteria.negation_code_list_id}:" - sdc = (criteria.source_data_criteria == criteria.id) ? 'SELF' : criteria.source_data_criteria - sdc_hash = hash_children([sdc], criteria_map) - # check if the hashed SDC is the same as self (different original ID) - if ("(#{sha256}12-SELF:)" == sdc_hash ) - sha256 << "12-SELF:" - else - sha256 << "12-#{sdc_hash}:" - end - - # sha256.hexdigest - sha256 - end - - # Hash subset operators - def self.hash_subsets(list) - return unless list - Digest::SHA256.hexdigest list.map { |x| x.to_json.to_json }.join(',') - end - - # Hash temporal references - def self.hash_temporals(list, criteria_map) - return unless list - list.each do |t| - t.reference.id = hash_criteria(criteria_map[t.reference.id], criteria_map) if criteria_map[t.reference.id] - end - - Digest::SHA256.hexdigest list.map { |x| x.to_json.to_json }.join(',') - end - - # Hash child criteria (using the criteria_map) - def self.hash_children(list, criteria_map) - return unless list - list.map! { |id| "(#{hash_criteria(criteria_map[id], criteria_map)})" } if list.count { |id| criteria_map[id] } == list.length - list.join(',') - end - - # Hash field values - def self.hash_fields(hash, criteria_map) - return unless hash - hash.values.each do |fv| - fv.instance_variable_set(:@title, '') - unless fv.instance_variable_get(:@reference).nil? - fv.instance_variable_set(:@reference, hash_criteria(criteria_map[fv.instance_variable_get(:@reference)], criteria_map)) - end - end - Digest::SHA256.hexdigest hash.to_json - end - - # Hash values for the criteria - def self.hash_values(value) - return unless value - value.instance_variable_set(:@title, '') if value.type == 'CD' - Digest::SHA256.hexdigest value.to_json.to_json - end -end