measure-EXM105-8.2.000.json

{
  "resourceType": "Measure",
  "id": "measure-EXM105-8.2.000",
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  "url": "http://hl7.org/fhir/us/cqfmeasures/Measure/EXM105",
  "identifier": [ {
    "use": "official",
    "system": "http://hl7.org/fhir/cqi/ecqm/Measure/Identifier/cms",
    "value": "105"
  } ],
  "version": "8.2.000",
  "name": "EXM105",
  "title": "Discharged on Statin Medication",
  "status": "active",
  "experimental": true,
  "date": "2018-09-17",
  "publisher": "The Joint Commission",
  "contact": [ {
    "telecom": [ {
      "system": "url",
      "value": "https://www.jointcommission.org/en/"
    } ]
  } ],
  "description": "Ischemic stroke patients who are prescribed or continuing to take statin medication at hospital discharge",
  "useContext": [ {
    "code": {
      "code": "program"
    },
    "valueCodeableConcept": {
      "text": "eligible-provider"
    }
  } ],
  "jurisdiction": [ {
    "coding": [ {
      "system": "urn:iso:std:iso:3166",
      "code": "US"
    } ]
  } ],
  "purpose": "Ischemic stroke patients who are prescribed or continuing to take statin medication at hospital discharge",
  "copyright": "LOINC(R) copyright 2004-2018 Regenstrief Institute, Inc. \r\nThis material contains SNOMED Clinical Terms(R) (SNOMED CT[R]) copyright 2004-2018 International Health Terminology Standards Development Organisation. All Rights Reserved.\r\n\r\nMeasure specifications are in the Public Domain.",
  "approvalDate": "2016-01-01",
  "lastReviewDate": "2016-09-01",
  "effectivePeriod": {
    "start": "2019-01-01",
    "end": "2019-12-31"
  },
  "topic": [ {
    "coding": [ {
      "system": "http://loinc.org",
      "code": "57024-2",
      "display": "Health Quality Measure Document"
    } ]
  } ],
  "relatedArtifact": [ {
    "type": "citation",
    "citation": "Amarenco, P., Bogousslavsky, J., Callahan, A., III, et al. (2006, August 10). High-dose atorvastatin after stroke or transient ischemic attack. New England Journal of Medicine, 355(6), 549-559. "
  }, {
    "type": "citation",
    "citation": "Biffi, A., Devan, W. J., Anderson, C. D., et al. (2011, May). Statin treatment and functional outcome after ischemic stroke: Case-control and meta-analysis. Stroke, 42(5), 1314-1319. "
  }, {
    "type": "citation",
    "citation": "Centers for Disease Control and Prevention. (2009, May 1). Prevalence and most common causes of disability among adults United States, 2005. Morbidity and Mortality Weekly Report, 58(16), 421-426. "
  }, {
    "type": "citation",
    "citation": "Chan, P. S., Nallamothu, B. K., Gurm, H. S., et al. (2007, May 8). Incremental benefit and cost-effectiveness of high-dose statin therapy in high-risk patients with coronary artery disease. Circulation, 115(18), 2398-2409. "
  }, {
    "type": "citation",
    "citation": "Culver, A. L., Ockene, I. S., Balasubramanian, R., et al. (2012, January 23). Statin use and risk of diabetes mellitus in postmenopausal women in the Women's Health Initiative. Archives of Internal Medicine, 172(2),  144-152. "
  }, {
    "type": "citation",
    "citation": "Feher, A., Pusch, G., Koltai, K., et al. (2011, April 14). Statin therapy in the primary and the secondary prevention of ischaemic cerebrovascular diseases. International Journal of Cardiology, 148(2), 131-138. "
  }, {
    "type": "citation",
    "citation": "Grundy, S. M., Cleeman, J. I., Merz, C. N., et al. (2004, July 13). Implications of recent clinical trials for the National Cholesterol Education Program Adult Treatment Panel III Guidelines. Circulation, 110(2), 227-239."
  }, {
    "type": "citation",
    "citation": "Kernan, W. N., Ovbiagele, B., Black, H. R., et al. (2014, May). Guidelines for the prevention of stroke in patients with stroke and transient ischemic attack: A guideline for health care professionals from the American Heart Association/American Stroke Association. Stroke, 45(7), 2160-2223. "
  }, {
    "type": "citation",
    "citation": "Kostis, W. J., Cheng, J. Q., Dobrzynski, J. M., et al. (2012, February 7). Meta-analysis of statin effects in women versus men. Journal of the American College of Cardiology, 59(6), 572-582."
  }, {
    "type": "citation",
    "citation": "Lazar, L. D., Pletcher, M. J., Coxson, P. G., et al. (2011, July 12). Cost-effectiveness of statin therapy for primary prevention in a low-cost statin era. Circulation, 124(2), 146-153."
  }, {
    "type": "citation",
    "citation": "Mitka, M. (2012, March 7). Some question use of statins to reduce cardiovascular risks in healthy women. JAMA, 307(9), 893-894."
  }, {
    "type": "citation",
    "citation": "National Cholesterol Education Program Expert Panel on Detection, Evaluation, and Adults Treatment of High Blood Cholesterol in Adults. (2002, December 17). 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), 3143-3421. "
  }, {
    "type": "citation",
    "citation": "Powers, W. J., Rabinstein, A. A., Ackerson, T., et al. (2018, January). 2018 guidelines for the early management of patients with acute ischemic stroke: A guideline for health care professionals from the American Heart Association/American Stroke Association. Stroke, 49, e44-e47. "
  }, {
    "type": "citation",
    "citation": "Rodriguez-Yanez, M., Agulla, J., Rodriguez-Gonzalez, R., et al. (2008, June). Statins and stroke. Therapeutic Advances in Cardiovascular Disease, 2(3), 157-166."
  }, {
    "type": "citation",
    "citation": "Roger, V. L., Go, A. S., Lloyd-Jones, D. M., et al. (2012, January 3). Heart disease and stroke statistics 2012 update: A report from the American Heart Association. Circulation, 125(1), e2-e220."
  }, {
    "type": "citation",
    "citation": "Schellinger, P. D., Bryan, R. N., Caplan, L. R., et al. (2010, July 13). Evidence-based guideline: The role of diffusion and perfusion MRI for the diagnosis of acute ischemic stroke: Report of the Therapeutics and Technology Assessment Subcommittee of the American Academy of Neurology.  Neurology, 75(2), 177-185."
  }, {
    "type": "citation",
    "citation": "Squizzato, A., Romualdi, E., Dentali, F., et al. (2011). Statins for acute ischemic stroke. Cochrane Database of Systematic Reviews, 8, CD007551. "
  }, {
    "type": "citation",
    "citation": "Stone, N. J., Robinson, J., Lichtenstein, A. H., et al. (2013, November). 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. Circulation, 11, 1-84. "
  }, {
    "type": "citation",
    "citation": "Van Dis, F. J., Keilson, L. M., Rundell, C. A., et al. (1996, June). Direct measurement of serum low-density lipoprotein cholesterol in patients with acute myocardial infarction on admission to the emergency room. American Journal of Cardiology, 77(14), 1232-1234. "
  }, {
    "type": "citation",
    "citation": "atients with or without type 2 diabetes mellitus receiving treatment with 3-hydroxy-3-methylglutaryl-coenzyme a reductase inhibitors. Clinical Therapeutics, 25(5), 1490-1497."
  }, {
    "type": "depends-on",
    "resource": "http://hl7.org/fhir/Library/FHIRHelpers|4.0.1"
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  "library": [ "http://fhir.org/guides/dbcg/connectathon/Library/EXM105" ],
  "disclaimer": "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.",
  "scoring": {
    "coding": [ {
      "system": "http://hl7.org/fhir/measure-scoring",
      "code": "proportion"
    } ]
  },
  "type": [ {
    "coding": [ {
      "system": "http://hl7.org/fhir/measure-type",
      "code": "process"
    } ]
  } ],
  "rationale": "There 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).",
  "clinicalRecommendationStatement": "For patients with stroke of atherosclerotic origin, intensive lipid lowering therapy with statins should be initiated",
  "improvementNotation": {
    "coding": [ {
      "system": "http://terminology.hl7.org/CodeSystem/measure-improvement-notation",
      "code": "increase"
    } ]
  },
  "guidance": "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 Inpatient Encounters include emergency, urgent, and unplanned admissions.\r\n\r\nThe \"Medication, Discharge\" datatype refers to the discharge medication list and is intended to express medications ordered for post-discharge use.",
  "group": [ {
    "id": "group-1",
    "population": [ {
      "code": {
        "coding": [ {
          "system": "http://terminology.hl7.org/CodeSystem/measure-population",
          "code": "initial-population",
          "display": "Initial Population"
        } ]
      },
      "criteria": {
        "language": "text/cql",
        "expression": "Initial Population"
      }
    }, {
      "code": {
        "coding": [ {
          "system": "http://terminology.hl7.org/CodeSystem/measure-population",
          "code": "numerator",
          "display": "Numerator"
        } ]
      },
      "criteria": {
        "language": "text/cql",
        "expression": "Numerator"
      }
    }, {
      "code": {
        "coding": [ {
          "system": "http://terminology.hl7.org/CodeSystem/measure-population",
          "code": "denominator",
          "display": "Denominator"
        } ]
      },
      "criteria": {
        "language": "text/cql",
        "expression": "Denominator"
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    }, {
      "code": {
        "coding": [ {
          "system": "http://terminology.hl7.org/CodeSystem/measure-population",
          "code": "denominator-exclusion",
          "display": "Denominator Exclusion"
        } ]
      },
      "criteria": {
        "language": "text/cql",
        "expression": "Denominator Exclusion"
      }
    }, {
      "code": {
        "coding": [ {
          "system": "http://terminology.hl7.org/CodeSystem/measure-population",
          "code": "denominator-exception",
          "display": "Denominator Exception"
        } ]
      },
      "criteria": {
        "language": "text/cql",
        "expression": "Denominator Exception"
      }
    } ]
  } ],
  "supplementalData": [ {
    "code": {
      "text": "sde-ethnicity"
    },
    "usage": [ {
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        "system": "http://hl7.org/fhir/measure-data-usage",
        "code": "supplemental-data"
      } ]
    } ],
    "criteria": {
      "language": "text/cql",
      "expression": "SDE Ethnicity"
    }
  }, {
    "code": {
      "text": "sde-payer"
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        "code": "supplemental-data"
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    } ],
    "criteria": {
      "language": "text/cql",
      "expression": "SDE Payer"
    }
  }, {
    "code": {
      "text": "sde-race"
    },
    "usage": [ {
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    } ],
    "criteria": {
      "language": "text/cql",
      "expression": "SDE Race"
    }
  }, {
    "code": {
      "text": "sde-sex"
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    "usage": [ {
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        "code": "supplemental-data"
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    } ],
    "criteria": {
      "language": "text/cql",
      "expression": "SDE Sex"
    }
  } ]
}