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Resource Measure/FHIR Server from package gov.healthit.ecqi.ecqms.subset#current (219 ms)

Package gov.healthit.ecqi.ecqms.subset
Type Measure
Id Id
FHIR Version R4
Source http://ecqi.healthit.gov/ecqms/subset/https://build.fhir.org/ig/cqframework/ecqm-content-qicore-2024-subset/Measure-GlobalMalnutritionCompositeFHIR.html
Url https://madie.cms.gov/Measure/GlobalMalnutritionCompositeFHIR
Version 0.2.000
Status active
Date 2024-09-09T19:21:02+00:00
Name GlobalMalnutritionCompositeFHIR
Title Global Malnutrition Composite ScoreFHIR
Experimental True
Description This measure assesses the percentage of hospitalizations of adults aged 65 years and older at the start of the inpatient encounter during the measurement period, with a length of stay equal to or greater than 24 hours, who received optimal malnutrition care where care performed was appropriate to the patient's level of malnutrition risk and severity. Malnutrition care best practices recommend that for each hospitalization, adult inpatients are (1) screened for malnutrition risk or for a hospital dietitian referral order to be placed, (2) assessed by a registered dietitian (RD) or registered dietitian nutritionist (RDN) to confirm findings of malnutrition risk, and if identified with a "moderate" or "severe" malnutrition status in the current performed malnutrition assessment, (3) receive a current "moderate" or "severe" malnutrition diagnosis by a physician or eligible provider as defined by the Centers for Medicare & Medicaid Services (CMS), and (4) have a current nutrition care plan performed by an RD/RDN.
Purpose UNKNOWN
Copyright Copyright (C) Academy of Nutrition and Dietetics 2024 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. LOINC(R) copyright 2004-2023 Regenstrief Institute, Inc. ICD-10 copyright 2023 World Health Organisation. This material contains SNOMED Clinical Terms (R) (SNOMED CT [R]) copyright 2004-2023. International Health Terminology Standards Development Organisation . All Rights Reserved.

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Narrative

Note: links and images are rebased to the (stated) source

Metadata
Title Global Malnutrition Composite ScoreFHIR
Version 0.2.000
Short Name CMS986FHIR
GUID (Version Independent) urn:uuid:eed68e80-b466-4369-be87-166ada45f7c5
GUID (Version Specific) urn:uuid:f503ad03-b5e9-457a-8253-bc619775ef20
CMS Identifier 986FHIR
CMS Consensus Based Entity Identifier 3592e
Effective Period 2026-01-01 through 2026-12-31
Experimental true
Use Context Venue = EH
Steward (Publisher) Academy of Nutrition and Dietetics
Developer Academy of Nutrition and Dietetics
Description

This measure assesses the percentage of hospitalizations of adults aged 65 years and older at the start of the inpatient encounter during the measurement period, with a length of stay equal to or greater than 24 hours, who received optimal malnutrition care where care performed was appropriate to the patient's level of malnutrition risk and severity. Malnutrition care best practices recommend that for each hospitalization, adult inpatients are (1) screened for malnutrition risk or for a hospital dietitian referral order to be placed, (2) assessed by a registered dietitian (RD) or registered dietitian nutritionist (RDN) to confirm findings of malnutrition risk, and if identified with a "moderate" or "severe" malnutrition status in the current performed malnutrition assessment, (3) receive a current "moderate" or "severe" malnutrition diagnosis by a physician or eligible provider as defined by the Centers for Medicare & Medicaid Services (CMS), and (4) have a current nutrition care plan performed by an RD/RDN.
Copyright

Copyright (C) Academy of Nutrition and Dietetics 2024

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.

LOINC(R) copyright 2004-2023 Regenstrief Institute, Inc.

ICD-10 copyright 2023 World Health Organisation.

This material contains SNOMED Clinical Terms (R) (SNOMED CT [R]) copyright 2004-2023. International Health Terminology Standards Development Organisation . All Rights Reserved.
Disclaimer

This measure and the specifications are subject to further revisions.

This performance measure is not a clinical guideline, does not establish a standard of medical care, and has not been tested for all potential applications.

THE MEASURE AND SPECIFICATIONS ARE PROVIDED "AS IS" WITHOUT WARRANTY OF ANY KIND.

Due to technical limitations, copyright is indicated by (C) or [C], registered trademarks are indicated by (R) or [R] and unregistered trademarks are indicated by (TM) or [TM].
Measure Scoring Continuous Variable
Rationale

The components of this measure are supported by clinical guidance that recommends the following: (1) malnutrition screening for patients admitted into the acute inpatient care setting; (2) nutrition assessment for patients identified at risk for malnutrition or with a hospital dietitian referral order to form the basis for appropriate nutrition interventions; (3) appropriate recognition, diagnosis, and documentation of the nutrition status of a patient in order to (4) address their condition with an appropriate plan of care and communicate patient needs to other care providers (Academy of Nutrition and Dietetics, 2017).

The process for risk identification, assessment, diagnosis, and treatment of malnutrition necessitates a multi-disciplinary care team that begins with the identification of an initial risk population for a more thorough assessment by the RD/RDN. The RD/RDN, in turn, provides the necessary treatment recommendations to address nutritional status utilizing a nutrition diagnosis and care plan, along with the clinical indicators that inform a medical diagnosis of malnutrition completed by a physician or eligible provider as defined by CMS. The four measure observations individually will only provide a fraction of the necessary information on quality of care for patients at risk for or with malnutrition. For example, knowing which patients have been assessed out of those who were initially identified as at risk, but not knowing if the appropriate proportion of patients were screened upon admission, would be an insufficient assessment of quality of care.

Implementation of this measure supports timely malnutrition risk screening and hand off to RDNs for appropriate nutrition assessment for identified patients during the current hospitalization. For patients identified with a moderate or severe malnutrition by the nutrition assessment, best practice also recommends a medical diagnosis by a physician or other eligible clinician and the execution of the nutrition care plan by an RD/RDN. Evidence demonstrates that implementing a standardized protocol for screening, assessment, diagnosis, and care planning results in better identification of malnourished patients and subsequent improvements in rates of associated nutrition interventions. Outcomes modeling, and those reported in other studies, also demonstrate the benefits to patient outcomes, including reduced risk of 30-day readmissions, length of hospital stays, and complications, as well as improved quality of life after hospitalization (Sriram, 2017).
Clinical Recommendation Statement

American Society for Parenteral and Enteral Nutrition (ASPEN) clinical guidelines on nutrition screening, assessment, and intervention in adults indicate that screening for nutrition risk is suggested for hospitalized patients (Mueller, et al., 2011).

This guideline places nutrition assessment and screening in the context of intervention as part of nutrition care. Screening those individuals at risk for malnutrition is the first step in nutrition care as risk for malnutrition, identified by nutrition screening, is associated with longer length of hospital stay, complications, and mortality. Malnutrition screening is also a predictor of mortality risk.

Malnourished patients, identified by nutrition assessment tools, have more complications and longer hospitalizations than do patients with optimal nutrition status. Such patients, identified by nutrition assessment tools, have more infectious and noninfectious complications, longer hospital length of stay, and greater mortality.

Nutrition intervention is recommended for patients identified by assessment as at risk for malnutrition or malnourished. Nutrition intervention with associated monitoring and evaluation plants in patients identified as at risk for malnutrition or malnourished improves clinical outcomes. Nutrition interventions and their associated monitoring and evaluation plans in malnourished patients are associated with improved nutrition status, nutrient intake, physical function, and quality of life. Hospital readmissions, inpatient length of stay, and complications were reduced with increased nutrition support interventions.
Guidance (Usage) This measure is constructed of four clinically eligible components that are aggregated as an arithmetic average of eligible hospitalizations and expressed as a percentage. The four populations used to calculate the four components may differ and the measure observations for the four components do not need to be performed sequentially. This eCQM is an episode-based measure. An episode is defined as each inpatient hospitalization or encounter with a length of stay of greater than or equal to 24 hours among individuals 65 years of age and older at the start of the inpatient encounter. This FHIR-based measure has been derived from the QDM-based measure: CMS986v4. Please refer to the HL7 QI-Core Implementation Guide (https://hl7.org/fhir/us/qicore/STU4.1.1/) for more information on QI-Core and mapping recommendations from QDM to QI-Core 4.1.1 (https://hl7.org/fhir/us/qicore/STU4.1.1/qdm-to-qicore.html).
Measure Group (Rate) (ID: 6644d75da7a1805d3b7375b4)
Summary Population Criteria 1
Basis Encounter
Scoring Continuous Variable
Type Outcome
Initial Population ID: a05fc6fb-1644-441f-b616-de21576a1813
Description:

Initial

Logic Definition: Initial Population
Measure Population ID: bc3d85e4-8f7d-4cc7-b260-9e8dc2d0848f
Description:

Measure

Logic Definition: Measure Population
Measure Observation ID: 087da320-e1ff-48ff-9b16-3990ff169148
Description:

Screening

Logic Definition: Measure Observation 1
Measure Group (Rate) (ID: 6644d75da7a1805d3b7375b5)
Basis Encounter
Scoring Continuous Variable
Type Outcome
Initial Population ID: 1cad8fc2-f1f6-446c-9e7b-9d547a1b38fd
Description:

Initial

Logic Definition: Initial Population
Measure Population ID: 61fd8f89-4579-4d93-a27f-a2ef3daaa94d
Description:

Measure

Logic Definition: Measure Population
Measure Observation ID: a816b04b-5147-476c-9136-819b5734be37
Description:

Assessment

Logic Definition: Measure Observation 2
Measure Group (Rate) (ID: 6644d75da7a1805d3b7375b6)
Basis Encounter
Scoring Continuous Variable
Type Outcome
Initial Population ID: 2ed7e4ba-50d2-4b51-bc06-c2bf9ee27bd1
Description:

Initial

Logic Definition: Initial Population
Measure Population ID: 67cef5f1-a6ec-4c0e-a077-b8b867431182
Description:

Measure

Logic Definition: Measure Population
Measure Observation ID: f936bb5d-3610-453b-abb1-d7358aca957a
Description:

Diagnosis

Logic Definition: Measure Observation 3
Measure Group (Rate) (ID: 6644d75da7a1805d3b7375b7)
Basis Encounter
Scoring Continuous Variable
Type Outcome
Initial Population ID: 57378bbc-9b1d-40da-b945-603862bb6ba4
Description:

Initial

Logic Definition: Initial Population
Measure Population ID: aaabf807-f476-4158-96dc-d6f9e2e360c4
Description:

Measure

Logic Definition: Measure Population
Measure Observation ID: e7adef10-7076-4e5a-8643-95ca17d02ecf
Description:

Care Plan

Logic Definition: Measure Observation 4
Measure Group (Rate) (ID: 6644d75da7a1805d3b7375b8)
Basis Encounter
Scoring Continuous Variable
Type Outcome
Initial Population ID: d3214243-5af2-4430-84a1-861477bee9e3
Description:

Initial

Logic Definition: Initial Population
Measure Population ID: 7137d595-07cf-4680-a21e-b5380d5e6f20
Description:

Measure

Logic Definition: Measure Population
Measure Observation ID: b6dc0a60-e3dc-4ef4-8f58-8728a69cba3c
Description:

Total Score

Logic Definition: Measure Observation Total Malnutrition Components Score
Measure Group (Rate) (ID: 6644d75da7a1805d3b7375b9)
Basis Encounter
Scoring Continuous Variable
Type Outcome
Initial Population ID: bd53026c-9027-4fdb-b5e6-d818dfb017f4
Description:

Initial

Logic Definition: Initial Population
Measure Population ID: 5be2bfc9-e31c-4253-bc4c-395baa4b101b
Description:

Measure

Logic Definition: Measure Population
Measure Observation ID: dd53fd31-7801-4b1f-ad36-8e688706d0eb
Description:

GMCS Percentage

Logic Definition: Measure Observation Total Malnutrition Composite Score as Percentage
Measure Logic
Primary Library GlobalMalnutritionCompositeFHIR
Contents Population Criteria
Logic Definitions
Terminology
Dependencies
Data Requirements
Population Criteria
Measure Group (Rate) (ID: 6644d75da7a1805d3b7375b4)
Initial Population 
define "Initial Population":
  [Encounter: "Encounter Inpatient"] EncounterInpatient
    where EncounterInpatient.period ends during day of "Measurement Period"
      and AgeInYearsAt(date from start of EncounterInpatient.period) >= 65
      and ( duration in hours of EncounterInpatient.period >= 24 )
      and EncounterInpatient.status = 'finished'
Measure Population 
define "Measure Population":
  "Initial Population"
Measure Observation 
define function "Measure Observation 1"(MalnutritionRiskScreening Encounter):
  if "Encounter with Malnutrition Risk Screening or with Hospital Dietitian Referral" contains MalnutritionRiskScreening then 1 
    else 0
Measure Group (Rate) (ID: 6644d75da7a1805d3b7375b5)
Initial Population 
define "Initial Population":
  [Encounter: "Encounter Inpatient"] EncounterInpatient
    where EncounterInpatient.period ends during day of "Measurement Period"
      and AgeInYearsAt(date from start of EncounterInpatient.period) >= 65
      and ( duration in hours of EncounterInpatient.period >= 24 )
      and EncounterInpatient.status = 'finished'
Measure Population 
define "Measure Population":
  "Initial Population"
Measure Observation 
define function "Measure Observation 2"(NutritionAssessment Encounter):
  if "Encounter with Malnutrition Not At Risk Screening and without Hospital Dietitian Referral" contains NutritionAssessment then 0 
    else if "Encounter with Malnutrition Risk Screening At Risk or with Hospital Dietitian Referral" contains NutritionAssessment then if "Encounter with Nutrition Assessment and Identified Status" contains NutritionAssessment then 1 
    else 0 
    else 0
Measure Group (Rate) (ID: 6644d75da7a1805d3b7375b6)
Initial Population 
define "Initial Population":
  [Encounter: "Encounter Inpatient"] EncounterInpatient
    where EncounterInpatient.period ends during day of "Measurement Period"
      and AgeInYearsAt(date from start of EncounterInpatient.period) >= 65
      and ( duration in hours of EncounterInpatient.period >= 24 )
      and EncounterInpatient.status = 'finished'
Measure Population 
define "Measure Population":
  "Initial Population"
Measure Observation 
define function "Measure Observation 3"(MalnutritionDiagonsis Encounter):
  if "Encounter with Malnutrition Not At Risk Screening and without Hospital Dietitian Referral" contains MalnutritionDiagonsis then 0 
    else if "Encounter with Malnutrition Risk Screening At Risk or with Hospital Dietitian Referral" contains MalnutritionDiagonsis then if "Encounter with Malnutrition Diagnosis" contains MalnutritionDiagonsis then if "Encounter with Nutrition Assessment Not or Mildly Malnourished" contains MalnutritionDiagonsis then 0 
    else if "Encounter with Nutrition Assessment Status Moderately Or Severely Malnourished" contains MalnutritionDiagonsis then 1 
    else 0 
    else 0 
    else 0
Measure Group (Rate) (ID: 6644d75da7a1805d3b7375b7)
Initial Population 
define "Initial Population":
  [Encounter: "Encounter Inpatient"] EncounterInpatient
    where EncounterInpatient.period ends during day of "Measurement Period"
      and AgeInYearsAt(date from start of EncounterInpatient.period) >= 65
      and ( duration in hours of EncounterInpatient.period >= 24 )
      and EncounterInpatient.status = 'finished'
Measure Population 
define "Measure Population":
  "Initial Population"
Measure Observation 
define function "Measure Observation 4"(NutritionCarePlan Encounter):
  if "Encounter with Malnutrition Not At Risk Screening and without Hospital Dietitian Referral" contains NutritionCarePlan then 0 
    else if "Encounter with Malnutrition Risk Screening At Risk or with Hospital Dietitian Referral" contains NutritionCarePlan then if "Encounter with Nutrition Care Plan" contains NutritionCarePlan then if "Encounter with Nutrition Assessment Not or Mildly Malnourished" contains NutritionCarePlan then 0 
    else if "Encounter with Nutrition Assessment Status Moderately Or Severely Malnourished" contains NutritionCarePlan then 1 
    else 0 
    else 0 
    else 0
Measure Group (Rate) (ID: 6644d75da7a1805d3b7375b8)
Initial Population 
define "Initial Population":
  [Encounter: "Encounter Inpatient"] EncounterInpatient
    where EncounterInpatient.period ends during day of "Measurement Period"
      and AgeInYearsAt(date from start of EncounterInpatient.period) >= 65
      and ( duration in hours of EncounterInpatient.period >= 24 )
      and EncounterInpatient.status = 'finished'
Measure Population 
define "Measure Population":
  "Initial Population"
Measure Observation 
define function "Measure Observation Total Malnutrition Components Score"(QualifyingEncounter Encounter):
  Sum({ "Measure Observation 1"(QualifyingEncounter), "Measure Observation 2"(QualifyingEncounter), "Measure Observation 3"(QualifyingEncounter), "Measure Observation 4"(QualifyingEncounter) })
Measure Group (Rate) (ID: 6644d75da7a1805d3b7375b9)
Initial Population 
define "Initial Population":
  [Encounter: "Encounter Inpatient"] EncounterInpatient
    where EncounterInpatient.period ends during day of "Measurement Period"
      and AgeInYearsAt(date from start of EncounterInpatient.period) >= 65
      and ( duration in hours of EncounterInpatient.period >= 24 )
      and EncounterInpatient.status = 'finished'
Measure Population 
define "Measure Population":
  "Initial Population"
Measure Observation 
define function "Measure Observation Total Malnutrition Composite Score as Percentage"(QualifyingEncounter Encounter):
  100 * ( "Measure Observation Total Malnutrition Components Score"(QualifyingEncounter) / "Total Malnutrition Composite Score Eligible Occurrences"(QualifyingEncounter) )
Logic Definitions
Logic Definition Library Name: GlobalMalnutritionCompositeFHIR 
define "Initial Population":
  [Encounter: "Encounter Inpatient"] EncounterInpatient
    where EncounterInpatient.period ends during day of "Measurement Period"
      and AgeInYearsAt(date from start of EncounterInpatient.period) >= 65
      and ( duration in hours of EncounterInpatient.period >= 24 )
      and EncounterInpatient.status = 'finished'
Logic Definition Library Name: GlobalMalnutritionCompositeFHIR 
define "Measure Population":
  "Initial Population"
Logic Definition Library Name: GlobalMalnutritionCompositeFHIR 
define function "Measure Observation 1"(MalnutritionRiskScreening Encounter):
  if "Encounter with Malnutrition Risk Screening or with Hospital Dietitian Referral" contains MalnutritionRiskScreening then 1 
    else 0
Logic Definition Library Name: GlobalMalnutritionCompositeFHIR 
define function "Measure Observation Total Malnutrition Components Score"(QualifyingEncounter Encounter):
  Sum({ "Measure Observation 1"(QualifyingEncounter), "Measure Observation 2"(QualifyingEncounter), "Measure Observation 3"(QualifyingEncounter), "Measure Observation 4"(QualifyingEncounter) })
Logic Definition Library Name: GlobalMalnutritionCompositeFHIR 
define function "Measure Observation 2"(NutritionAssessment Encounter):
  if "Encounter with Malnutrition Not At Risk Screening and without Hospital Dietitian Referral" contains NutritionAssessment then 0 
    else if "Encounter with Malnutrition Risk Screening At Risk or with Hospital Dietitian Referral" contains NutritionAssessment then if "Encounter with Nutrition Assessment and Identified Status" contains NutritionAssessment then 1 
    else 0 
    else 0
Logic Definition Library Name: GlobalMalnutritionCompositeFHIR 
define function "Measure Observation 3"(MalnutritionDiagonsis Encounter):
  if "Encounter with Malnutrition Not At Risk Screening and without Hospital Dietitian Referral" contains MalnutritionDiagonsis then 0 
    else if "Encounter with Malnutrition Risk Screening At Risk or with Hospital Dietitian Referral" contains MalnutritionDiagonsis then if "Encounter with Malnutrition Diagnosis" contains MalnutritionDiagonsis then if "Encounter with Nutrition Assessment Not or Mildly Malnourished" contains MalnutritionDiagonsis then 0 
    else if "Encounter with Nutrition Assessment Status Moderately Or Severely Malnourished" contains MalnutritionDiagonsis then 1 
    else 0 
    else 0 
    else 0
Logic Definition Library Name: GlobalMalnutritionCompositeFHIR 
define function "Measure Observation 4"(NutritionCarePlan Encounter):
  if "Encounter with Malnutrition Not At Risk Screening and without Hospital Dietitian Referral" contains NutritionCarePlan then 0 
    else if "Encounter with Malnutrition Risk Screening At Risk or with Hospital Dietitian Referral" contains NutritionCarePlan then if "Encounter with Nutrition Care Plan" contains NutritionCarePlan then if "Encounter with Nutrition Assessment Not or Mildly Malnourished" contains NutritionCarePlan then 0 
    else if "Encounter with Nutrition Assessment Status Moderately Or Severely Malnourished" contains NutritionCarePlan then 1 
    else 0 
    else 0 
    else 0
Logic Definition Library Name: GlobalMalnutritionCompositeFHIR 
define function "Measure Observation Total Malnutrition Composite Score as Percentage"(QualifyingEncounter Encounter):
  100 * ( "Measure Observation Total Malnutrition Components Score"(QualifyingEncounter) / "Total Malnutrition Composite Score Eligible Occurrences"(QualifyingEncounter) )
Logic Definition Library Name: GlobalMalnutritionCompositeFHIR 
define function "Total Malnutrition Composite Score Eligible Occurrences"(QualifyingEncounter Encounter):
  if ( ( "Encounter with Malnutrition Risk Screening or with Hospital Dietitian Referral" contains QualifyingEncounter )
      and ( "Encounter with Malnutrition Risk Screening Not At Risk" contains QualifyingEncounter )
  )
    and not ( "Encounter with Hospital Dietitian Referral" contains QualifyingEncounter ) then 1 
    else if ( ( ( "Encounter with Malnutrition Risk Screening or with Hospital Dietitian Referral" contains QualifyingEncounter )
        and ( "Encounter with Malnutrition Risk Screening At Risk" contains QualifyingEncounter )
    )
      or ( "Encounter with Hospital Dietitian Referral" contains QualifyingEncounter )
  )
    and ( "Encounter with Nutrition Assessment Not or Mildly Malnourished" contains QualifyingEncounter )
    or not ( "Encounter with Nutrition Assessment and Identified Status" contains QualifyingEncounter ) then 2 
    else 4
Terminology
Value Set Description: Value set Encounter Inpatient
Resource: Encounter Inpatient
Canonical URL: http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.666.5.307
Dependencies
Dependency Description: Library FHIRHelpers
Resource: Library/FHIRHelpers|4.4.000
Canonical URL: Library/FHIRHelpers|4.4.000
Data Requirements
Data Requirement Type: Patient
Profile(s): QICorePatient
Data Requirement Type: Encounter
Profile(s): QICoreEncounter
Must Support Elements: type, period, status, status.value
Code Filter(s):
Path: type
ValueSet: Encounter Inpatient
Path: status.value
Code(s): [not stated] finished: finished
Generated using version 0.4.8 of the sample-content-ig Liquid templates

Source

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  "id" : "GlobalMalnutritionCompositeFHIR",
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      "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/executable-measure-cqfm"
    ]
  },
  "text" : {
    "status" : "extensions",
    "div" : "<div xmlns=\"http://www.w3.org/1999/xhtml\">\n  <table class=\"narrative-table\">\n    <tbody>\n<tr>\n\n\n<th colspan=\"2\" scope=\"row\" class=\"row-header\">Metadata</th>\n\n\n</tr>\n\n<tr>\n\n\n<th scope=\"row\" class=\"row-header\">Title</th>\n\n\n<td class=\"content-container\">Global Malnutrition Composite ScoreFHIR</td>\n</tr>\n\n\n\n<tr>\n\n\n<th scope=\"row\" class=\"row-header\">Version</th>\n\n\n<td class=\"content-container\">0.2.000</td>\n</tr>\n\n\n  \n<tr>\n\n\n<th scope=\"row\" class=\"row-header\">Short Name</th>\n\n\n<td class=\"content-container\">CMS986FHIR</td>\n</tr>\n\n\n\n  \n<tr>\n\n\n<th scope=\"row\" class=\"row-header\">GUID (Version Independent)</th>\n\n\n<td class=\"content-container\">urn:uuid:eed68e80-b466-4369-be87-166ada45f7c5</td>\n</tr>\n\n\n\n  \n<tr>\n\n\n<th scope=\"row\" class=\"row-header\">GUID (Version Specific)</th>\n\n\n<td class=\"content-container\">urn:uuid:f503ad03-b5e9-457a-8253-bc619775ef20</td>\n</tr>\n\n\n\n  \n    \n    \n<tr>\n\n\n<th scope=\"row\" class=\"row-header\">CMS Identifier</th>\n\n\n<td class=\"content-container\">986FHIR</td>\n</tr>\n\n  \n\n\n  \n    \n    \n<tr>\n\n\n<th scope=\"row\" class=\"row-header\">CMS Consensus Based Entity Identifier</th>\n\n\n<td class=\"content-container\">3592e</td>\n</tr>\n\n  \n\n\n\n  \n    \n    \n<tr>\n\n\n<th scope=\"row\" class=\"row-header\">Effective Period</th>\n\n\n<td class=\"content-container\">2026-01-01 through 2026-12-31</td>\n</tr>\n\n  \n\n\n\n\n\n\n<tr>\n\n\n<th scope=\"row\" class=\"row-header\">Experimental</th>\n\n\n<td class=\"content-container\">true</td>\n</tr>\n\n\n\n\n<tr>\n\n\n<th scope=\"row\" class=\"row-header\">Use Context</th>\n\n\n<td class=\"content-container\"><span title=\"{http://terminology.hl7.org/CodeSystem/usage-context-type venue}\">Venue</span> = <span title=\"Codes:{http://hl7.org/fhir/us/cqfmeasures/CodeSystem/intended-venue-codes eh}\">EH</span></td>\n</tr>\n\n\n\n\n\n\n\n\n\n<tr>\n\n\n<th scope=\"row\" class=\"row-header\">Steward (Publisher)</th>\n\n\n<td class=\"content-container\">Academy of Nutrition and Dietetics</td>\n</tr>\n\n\n\n\n\n\n<tr>\n\n\n<th scope=\"row\" class=\"row-header\">Developer</th>\n\n\n<td class=\"content-container\">Academy of Nutrition and Dietetics</td>\n</tr>\n\n\n\n\n\n\n<tr>\n\n\n<th scope=\"row\" class=\"row-header\">Description</th>\n\n\n<td class=\"content-container\"><div><p>This measure assesses the percentage of hospitalizations of adults aged 65 years and older at the start of the inpatient encounter during the measurement period, with a length of stay equal to or greater than 24 hours, who received optimal malnutrition care where care performed was appropriate to the patient's level of malnutrition risk and severity. Malnutrition care best practices recommend that for each hospitalization, adult inpatients are (1) screened for malnutrition risk or for a hospital dietitian referral order to be placed, (2) assessed by a registered dietitian (RD) or registered dietitian nutritionist (RDN) to confirm findings of malnutrition risk, and if identified with a &quot;moderate&quot; or &quot;severe&quot; malnutrition status in the current performed malnutrition assessment, (3) receive a current &quot;moderate&quot; or &quot;severe&quot; malnutrition diagnosis by a physician or eligible provider as defined by the Centers for Medicare &amp; Medicaid Services (CMS), and (4) have a current nutrition care plan performed by an RD/RDN.</p>\n</div></td>\n</tr>\n\n\n\n<tr>\n\n\n<th scope=\"row\" class=\"row-header\">Copyright</th>\n\n\n<td class=\"content-container\"><div><p>Copyright (C) Academy of Nutrition and Dietetics 2024</p>\n<p>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.</p>\n<p>LOINC(R) copyright 2004-2023 Regenstrief Institute, Inc.</p>\n<p>ICD-10 copyright 2023 World Health Organisation.</p>\n<p>This material contains SNOMED Clinical Terms (R) (SNOMED CT [R]) copyright 2004-2023. International Health Terminology Standards Development Organisation . All Rights Reserved.</p>\n</div></td>\n</tr>\n\n\n<tr>\n\n\n<th scope=\"row\" class=\"row-header\">Disclaimer</th>\n\n\n<td class=\"content-container\"><div><p>This measure and the specifications are subject to further revisions.</p>\n<p>This performance measure is not a clinical guideline, does not establish a standard of medical care, and has not been tested for all potential applications.</p>\n<p>THE MEASURE AND SPECIFICATIONS ARE PROVIDED &quot;AS IS&quot; WITHOUT WARRANTY OF ANY KIND.</p>\n<p>Due to technical limitations, copyright is indicated by (C) or [C], registered trademarks are indicated by (R) or [R] and unregistered trademarks are indicated by (TM) or [TM].</p>\n</div></td>\n</tr>\n\n\n\n\n<tr>\n\n\n<th scope=\"row\" class=\"row-header\">Measure Scoring</th>\n\n\n<td class=\"content-container\"><span title=\"Codes:{http://terminology.hl7.org/CodeSystem/measure-scoring continuous-variable}\">Continuous Variable</span></td>\n</tr>\n\n\n\n\n\n\n\n\n<tr>\n\n\n<th scope=\"row\" class=\"row-header\">Rationale</th>\n\n\n<td class=\"content-container\"><div><p>The components of this measure are supported by clinical guidance that recommends the following: (1) malnutrition screening for patients admitted into the acute inpatient care setting; (2) nutrition assessment for patients identified at risk for malnutrition or with a hospital dietitian referral order to form the basis for appropriate nutrition interventions; (3) appropriate recognition, diagnosis, and documentation of the nutrition status of a patient in order to (4) address their condition with an appropriate plan of care and communicate patient needs to other care providers (Academy of Nutrition and Dietetics, 2017).</p>\n<p>The process for risk identification, assessment, diagnosis, and treatment of malnutrition necessitates a multi-disciplinary care team that begins with the identification of an initial risk population for a more thorough assessment by the RD/RDN. The RD/RDN, in turn, provides the necessary treatment recommendations to address nutritional status utilizing a nutrition diagnosis and care plan, along with the clinical indicators that inform a medical diagnosis of malnutrition completed by a physician or eligible provider as defined by CMS. The four measure observations individually will only provide a fraction of the necessary information on quality of care for patients at risk for or with malnutrition. For example, knowing which patients have been assessed out of those who were initially identified as at risk, but not knowing if the appropriate proportion of patients were screened upon admission, would be an insufficient assessment of quality of care.</p>\n<p>Implementation of this measure supports timely malnutrition risk screening and hand off to RDNs for appropriate nutrition assessment for identified patients during the current hospitalization. For patients identified with a moderate or severe malnutrition by the nutrition assessment, best practice also recommends a medical diagnosis by a physician or other eligible clinician and the execution of the nutrition care plan by an RD/RDN. Evidence demonstrates that implementing a standardized protocol for screening, assessment, diagnosis, and care planning results in better identification of malnourished patients and subsequent improvements in rates of associated nutrition interventions. Outcomes modeling, and those reported in other studies, also demonstrate the benefits to patient outcomes, including reduced risk of 30-day readmissions, length of hospital stays, and complications, as well as improved quality of life after hospitalization (Sriram, 2017).</p>\n</div></td>\n</tr>\n\n\n<tr>\n\n\n<th scope=\"row\" class=\"row-header\">Clinical Recommendation Statement</th>\n\n\n<td class=\"content-container\"><div><p>American Society for Parenteral and Enteral Nutrition (ASPEN) clinical guidelines on nutrition screening, assessment, and intervention in adults indicate that screening for nutrition risk is suggested for hospitalized patients (Mueller, et al., 2011).</p>\n<p>This guideline places nutrition assessment and screening in the context of intervention as part of nutrition care. Screening those individuals at risk for malnutrition is the first step in nutrition care as risk for malnutrition, identified by nutrition screening, is associated with longer length of hospital stay, complications, and mortality. Malnutrition screening is also a predictor of mortality risk.</p>\n<p>Malnourished patients, identified by nutrition assessment tools, have more complications and longer hospitalizations than do patients with optimal nutrition status. Such patients, identified by nutrition assessment tools, have more infectious and noninfectious complications, longer hospital length of stay, and greater mortality.</p>\n<p>Nutrition intervention is recommended for patients identified by assessment as at risk for malnutrition or malnourished. Nutrition intervention with associated monitoring and evaluation plants in patients identified as at risk for malnutrition or malnourished improves clinical outcomes. Nutrition interventions and their associated monitoring and evaluation plans in malnourished patients are associated with improved nutrition status, nutrient intake, physical function, and quality of life. Hospital readmissions, inpatient length of stay, and complications were reduced with increased nutrition support interventions.</p>\n</div></td>\n</tr>\n\n\n\n\n\n\n\n\n<tr>\n\n\n<th scope=\"row\" class=\"row-header\">Guidance (Usage)</th>\n\n\n<td class=\"content-container\">This measure is constructed of four clinically eligible components that are aggregated as an arithmetic average of eligible hospitalizations and expressed as a percentage. The four populations used to calculate the four components may differ and the measure observations for the four components do not need to be performed sequentially. \n\nThis eCQM is an episode-based measure. An episode is defined as each inpatient hospitalization or encounter with a length of stay of greater than or equal to 24 hours among individuals 65 years of age and older at the start of the inpatient encounter. \n\nThis FHIR-based measure has been derived from the QDM-based measure: CMS986v4.\n\nPlease refer to the HL7 QI-Core Implementation Guide\n(https://hl7.org/fhir/us/qicore/STU4.1.1/) for more information on QI-Core and\nmapping recommendations from QDM to QI-Core\n4.1.1 (https://hl7.org/fhir/us/qicore/STU4.1.1/qdm-to-qicore.html).</td>\n</tr>\n\n\n\n  \n    \n    <tr>\n\n\n<th colspan=\"2\" scope=\"row\" class=\"row-header\">Measure Group (Rate) (ID: 6644d75da7a1805d3b7375b4)</th>\n\n\n</tr>\n  \n  \n    \n<tr>\n\n\n<th scope=\"row\" class=\"row-header\">Summary</th>\n\n\n<td class=\"content-container\">Population Criteria 1 </td>\n</tr>\n\n  \n  \n  \n<tr>\n\n\n<th scope=\"row\" class=\"row-header\">Basis</th>\n\n\n<td class=\"content-container\">Encounter</td>\n</tr>\n\n\n\n  \n<tr>\n\n\n<th scope=\"row\" class=\"row-header\">Scoring</th>\n\n\n<td class=\"content-container\"><span title=\"Codes:{http://terminology.hl7.org/CodeSystem/measure-scoring continuous-variable}\">Continuous Variable</span></td>\n</tr>\n\n\n\n\n\n\n\n  \n<tr>\n\n\n<th scope=\"row\" class=\"row-header\">Type</th>\n\n\n<td class=\"content-container\"><span title=\"Codes:{http://terminology.hl7.org/CodeSystem/measure-type outcome}\">Outcome</span></td>\n</tr>\n\n\n\n\n\n  \n  \n    <tr>\n      \n        \n\n<th scope=\"row\" class=\"row-header\">Initial Population</th>\n\n\n      \n      <td class=\"content-container\">\n        \n        <em>ID</em>: a05fc6fb-1644-441f-b616-de21576a1813\n        <br/>\n        \n        \n          <em>Description</em>:\n          <p style=\"white-space: pre-line\" class=\"tab-one\">Initial</p>\n        \n        \n          \n            \n            <em>Logic Definition</em>: <a href=\"#primary-globalmalnutritioncompositefhir-initial-population\">Initial Population</a> \n          \n        \n      </td>\n    </tr>\n  \n\n  \n    <tr>\n      \n        \n\n<th scope=\"row\" class=\"row-header\">Measure Population</th>\n\n\n      \n      <td class=\"content-container\">\n        \n        <em>ID</em>: bc3d85e4-8f7d-4cc7-b260-9e8dc2d0848f\n        <br/>\n        \n        \n          <em>Description</em>:\n          <p style=\"white-space: pre-line\" class=\"tab-one\">Measure</p>\n        \n        \n          \n            \n            <em>Logic Definition</em>: <a href=\"#primary-globalmalnutritioncompositefhir-measure-population\">Measure Population</a> \n          \n        \n      </td>\n    </tr>\n  \n\n  \n    <tr>\n      \n        \n\n<th scope=\"row\" class=\"row-header\">Measure Observation</th>\n\n\n      \n      <td class=\"content-container\">\n        \n        <em>ID</em>: 087da320-e1ff-48ff-9b16-3990ff169148\n        <br/>\n        \n        \n          <em>Description</em>:\n          <p style=\"white-space: pre-line\" class=\"tab-one\">Screening</p>\n        \n        \n          \n            \n            <em>Logic Definition</em>: <a href=\"#primary-globalmalnutritioncompositefhir-measure-observation-1\">Measure Observation 1</a> \n          \n        \n      </td>\n    </tr>\n  \n\n  \n\n  \n    \n    <tr>\n\n\n<th colspan=\"2\" scope=\"row\" class=\"row-header\">Measure Group (Rate) (ID: 6644d75da7a1805d3b7375b5)</th>\n\n\n</tr>\n  \n  \n  \n  \n<tr>\n\n\n<th scope=\"row\" class=\"row-header\">Basis</th>\n\n\n<td class=\"content-container\">Encounter</td>\n</tr>\n\n\n\n  \n<tr>\n\n\n<th scope=\"row\" class=\"row-header\">Scoring</th>\n\n\n<td class=\"content-container\"><span title=\"Codes:{http://terminology.hl7.org/CodeSystem/measure-scoring continuous-variable}\">Continuous Variable</span></td>\n</tr>\n\n\n\n\n\n\n\n  \n<tr>\n\n\n<th scope=\"row\" class=\"row-header\">Type</th>\n\n\n<td class=\"content-container\"><span title=\"Codes:{http://terminology.hl7.org/CodeSystem/measure-type outcome}\">Outcome</span></td>\n</tr>\n\n\n\n\n\n  \n  \n    <tr>\n      \n        \n\n<th scope=\"row\" class=\"row-header\">Initial Population</th>\n\n\n      \n      <td class=\"content-container\">\n        \n        <em>ID</em>: 1cad8fc2-f1f6-446c-9e7b-9d547a1b38fd\n        <br/>\n        \n        \n          <em>Description</em>:\n          <p style=\"white-space: pre-line\" class=\"tab-one\">Initial</p>\n        \n        \n          \n            \n            <em>Logic Definition</em>: <a href=\"#primary-globalmalnutritioncompositefhir-initial-population\">Initial Population</a> \n          \n        \n      </td>\n    </tr>\n  \n\n  \n    <tr>\n      \n        \n\n<th scope=\"row\" class=\"row-header\">Measure Population</th>\n\n\n      \n      <td class=\"content-container\">\n        \n        <em>ID</em>: 61fd8f89-4579-4d93-a27f-a2ef3daaa94d\n        <br/>\n        \n        \n          <em>Description</em>:\n          <p style=\"white-space: pre-line\" class=\"tab-one\">Measure</p>\n        \n        \n          \n            \n            <em>Logic Definition</em>: <a href=\"#primary-globalmalnutritioncompositefhir-measure-population\">Measure Population</a> \n          \n        \n      </td>\n    </tr>\n  \n\n  \n    <tr>\n      \n        \n\n<th scope=\"row\" class=\"row-header\">Measure Observation</th>\n\n\n      \n      <td class=\"content-container\">\n        \n        <em>ID</em>: a816b04b-5147-476c-9136-819b5734be37\n        <br/>\n        \n        \n          <em>Description</em>:\n          <p style=\"white-space: pre-line\" class=\"tab-one\">Assessment</p>\n        \n        \n          \n            \n            <em>Logic Definition</em>: <a href=\"#primary-globalmalnutritioncompositefhir-measure-observation-2\">Measure Observation 2</a> \n          \n        \n      </td>\n    </tr>\n  \n\n  \n\n  \n    \n    <tr>\n\n\n<th colspan=\"2\" scope=\"row\" class=\"row-header\">Measure Group (Rate) (ID: 6644d75da7a1805d3b7375b6)</th>\n\n\n</tr>\n  \n  \n  \n  \n<tr>\n\n\n<th scope=\"row\" class=\"row-header\">Basis</th>\n\n\n<td class=\"content-container\">Encounter</td>\n</tr>\n\n\n\n  \n<tr>\n\n\n<th scope=\"row\" class=\"row-header\">Scoring</th>\n\n\n<td class=\"content-container\"><span title=\"Codes:{http://terminology.hl7.org/CodeSystem/measure-scoring continuous-variable}\">Continuous Variable</span></td>\n</tr>\n\n\n\n\n\n\n\n  \n<tr>\n\n\n<th scope=\"row\" class=\"row-header\">Type</th>\n\n\n<td class=\"content-container\"><span title=\"Codes:{http://terminology.hl7.org/CodeSystem/measure-type outcome}\">Outcome</span></td>\n</tr>\n\n\n\n\n\n  \n  \n    <tr>\n      \n        \n\n<th scope=\"row\" class=\"row-header\">Initial Population</th>\n\n\n      \n      <td class=\"content-container\">\n        \n        <em>ID</em>: 2ed7e4ba-50d2-4b51-bc06-c2bf9ee27bd1\n        <br/>\n        \n        \n          <em>Description</em>:\n          <p style=\"white-space: pre-line\" class=\"tab-one\">Initial</p>\n        \n        \n          \n            \n            <em>Logic Definition</em>: <a href=\"#primary-globalmalnutritioncompositefhir-initial-population\">Initial Population</a> \n          \n        \n      </td>\n    </tr>\n  \n\n  \n    <tr>\n      \n        \n\n<th scope=\"row\" class=\"row-header\">Measure Population</th>\n\n\n      \n      <td class=\"content-container\">\n        \n        <em>ID</em>: 67cef5f1-a6ec-4c0e-a077-b8b867431182\n        <br/>\n        \n        \n          <em>Description</em>:\n          <p style=\"white-space: pre-line\" class=\"tab-one\">Measure</p>\n        \n        \n          \n            \n            <em>Logic Definition</em>: <a href=\"#primary-globalmalnutritioncompositefhir-measure-population\">Measure Population</a> \n          \n        \n      </td>\n    </tr>\n  \n\n  \n    <tr>\n      \n        \n\n<th scope=\"row\" class=\"row-header\">Measure Observation</th>\n\n\n      \n      <td class=\"content-container\">\n        \n        <em>ID</em>: f936bb5d-3610-453b-abb1-d7358aca957a\n        <br/>\n        \n        \n          <em>Description</em>:\n          <p style=\"white-space: pre-line\" class=\"tab-one\">Diagnosis</p>\n        \n        \n          \n            \n            <em>Logic Definition</em>: <a href=\"#primary-globalmalnutritioncompositefhir-measure-observation-3\">Measure Observation 3</a> \n          \n        \n      </td>\n    </tr>\n  \n\n  \n\n  \n    \n    <tr>\n\n\n<th colspan=\"2\" scope=\"row\" class=\"row-header\">Measure Group (Rate) (ID: 6644d75da7a1805d3b7375b7)</th>\n\n\n</tr>\n  \n  \n  \n  \n<tr>\n\n\n<th scope=\"row\" class=\"row-header\">Basis</th>\n\n\n<td class=\"content-container\">Encounter</td>\n</tr>\n\n\n\n  \n<tr>\n\n\n<th scope=\"row\" class=\"row-header\">Scoring</th>\n\n\n<td class=\"content-container\"><span title=\"Codes:{http://terminology.hl7.org/CodeSystem/measure-scoring continuous-variable}\">Continuous Variable</span></td>\n</tr>\n\n\n\n\n\n\n\n  \n<tr>\n\n\n<th scope=\"row\" class=\"row-header\">Type</th>\n\n\n<td class=\"content-container\"><span title=\"Codes:{http://terminology.hl7.org/CodeSystem/measure-type outcome}\">Outcome</span></td>\n</tr>\n\n\n\n\n\n  \n  \n    <tr>\n      \n        \n\n<th scope=\"row\" class=\"row-header\">Initial Population</th>\n\n\n      \n      <td class=\"content-container\">\n        \n        <em>ID</em>: 57378bbc-9b1d-40da-b945-603862bb6ba4\n        <br/>\n        \n        \n          <em>Description</em>:\n          <p style=\"white-space: pre-line\" class=\"tab-one\">Initial</p>\n        \n        \n          \n            \n            <em>Logic Definition</em>: <a href=\"#primary-globalmalnutritioncompositefhir-initial-population\">Initial Population</a> \n          \n        \n      </td>\n    </tr>\n  \n\n  \n    <tr>\n      \n        \n\n<th scope=\"row\" class=\"row-header\">Measure Population</th>\n\n\n      \n      <td class=\"content-container\">\n        \n        <em>ID</em>: aaabf807-f476-4158-96dc-d6f9e2e360c4\n        <br/>\n        \n        \n          <em>Description</em>:\n          <p style=\"white-space: pre-line\" class=\"tab-one\">Measure</p>\n        \n        \n          \n            \n            <em>Logic Definition</em>: <a href=\"#primary-globalmalnutritioncompositefhir-measure-population\">Measure Population</a> \n          \n        \n      </td>\n    </tr>\n  \n\n  \n    <tr>\n      \n        \n\n<th scope=\"row\" class=\"row-header\">Measure Observation</th>\n\n\n      \n      <td class=\"content-container\">\n        \n        <em>ID</em>: e7adef10-7076-4e5a-8643-95ca17d02ecf\n        <br/>\n        \n        \n          <em>Description</em>:\n          <p style=\"white-space: pre-line\" class=\"tab-one\">Care Plan</p>\n        \n        \n          \n            \n            <em>Logic Definition</em>: <a href=\"#primary-globalmalnutritioncompositefhir-measure-observation-4\">Measure Observation 4</a> \n          \n        \n      </td>\n    </tr>\n  \n\n  \n\n  \n    \n    <tr>\n\n\n<th colspan=\"2\" scope=\"row\" class=\"row-header\">Measure Group (Rate) (ID: 6644d75da7a1805d3b7375b8)</th>\n\n\n</tr>\n  \n  \n  \n  \n<tr>\n\n\n<th scope=\"row\" class=\"row-header\">Basis</th>\n\n\n<td class=\"content-container\">Encounter</td>\n</tr>\n\n\n\n  \n<tr>\n\n\n<th scope=\"row\" class=\"row-header\">Scoring</th>\n\n\n<td class=\"content-container\"><span title=\"Codes:{http://terminology.hl7.org/CodeSystem/measure-scoring continuous-variable}\">Continuous Variable</span></td>\n</tr>\n\n\n\n\n\n\n\n  \n<tr>\n\n\n<th scope=\"row\" class=\"row-header\">Type</th>\n\n\n<td class=\"content-container\"><span title=\"Codes:{http://terminology.hl7.org/CodeSystem/measure-type outcome}\">Outcome</span></td>\n</tr>\n\n\n\n\n\n  \n  \n    <tr>\n      \n        \n\n<th scope=\"row\" class=\"row-header\">Initial Population</th>\n\n\n      \n      <td class=\"content-container\">\n        \n        <em>ID</em>: d3214243-5af2-4430-84a1-861477bee9e3\n        <br/>\n        \n        \n          <em>Description</em>:\n          <p style=\"white-space: pre-line\" class=\"tab-one\">Initial</p>\n        \n        \n          \n            \n            <em>Logic Definition</em>: <a href=\"#primary-globalmalnutritioncompositefhir-initial-population\">Initial Population</a> \n          \n        \n      </td>\n    </tr>\n  \n\n  \n    <tr>\n      \n        \n\n<th scope=\"row\" class=\"row-header\">Measure Population</th>\n\n\n      \n      <td class=\"content-container\">\n        \n        <em>ID</em>: 7137d595-07cf-4680-a21e-b5380d5e6f20\n        <br/>\n        \n        \n          <em>Description</em>:\n          <p style=\"white-space: pre-line\" class=\"tab-one\">Measure</p>\n        \n        \n          \n            \n            <em>Logic Definition</em>: <a href=\"#primary-globalmalnutritioncompositefhir-measure-population\">Measure Population</a> \n          \n        \n      </td>\n    </tr>\n  \n\n  \n    <tr>\n      \n        \n\n<th scope=\"row\" class=\"row-header\">Measure Observation</th>\n\n\n      \n      <td class=\"content-container\">\n        \n        <em>ID</em>: b6dc0a60-e3dc-4ef4-8f58-8728a69cba3c\n        <br/>\n        \n        \n          <em>Description</em>:\n          <p style=\"white-space: pre-line\" class=\"tab-one\">Total Score</p>\n        \n        \n          \n            \n            <em>Logic Definition</em>: <a href=\"#primary-globalmalnutritioncompositefhir-measure-observation-total-malnutrition-components-score\">Measure Observation Total Malnutrition Components Score</a> \n          \n        \n      </td>\n    </tr>\n  \n\n  \n\n  \n    \n    <tr>\n\n\n<th colspan=\"2\" scope=\"row\" class=\"row-header\">Measure Group (Rate) (ID: 6644d75da7a1805d3b7375b9)</th>\n\n\n</tr>\n  \n  \n  \n  \n<tr>\n\n\n<th scope=\"row\" class=\"row-header\">Basis</th>\n\n\n<td class=\"content-container\">Encounter</td>\n</tr>\n\n\n\n  \n<tr>\n\n\n<th scope=\"row\" class=\"row-header\">Scoring</th>\n\n\n<td class=\"content-container\"><span title=\"Codes:{http://terminology.hl7.org/CodeSystem/measure-scoring continuous-variable}\">Continuous Variable</span></td>\n</tr>\n\n\n\n\n\n\n\n  \n<tr>\n\n\n<th scope=\"row\" class=\"row-header\">Type</th>\n\n\n<td class=\"content-container\"><span title=\"Codes:{http://terminology.hl7.org/CodeSystem/measure-type outcome}\">Outcome</span></td>\n</tr>\n\n\n\n\n\n  \n  \n    <tr>\n      \n        \n\n<th scope=\"row\" class=\"row-header\">Initial Population</th>\n\n\n      \n      <td class=\"content-container\">\n        \n        <em>ID</em>: bd53026c-9027-4fdb-b5e6-d818dfb017f4\n        <br/>\n        \n        \n          <em>Description</em>:\n          <p style=\"white-space: pre-line\" class=\"tab-one\">Initial</p>\n        \n        \n          \n            \n            <em>Logic Definition</em>: <a href=\"#primary-globalmalnutritioncompositefhir-initial-population\">Initial Population</a> \n          \n        \n      </td>\n    </tr>\n  \n\n  \n    <tr>\n      \n        \n\n<th scope=\"row\" class=\"row-header\">Measure Population</th>\n\n\n      \n      <td class=\"content-container\">\n        \n        <em>ID</em>: 5be2bfc9-e31c-4253-bc4c-395baa4b101b\n        <br/>\n        \n        \n          <em>Description</em>:\n          <p style=\"white-space: pre-line\" class=\"tab-one\">Measure</p>\n        \n        \n          \n            \n            <em>Logic Definition</em>: <a href=\"#primary-globalmalnutritioncompositefhir-measure-population\">Measure Population</a> \n          \n        \n      </td>\n    </tr>\n  \n\n  \n    <tr>\n      \n        \n\n<th scope=\"row\" class=\"row-header\">Measure Observation</th>\n\n\n      \n      <td class=\"content-container\">\n        \n        <em>ID</em>: dd53fd31-7801-4b1f-ad36-8e688706d0eb\n        <br/>\n        \n        \n          <em>Description</em>:\n          <p style=\"white-space: pre-line\" class=\"tab-one\">GMCS Percentage</p>\n        \n        \n          \n            \n            <em>Logic Definition</em>: <a href=\"#primary-globalmalnutritioncompositefhir-measure-observation-total-malnutrition-composite-score-as-percentage\">Measure Observation Total Malnutrition Composite Score as Percentage</a> \n          \n        \n      </td>\n    </tr>\n  \n\n  \n\n\n\n\n\n<tr>\n\n\n<th colspan=\"2\" scope=\"row\" class=\"row-header\">Measure Logic</th>\n\n\n</tr>\n\n<tr>\n\n\n<th scope=\"row\" class=\"row-header\">Primary Library</th>\n\n\n<td class=\"content-container\"><a href=\"Library-GlobalMalnutritionCompositeFHIR.html\">GlobalMalnutritionCompositeFHIR</a></td>\n</tr>\n\n\n\n\n<tr>\n  <th scope=\"row\" class=\"row-header\">Contents</th>\n  <td class=\"content-container\">\n    <em><a href=\"#population-criteria\">Population Criteria</a></em>\n    <br/>\n    <em><a href=\"#definitions\">Logic Definitions</a></em>\n    <br/>\n    <em><a href=\"#terminology\">Terminology</a></em>\n    <br/>\n    <em><a href=\"#dependencies\">Dependencies</a></em>\n    <br/>\n    <em><a href=\"#data-requirements\">Data Requirements</a></em>\n    <br/>\n  </td>\n</tr>\n\n\n  <tr>\n\n\n<th colspan=\"2\" scope=\"row\" class=\"row-header\"><a name=\"population-criteria\"> </a>Population Criteria</th>\n\n\n</tr>\n  \n  \n  \n  \n    \n    <tr>\n\n\n<th colspan=\"2\" scope=\"row\" class=\"row-header\">Measure Group (Rate) (ID: 6644d75da7a1805d3b7375b4)</th>\n\n\n</tr>\n  \n  \n  \n  \n    \n      \n        \n          \n            \n              \n            \n            <tr>\n  <th scope=\"row\" rowspan=\"2\" class=\"row-header\">\n    \n      \n      <a name=\"primary-globalmalnutritioncompositefhir-initial-population\"> </a>\n    \n    \n    Initial Population\n    \n  </th>\n</tr>\n<tr>\n\n  <td>\n    <pre style=\"border: none;\" class=\"content-container highlight language-cql\"><code class=\"language-cql\">define &quot;Initial Population&quot;:\n  [Encounter: &quot;Encounter Inpatient&quot;] EncounterInpatient\n    where EncounterInpatient.period ends during day of &quot;Measurement Period&quot;\n      and AgeInYearsAt(date from start of EncounterInpatient.period) &gt;= 65\n      and ( duration in hours of EncounterInpatient.period &gt;= 24 )\n      and EncounterInpatient.status = 'finished'</code></pre>\n  </td>\n\n</tr>\n\n          \n        \n          \n        \n          \n        \n          \n        \n          \n        \n          \n        \n          \n        \n          \n        \n          \n        \n      \n    \n  \n\n  \n    \n      \n        \n          \n        \n          \n            \n              \n            \n            <tr>\n  <th scope=\"row\" rowspan=\"2\" class=\"row-header\">\n    \n      \n      <a name=\"primary-globalmalnutritioncompositefhir-measure-population\"> </a>\n    \n    \n    Measure Population\n    \n  </th>\n</tr>\n<tr>\n\n  <td>\n    <pre style=\"border: none;\" class=\"content-container highlight language-cql\"><code class=\"language-cql\">define &quot;Measure Population&quot;:\n  &quot;Initial Population&quot;</code></pre>\n  </td>\n\n</tr>\n\n          \n        \n          \n        \n          \n        \n          \n        \n          \n        \n          \n        \n          \n        \n          \n        \n      \n    \n  \n\n  \n    \n      \n        \n          \n        \n          \n        \n          \n            \n              \n            \n            <tr>\n  <th scope=\"row\" rowspan=\"2\" class=\"row-header\">\n    \n      \n      <a name=\"primary-globalmalnutritioncompositefhir-measure-observation-1\"> </a>\n    \n    \n    Measure Observation\n    \n  </th>\n</tr>\n<tr>\n\n  <td>\n    <pre style=\"border: none;\" class=\"content-container highlight language-cql\"><code class=\"language-cql\">define function &quot;Measure Observation 1&quot;(MalnutritionRiskScreening Encounter):\n  if &quot;Encounter with Malnutrition Risk Screening or with Hospital Dietitian Referral&quot; contains MalnutritionRiskScreening then 1 \n    else 0</code></pre>\n  </td>\n\n</tr>\n\n          \n        \n          \n        \n          \n        \n          \n        \n          \n        \n          \n        \n          \n        \n      \n    \n  \n\n  \n  \n\n  \n    \n    <tr>\n\n\n<th colspan=\"2\" scope=\"row\" class=\"row-header\">Measure Group (Rate) (ID: 6644d75da7a1805d3b7375b5)</th>\n\n\n</tr>\n  \n  \n  \n  \n    \n      \n        \n          \n            \n              \n            \n            <tr>\n  <th scope=\"row\" rowspan=\"2\" class=\"row-header\">\n    \n      \n      <a name=\"primary-globalmalnutritioncompositefhir-initial-population\"> </a>\n    \n    \n    Initial Population\n    \n  </th>\n</tr>\n<tr>\n\n  <td>\n    <pre style=\"border: none;\" class=\"content-container highlight language-cql\"><code class=\"language-cql\">define &quot;Initial Population&quot;:\n  [Encounter: &quot;Encounter Inpatient&quot;] EncounterInpatient\n    where EncounterInpatient.period ends during day of &quot;Measurement Period&quot;\n      and AgeInYearsAt(date from start of EncounterInpatient.period) &gt;= 65\n      and ( duration in hours of EncounterInpatient.period &gt;= 24 )\n      and EncounterInpatient.status = 'finished'</code></pre>\n  </td>\n\n</tr>\n\n          \n        \n          \n        \n          \n        \n          \n        \n          \n        \n          \n        \n          \n        \n          \n        \n          \n        \n      \n    \n  \n\n  \n    \n      \n        \n          \n        \n          \n            \n              \n            \n            <tr>\n  <th scope=\"row\" rowspan=\"2\" class=\"row-header\">\n    \n      \n      <a name=\"primary-globalmalnutritioncompositefhir-measure-population\"> </a>\n    \n    \n    Measure Population\n    \n  </th>\n</tr>\n<tr>\n\n  <td>\n    <pre style=\"border: none;\" class=\"content-container highlight language-cql\"><code class=\"language-cql\">define &quot;Measure Population&quot;:\n  &quot;Initial Population&quot;</code></pre>\n  </td>\n\n</tr>\n\n          \n        \n          \n        \n          \n        \n          \n        \n          \n        \n          \n        \n          \n        \n          \n        \n      \n    \n  \n\n  \n    \n      \n        \n          \n        \n          \n        \n          \n        \n          \n        \n          \n            \n              \n            \n            <tr>\n  <th scope=\"row\" rowspan=\"2\" class=\"row-header\">\n    \n      \n      <a name=\"primary-globalmalnutritioncompositefhir-measure-observation-2\"> </a>\n    \n    \n    Measure Observation\n    \n  </th>\n</tr>\n<tr>\n\n  <td>\n    <pre style=\"border: none;\" class=\"content-container highlight language-cql\"><code class=\"language-cql\">define function &quot;Measure Observation 2&quot;(NutritionAssessment Encounter):\n  if &quot;Encounter with Malnutrition Not At Risk Screening and without Hospital Dietitian Referral&quot; contains NutritionAssessment then 0 \n    else if &quot;Encounter with Malnutrition Risk Screening At Risk or with Hospital Dietitian Referral&quot; contains NutritionAssessment then if &quot;Encounter with Nutrition Assessment and Identified Status&quot; contains NutritionAssessment then 1 \n    else 0 \n    else 0</code></pre>\n  </td>\n\n</tr>\n\n          \n        \n          \n        \n          \n        \n          \n        \n          \n        \n      \n    \n  \n\n  \n  \n\n  \n    \n    <tr>\n\n\n<th colspan=\"2\" scope=\"row\" class=\"row-header\">Measure Group (Rate) (ID: 6644d75da7a1805d3b7375b6)</th>\n\n\n</tr>\n  \n  \n  \n  \n    \n      \n        \n          \n            \n              \n            \n            <tr>\n  <th scope=\"row\" rowspan=\"2\" class=\"row-header\">\n    \n      \n      <a name=\"primary-globalmalnutritioncompositefhir-initial-population\"> </a>\n    \n    \n    Initial Population\n    \n  </th>\n</tr>\n<tr>\n\n  <td>\n    <pre style=\"border: none;\" class=\"content-container highlight language-cql\"><code class=\"language-cql\">define &quot;Initial Population&quot;:\n  [Encounter: &quot;Encounter Inpatient&quot;] EncounterInpatient\n    where EncounterInpatient.period ends during day of &quot;Measurement Period&quot;\n      and AgeInYearsAt(date from start of EncounterInpatient.period) &gt;= 65\n      and ( duration in hours of EncounterInpatient.period &gt;= 24 )\n      and EncounterInpatient.status = 'finished'</code></pre>\n  </td>\n\n</tr>\n\n          \n        \n          \n        \n          \n        \n          \n        \n          \n        \n          \n        \n          \n        \n          \n        \n          \n        \n      \n    \n  \n\n  \n    \n      \n        \n          \n        \n          \n            \n              \n            \n            <tr>\n  <th scope=\"row\" rowspan=\"2\" class=\"row-header\">\n    \n      \n      <a name=\"primary-globalmalnutritioncompositefhir-measure-population\"> </a>\n    \n    \n    Measure Population\n    \n  </th>\n</tr>\n<tr>\n\n  <td>\n    <pre style=\"border: none;\" class=\"content-container highlight language-cql\"><code class=\"language-cql\">define &quot;Measure Population&quot;:\n  &quot;Initial Population&quot;</code></pre>\n  </td>\n\n</tr>\n\n          \n        \n          \n        \n          \n        \n          \n        \n          \n        \n          \n        \n          \n        \n          \n        \n      \n    \n  \n\n  \n    \n      \n        \n          \n        \n          \n        \n          \n        \n          \n        \n          \n        \n          \n            \n              \n            \n            <tr>\n  <th scope=\"row\" rowspan=\"2\" class=\"row-header\">\n    \n      \n      <a name=\"primary-globalmalnutritioncompositefhir-measure-observation-3\"> </a>\n    \n    \n    Measure Observation\n    \n  </th>\n</tr>\n<tr>\n\n  <td>\n    <pre style=\"border: none;\" class=\"content-container highlight language-cql\"><code class=\"language-cql\">define function &quot;Measure Observation 3&quot;(MalnutritionDiagonsis Encounter):\n  if &quot;Encounter with Malnutrition Not At Risk Screening and without Hospital Dietitian Referral&quot; contains MalnutritionDiagonsis then 0 \n    else if &quot;Encounter with Malnutrition Risk Screening At Risk or with Hospital Dietitian Referral&quot; contains MalnutritionDiagonsis then if &quot;Encounter with Malnutrition Diagnosis&quot; contains MalnutritionDiagonsis then if &quot;Encounter with Nutrition Assessment Not or Mildly Malnourished&quot; contains MalnutritionDiagonsis then 0 \n    else if &quot;Encounter with Nutrition Assessment Status Moderately Or Severely Malnourished&quot; contains MalnutritionDiagonsis then 1 \n    else 0 \n    else 0 \n    else 0</code></pre>\n  </td>\n\n</tr>\n\n          \n        \n          \n        \n          \n        \n          \n        \n      \n    \n  \n\n  \n  \n\n  \n    \n    <tr>\n\n\n<th colspan=\"2\" scope=\"row\" class=\"row-header\">Measure Group (Rate) (ID: 6644d75da7a1805d3b7375b7)</th>\n\n\n</tr>\n  \n  \n  \n  \n    \n      \n        \n          \n            \n              \n            \n            <tr>\n  <th scope=\"row\" rowspan=\"2\" class=\"row-header\">\n    \n      \n      <a name=\"primary-globalmalnutritioncompositefhir-initial-population\"> </a>\n    \n    \n    Initial Population\n    \n  </th>\n</tr>\n<tr>\n\n  <td>\n    <pre style=\"border: none;\" class=\"content-container highlight language-cql\"><code class=\"language-cql\">define &quot;Initial Population&quot;:\n  [Encounter: &quot;Encounter Inpatient&quot;] EncounterInpatient\n    where EncounterInpatient.period ends during day of &quot;Measurement Period&quot;\n      and AgeInYearsAt(date from start of EncounterInpatient.period) &gt;= 65\n      and ( duration in hours of EncounterInpatient.period &gt;= 24 )\n      and EncounterInpatient.status = 'finished'</code></pre>\n  </td>\n\n</tr>\n\n          \n        \n          \n        \n          \n        \n          \n        \n          \n        \n          \n        \n          \n        \n          \n        \n          \n        \n      \n    \n  \n\n  \n    \n      \n        \n          \n        \n          \n            \n              \n            \n            <tr>\n  <th scope=\"row\" rowspan=\"2\" class=\"row-header\">\n    \n      \n      <a name=\"primary-globalmalnutritioncompositefhir-measure-population\"> </a>\n    \n    \n    Measure Population\n    \n  </th>\n</tr>\n<tr>\n\n  <td>\n    <pre style=\"border: none;\" class=\"content-container highlight language-cql\"><code class=\"language-cql\">define &quot;Measure Population&quot;:\n  &quot;Initial Population&quot;</code></pre>\n  </td>\n\n</tr>\n\n          \n        \n          \n        \n          \n        \n          \n        \n          \n        \n          \n        \n          \n        \n          \n        \n      \n    \n  \n\n  \n    \n      \n        \n          \n        \n          \n        \n          \n        \n          \n        \n          \n        \n          \n        \n          \n            \n              \n            \n            <tr>\n  <th scope=\"row\" rowspan=\"2\" class=\"row-header\">\n    \n      \n      <a name=\"primary-globalmalnutritioncompositefhir-measure-observation-4\"> </a>\n    \n    \n    Measure Observation\n    \n  </th>\n</tr>\n<tr>\n\n  <td>\n    <pre style=\"border: none;\" class=\"content-container highlight language-cql\"><code class=\"language-cql\">define function &quot;Measure Observation 4&quot;(NutritionCarePlan Encounter):\n  if &quot;Encounter with Malnutrition Not At Risk Screening and without Hospital Dietitian Referral&quot; contains NutritionCarePlan then 0 \n    else if &quot;Encounter with Malnutrition Risk Screening At Risk or with Hospital Dietitian Referral&quot; contains NutritionCarePlan then if &quot;Encounter with Nutrition Care Plan&quot; contains NutritionCarePlan then if &quot;Encounter with Nutrition Assessment Not or Mildly Malnourished&quot; contains NutritionCarePlan then 0 \n    else if &quot;Encounter with Nutrition Assessment Status Moderately Or Severely Malnourished&quot; contains NutritionCarePlan then 1 \n    else 0 \n    else 0 \n    else 0</code></pre>\n  </td>\n\n</tr>\n\n          \n        \n          \n        \n          \n        \n      \n    \n  \n\n  \n  \n\n  \n    \n    <tr>\n\n\n<th colspan=\"2\" scope=\"row\" class=\"row-header\">Measure Group (Rate) (ID: 6644d75da7a1805d3b7375b8)</th>\n\n\n</tr>\n  \n  \n  \n  \n    \n      \n        \n          \n            \n              \n            \n            <tr>\n  <th scope=\"row\" rowspan=\"2\" class=\"row-header\">\n    \n      \n      <a name=\"primary-globalmalnutritioncompositefhir-initial-population\"> </a>\n    \n    \n    Initial Population\n    \n  </th>\n</tr>\n<tr>\n\n  <td>\n    <pre style=\"border: none;\" class=\"content-container highlight language-cql\"><code class=\"language-cql\">define &quot;Initial Population&quot;:\n  [Encounter: &quot;Encounter Inpatient&quot;] EncounterInpatient\n    where EncounterInpatient.period ends during day of &quot;Measurement Period&quot;\n      and AgeInYearsAt(date from start of EncounterInpatient.period) &gt;= 65\n      and ( duration in hours of EncounterInpatient.period &gt;= 24 )\n      and EncounterInpatient.status = 'finished'</code></pre>\n  </td>\n\n</tr>\n\n          \n        \n          \n        \n          \n        \n          \n        \n          \n        \n          \n        \n          \n        \n          \n        \n          \n        \n      \n    \n  \n\n  \n    \n      \n        \n          \n        \n          \n            \n              \n            \n            <tr>\n  <th scope=\"row\" rowspan=\"2\" class=\"row-header\">\n    \n      \n      <a name=\"primary-globalmalnutritioncompositefhir-measure-population\"> </a>\n    \n    \n    Measure Population\n    \n  </th>\n</tr>\n<tr>\n\n  <td>\n    <pre style=\"border: none;\" class=\"content-container highlight language-cql\"><code class=\"language-cql\">define &quot;Measure Population&quot;:\n  &quot;Initial Population&quot;</code></pre>\n  </td>\n\n</tr>\n\n          \n        \n          \n        \n          \n        \n          \n        \n          \n        \n          \n        \n          \n        \n          \n        \n      \n    \n  \n\n  \n    \n      \n        \n          \n        \n          \n        \n          \n        \n          \n            \n              \n            \n            <tr>\n  <th scope=\"row\" rowspan=\"2\" class=\"row-header\">\n    \n      \n      <a name=\"primary-globalmalnutritioncompositefhir-measure-observation-total-malnutrition-components-score\"> </a>\n    \n    \n    Measure Observation\n    \n  </th>\n</tr>\n<tr>\n\n  <td>\n    <pre style=\"border: none;\" class=\"content-container highlight language-cql\"><code class=\"language-cql\">define function &quot;Measure Observation Total Malnutrition Components Score&quot;(QualifyingEncounter Encounter):\n  Sum({ &quot;Measure Observation 1&quot;(QualifyingEncounter), &quot;Measure Observation 2&quot;(QualifyingEncounter), &quot;Measure Observation 3&quot;(QualifyingEncounter), &quot;Measure Observation 4&quot;(QualifyingEncounter) })</code></pre>\n  </td>\n\n</tr>\n\n          \n        \n          \n        \n          \n        \n          \n        \n          \n        \n          \n        \n      \n    \n  \n\n  \n  \n\n  \n    \n    <tr>\n\n\n<th colspan=\"2\" scope=\"row\" class=\"row-header\">Measure Group (Rate) (ID: 6644d75da7a1805d3b7375b9)</th>\n\n\n</tr>\n  \n  \n  \n  \n    \n      \n        \n          \n            \n              \n            \n            <tr>\n  <th scope=\"row\" rowspan=\"2\" class=\"row-header\">\n    \n      \n      <a name=\"primary-globalmalnutritioncompositefhir-initial-population\"> </a>\n    \n    \n    Initial Population\n    \n  </th>\n</tr>\n<tr>\n\n  <td>\n    <pre style=\"border: none;\" class=\"content-container highlight language-cql\"><code class=\"language-cql\">define &quot;Initial Population&quot;:\n  [Encounter: &quot;Encounter Inpatient&quot;] EncounterInpatient\n    where EncounterInpatient.period ends during day of &quot;Measurement Period&quot;\n      and AgeInYearsAt(date from start of EncounterInpatient.period) &gt;= 65\n      and ( duration in hours of EncounterInpatient.period &gt;= 24 )\n      and EncounterInpatient.status = 'finished'</code></pre>\n  </td>\n\n</tr>\n\n          \n        \n          \n        \n          \n        \n          \n        \n          \n        \n          \n        \n          \n        \n          \n        \n          \n        \n      \n    \n  \n\n  \n    \n      \n        \n          \n        \n          \n            \n              \n            \n            <tr>\n  <th scope=\"row\" rowspan=\"2\" class=\"row-header\">\n    \n      \n      <a name=\"primary-globalmalnutritioncompositefhir-measure-population\"> </a>\n    \n    \n    Measure Population\n    \n  </th>\n</tr>\n<tr>\n\n  <td>\n    <pre style=\"border: none;\" class=\"content-container highlight language-cql\"><code class=\"language-cql\">define &quot;Measure Population&quot;:\n  &quot;Initial Population&quot;</code></pre>\n  </td>\n\n</tr>\n\n          \n        \n          \n        \n          \n        \n          \n        \n          \n        \n          \n        \n          \n        \n          \n        \n      \n    \n  \n\n  \n    \n      \n        \n          \n        \n          \n        \n          \n        \n          \n        \n          \n        \n          \n        \n          \n        \n          \n            \n              \n            \n            <tr>\n  <th scope=\"row\" rowspan=\"2\" class=\"row-header\">\n    \n      \n      <a name=\"primary-globalmalnutritioncompositefhir-measure-observation-total-malnutrition-composite-score-as-percentage\"> </a>\n    \n    \n    Measure Observation\n    \n  </th>\n</tr>\n<tr>\n\n  <td>\n    <pre style=\"border: none;\" class=\"content-container highlight language-cql\"><code class=\"language-cql\">define function &quot;Measure Observation Total Malnutrition Composite Score as Percentage&quot;(QualifyingEncounter Encounter):\n  100 * ( &quot;Measure Observation Total Malnutrition Components Score&quot;(QualifyingEncounter) / &quot;Total Malnutrition Composite Score Eligible Occurrences&quot;(QualifyingEncounter) )</code></pre>\n  </td>\n\n</tr>\n\n          \n        \n          \n        \n      \n    \n  \n\n  \n  \n\n  \n  \n\n\n  <tr>\n\n\n<th colspan=\"2\" scope=\"row\" class=\"row-header\"><a name=\"definitions\"> </a>Logic Definitions</th>\n\n\n</tr>\n  \n  \n          \n        \n\n\n<tr>\n  <th scope=\"row\" rowspan=\"2\" class=\"row-header\">\n    \n      \n      <a name=\"globalmalnutritioncompositefhir-initial-population\"> </a>\n    \n    Logic Definition\n  </th>\n\n  <td class=\"content-container\"><em>Library Name:</em> GlobalMalnutritionCompositeFHIR</td>\n\n</tr>\n<tr>\n\n  <td>\n    <pre style=\"border: none;\" class=\"content-container highlight language-cql\"><code class=\"language-cql\">define &quot;Initial Population&quot;:\n  [Encounter: &quot;Encounter Inpatient&quot;] EncounterInpatient\n    where EncounterInpatient.period ends during day of &quot;Measurement Period&quot;\n      and AgeInYearsAt(date from start of EncounterInpatient.period) &gt;= 65\n      and ( duration in hours of EncounterInpatient.period &gt;= 24 )\n      and EncounterInpatient.status = 'finished'</code></pre>\n  </td>\n\n</tr>\n\n\n\n        \n\n\n<tr>\n  <th scope=\"row\" rowspan=\"2\" class=\"row-header\">\n    \n      \n      <a name=\"globalmalnutritioncompositefhir-measure-population\"> </a>\n    \n    Logic Definition\n  </th>\n\n  <td class=\"content-container\"><em>Library Name:</em> GlobalMalnutritionCompositeFHIR</td>\n\n</tr>\n<tr>\n\n  <td>\n    <pre style=\"border: none;\" class=\"content-container highlight language-cql\"><code class=\"language-cql\">define &quot;Measure Population&quot;:\n  &quot;Initial Population&quot;</code></pre>\n  </td>\n\n</tr>\n\n\n\n        \n\n\n<tr>\n  <th scope=\"row\" rowspan=\"2\" class=\"row-header\">\n    \n      \n      <a name=\"globalmalnutritioncompositefhir-measure-observation-1\"> </a>\n    \n    Logic Definition\n  </th>\n\n  <td class=\"content-container\"><em>Library Name:</em> GlobalMalnutritionCompositeFHIR</td>\n\n</tr>\n<tr>\n\n  <td>\n    <pre style=\"border: none;\" class=\"content-container highlight language-cql\"><code class=\"language-cql\">define function &quot;Measure Observation 1&quot;(MalnutritionRiskScreening Encounter):\n  if &quot;Encounter with Malnutrition Risk Screening or with Hospital Dietitian Referral&quot; contains MalnutritionRiskScreening then 1 \n    else 0</code></pre>\n  </td>\n\n</tr>\n\n\n\n        \n\n\n<tr>\n  <th scope=\"row\" rowspan=\"2\" class=\"row-header\">\n    \n      \n      <a name=\"globalmalnutritioncompositefhir-measure-observation-total-malnutrition-components-score\"> </a>\n    \n    Logic Definition\n  </th>\n\n  <td class=\"content-container\"><em>Library Name:</em> GlobalMalnutritionCompositeFHIR</td>\n\n</tr>\n<tr>\n\n  <td>\n    <pre style=\"border: none;\" class=\"content-container highlight language-cql\"><code class=\"language-cql\">define function &quot;Measure Observation Total Malnutrition Components Score&quot;(QualifyingEncounter Encounter):\n  Sum({ &quot;Measure Observation 1&quot;(QualifyingEncounter), &quot;Measure Observation 2&quot;(QualifyingEncounter), &quot;Measure Observation 3&quot;(QualifyingEncounter), &quot;Measure Observation 4&quot;(QualifyingEncounter) })</code></pre>\n  </td>\n\n</tr>\n\n\n\n        \n\n\n<tr>\n  <th scope=\"row\" rowspan=\"2\" class=\"row-header\">\n    \n      \n      <a name=\"globalmalnutritioncompositefhir-measure-observation-2\"> </a>\n    \n    Logic Definition\n  </th>\n\n  <td class=\"content-container\"><em>Library Name:</em> GlobalMalnutritionCompositeFHIR</td>\n\n</tr>\n<tr>\n\n  <td>\n    <pre style=\"border: none;\" class=\"content-container highlight language-cql\"><code class=\"language-cql\">define function &quot;Measure Observation 2&quot;(NutritionAssessment Encounter):\n  if &quot;Encounter with Malnutrition Not At Risk Screening and without Hospital Dietitian Referral&quot; contains NutritionAssessment then 0 \n    else if &quot;Encounter with Malnutrition Risk Screening At Risk or with Hospital Dietitian Referral&quot; contains NutritionAssessment then if &quot;Encounter with Nutrition Assessment and Identified Status&quot; contains NutritionAssessment then 1 \n    else 0 \n    else 0</code></pre>\n  </td>\n\n</tr>\n\n\n\n        \n\n\n<tr>\n  <th scope=\"row\" rowspan=\"2\" class=\"row-header\">\n    \n      \n      <a name=\"globalmalnutritioncompositefhir-measure-observation-3\"> </a>\n    \n    Logic Definition\n  </th>\n\n  <td class=\"content-container\"><em>Library Name:</em> GlobalMalnutritionCompositeFHIR</td>\n\n</tr>\n<tr>\n\n  <td>\n    <pre style=\"border: none;\" class=\"content-container highlight language-cql\"><code class=\"language-cql\">define function &quot;Measure Observation 3&quot;(MalnutritionDiagonsis Encounter):\n  if &quot;Encounter with Malnutrition Not At Risk Screening and without Hospital Dietitian Referral&quot; contains MalnutritionDiagonsis then 0 \n    else if &quot;Encounter with Malnutrition Risk Screening At Risk or with Hospital Dietitian Referral&quot; contains MalnutritionDiagonsis then if &quot;Encounter with Malnutrition Diagnosis&quot; contains MalnutritionDiagonsis then if &quot;Encounter with Nutrition Assessment Not or Mildly Malnourished&quot; contains MalnutritionDiagonsis then 0 \n    else if &quot;Encounter with Nutrition Assessment Status Moderately Or Severely Malnourished&quot; contains MalnutritionDiagonsis then 1 \n    else 0 \n    else 0 \n    else 0</code></pre>\n  </td>\n\n</tr>\n\n\n\n        \n\n\n<tr>\n  <th scope=\"row\" rowspan=\"2\" class=\"row-header\">\n    \n      \n      <a name=\"globalmalnutritioncompositefhir-measure-observation-4\"> </a>\n    \n    Logic Definition\n  </th>\n\n  <td class=\"content-container\"><em>Library Name:</em> GlobalMalnutritionCompositeFHIR</td>\n\n</tr>\n<tr>\n\n  <td>\n    <pre style=\"border: none;\" class=\"content-container highlight language-cql\"><code class=\"language-cql\">define function &quot;Measure Observation 4&quot;(NutritionCarePlan Encounter):\n  if &quot;Encounter with Malnutrition Not At Risk Screening and without Hospital Dietitian Referral&quot; contains NutritionCarePlan then 0 \n    else if &quot;Encounter with Malnutrition Risk Screening At Risk or with Hospital Dietitian Referral&quot; contains NutritionCarePlan then if &quot;Encounter with Nutrition Care Plan&quot; contains NutritionCarePlan then if &quot;Encounter with Nutrition Assessment Not or Mildly Malnourished&quot; contains NutritionCarePlan then 0 \n    else if &quot;Encounter with Nutrition Assessment Status Moderately Or Severely Malnourished&quot; contains NutritionCarePlan then 1 \n    else 0 \n    else 0 \n    else 0</code></pre>\n  </td>\n\n</tr>\n\n\n\n        \n\n\n<tr>\n  <th scope=\"row\" rowspan=\"2\" class=\"row-header\">\n    \n      \n      <a name=\"globalmalnutritioncompositefhir-measure-observation-total-malnutrition-composite-score-as-percentage\"> </a>\n    \n    Logic Definition\n  </th>\n\n  <td class=\"content-container\"><em>Library Name:</em> GlobalMalnutritionCompositeFHIR</td>\n\n</tr>\n<tr>\n\n  <td>\n    <pre style=\"border: none;\" class=\"content-container highlight language-cql\"><code class=\"language-cql\">define function &quot;Measure Observation Total Malnutrition Composite Score as Percentage&quot;(QualifyingEncounter Encounter):\n  100 * ( &quot;Measure Observation Total Malnutrition Components Score&quot;(QualifyingEncounter) / &quot;Total Malnutrition Composite Score Eligible Occurrences&quot;(QualifyingEncounter) )</code></pre>\n  </td>\n\n</tr>\n\n\n\n        \n\n\n<tr>\n  <th scope=\"row\" rowspan=\"2\" class=\"row-header\">\n    \n      \n      <a name=\"globalmalnutritioncompositefhir-total-malnutrition-composite-score-eligible-occurrences\"> </a>\n    \n    Logic Definition\n  </th>\n\n  <td class=\"content-container\"><em>Library Name:</em> GlobalMalnutritionCompositeFHIR</td>\n\n</tr>\n<tr>\n\n  <td>\n    <pre style=\"border: none;\" class=\"content-container highlight language-cql\"><code class=\"language-cql\">define function &quot;Total Malnutrition Composite Score Eligible Occurrences&quot;(QualifyingEncounter Encounter):\n  if ( ( &quot;Encounter with Malnutrition Risk Screening or with Hospital Dietitian Referral&quot; contains QualifyingEncounter )\n      and ( &quot;Encounter with Malnutrition Risk Screening Not At Risk&quot; contains QualifyingEncounter )\n  )\n    and not ( &quot;Encounter with Hospital Dietitian Referral&quot; contains QualifyingEncounter ) then 1 \n    else if ( ( ( &quot;Encounter with Malnutrition Risk Screening or with Hospital Dietitian Referral&quot; contains QualifyingEncounter )\n        and ( &quot;Encounter with Malnutrition Risk Screening At Risk&quot; contains QualifyingEncounter )\n    )\n      or ( &quot;Encounter with Hospital Dietitian Referral&quot; contains QualifyingEncounter )\n  )\n    and ( &quot;Encounter with Nutrition Assessment Not or Mildly Malnourished&quot; contains QualifyingEncounter )\n    or not ( &quot;Encounter with Nutrition Assessment and Identified Status&quot; contains QualifyingEncounter ) then 2 \n    else 4</code></pre>\n  </td>\n\n</tr>\n\n\n\n\n\n  \n  \n\n\n  <tr>\n\n\n<th colspan=\"2\" scope=\"row\" class=\"row-header\"><a name=\"terminology\"> </a>Terminology</th>\n\n\n</tr>\n  \n  \n  \n\n \n\n\n<tr>\n  \n  \n\n<th scope=\"row\" class=\"row-header\">Value Set</th>\n\n\n  \n  \n  <td class=\"content-container\">\n    \n    <em>Description</em>: Value set Encounter Inpatient\n    \n    <br/>\n    \n    \n    \n    \n    \n    \n    <em>Resource</em>: <a href=\"https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.666.5.307/expansion\">Encounter Inpatient</a>\n    <br/>\n    <em>Canonical URL</em>: <tt>http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.666.5.307</tt>\n    \n  </td>\n</tr>\n \n\n\n  \n  \n  \n\n\n  <tr>\n\n\n<th colspan=\"2\" scope=\"row\" class=\"row-header\"><a name=\"dependencies\"> </a>Dependencies</th>\n\n\n</tr>\n  \n  \n  \n\n\n<tr>\n  \n\n<th scope=\"row\" class=\"row-header\">Dependency</th>\n\n\n  <td class=\"content-container\">\n    \n    <em>Description</em>: Library FHIRHelpers\n    \n    <br/>\n    \n    \n    \n    \n    \n    \n    <em>Resource</em>: <code>Library/FHIRHelpers|4.4.000</code>\n    <br/>\n    <em>Canonical URL</em>: <tt>Library/FHIRHelpers|4.4.000</tt>\n    \n  </td>\n</tr>\n \n\n \n\n\n  \n  \n\n\n  <tr>\n\n\n<th colspan=\"2\" scope=\"row\" class=\"row-header\"><a name=\"data-requirements\"> </a>Data Requirements</th>\n\n\n</tr>\n  \n  \n  \n<tr>\n  <th scope=\"row\" class=\"row-header\">Data Requirement</th>\n  <td class=\"content-container\">\n    <em>Type</em>: Patient\n    <br/>\n  \n    <em>Profile(s)</em>: \n  \n    <a href=\"http://hl7.org/fhir/us/qicore/STU4.1.1/StructureDefinition-qicore-patient.html\">QICorePatient</a>\n    <br/>        \n  \n   \n   \n   \n  </td>\n</tr>\n\n<tr>\n  <th scope=\"row\" class=\"row-header\">Data Requirement</th>\n  <td class=\"content-container\">\n    <em>Type</em>: Encounter\n    <br/>\n  \n    <em>Profile(s)</em>: \n  \n    <a href=\"http://hl7.org/fhir/us/qicore/STU4.1.1/StructureDefinition-qicore-encounter.html\">QICoreEncounter</a>\n    <br/>        \n  \n   \n   \n    <em>Must Support Elements</em>: type, period, status, status.value\n    <br/>\n   \n  \n    <em>Code Filter(s)</em>: \n    <br/>\n  \n  \n    <span class=\"tab-one\"><em>Path</em>: type</span>\n    <br/>\n  \n  \n  \n    <span class=\"tab-one\"><em>ValueSet</em>:</span> <a href=\"https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.666.5.307/expansion\">Encounter Inpatient</a>\n    <br/> \n  \n  \n  \n  \n    <span class=\"tab-one\"><em>Path</em>: status.value</span>\n    <br/>\n  \n  \n  \n  \n    <span class=\"tab-one\"><em>Code(s)</em>: \n    \n      \n      [not stated] finished: finished\n      \n    \n    </span>\n    <br/>\n  \n  \n   \n  </td>\n</tr>\n\n  \n  \n\n<tr>\n  <th colspan=\"2\" scope=\"row\" class=\"row-header\">Generated using version 0.4.8 of the sample-content-ig Liquid templates</th>\n</tr>\n\n    </tbody>\n  </table>\n</div>"
  },
  "contained" : [
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      "resourceType" : "Library",
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            },
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            },
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            }
          ],
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          "extension" : [
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            },
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            },
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            },
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            },
            {
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            }
          ],
          "url" : "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition"
        }
      ],
      "name" : "EffectiveDataRequirements",
      "status" : "active",
      "type" : {
        "coding" : [
          {
            "system" : "http://terminology.hl7.org/CodeSystem/library-type",
            "code" : "module-definition"
          }
        ]
      },
      "relatedArtifact" : [
        {
          "type" : "depends-on",
          "display" : "Library FHIRHelpers",
          "resource" : "Library/FHIRHelpers|4.4.000"
        },
        {
          "type" : "depends-on",
          "display" : "Value set Encounter Inpatient",
          "resource" : "http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.666.5.307"
        }
      ],
      "parameter" : [
        {
          "name" : "Measurement Period",
          "use" : "in",
          "min" : 0,
          "max" : "1",
          "type" : "Period"
        },
        {
          "name" : "Initial Population",
          "use" : "out",
          "min" : 0,
          "max" : "*",
          "type" : "Resource"
        },
        {
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          "use" : "out",
          "min" : 0,
          "max" : "*",
          "type" : "Resource"
        }
      ],
      "dataRequirement" : [
        {
          "type" : "Patient",
          "profile" : [
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          ]
        },
        {
          "type" : "Encounter",
          "profile" : [
            "http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-encounter"
          ],
          "mustSupport" : [
            "type",
            "period",
            "status",
            "status.value"
          ],
          "codeFilter" : [
            {
              "path" : "type",
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            },
            {
              "path" : "status.value",
              "code" : [
                {
                  "code" : "finished"
                }
              ]
            }
          ],
          "dateFilter" : [
            {
              "path" : "period",
              "valuePeriod" : {
                "extension" : [
                  {
                    "url" : "http://hl7.org/fhir/StructureDefinition/cqf-expression",
                    "valueExpression" : {
                      "language" : "text/cql-identifier",
                      "expression" : "Measurement Period"
                    }
                  }
                ]
              }
            }
          ]
        }
      ]
    }
  ],
  "extension" : [
    {
      "url" : "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-softwaresystem",
      "valueReference" : {
        "reference" : "Device/cqf-tooling"
      }
    },
    {
      "id" : "effective-data-requirements",
      "url" : "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-effectiveDataRequirements",
      "valueReference" : {
        "reference" : "#effective-data-requirements"
      }
    }
  ],
  "url" : "https://madie.cms.gov/Measure/GlobalMalnutritionCompositeFHIR",
  "identifier" : [
    {
      "use" : "usual",
      "type" : {
        "coding" : [
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            "system" : "http://hl7.org/fhir/us/cqfmeasures/CodeSystem/identifier-type",
            "code" : "short-name",
            "display" : "Short Name"
          }
        ]
      },
      "system" : "https://madie.cms.gov/measure/shortName",
      "value" : "CMS986FHIR"
    },
    {
      "use" : "official",
      "type" : {
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            "system" : "http://hl7.org/fhir/us/cqfmeasures/CodeSystem/identifier-type",
            "code" : "version-independent",
            "display" : "Version Independent"
          }
        ]
      },
      "system" : "urn:ietf:rfc:3986",
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    },
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      "use" : "official",
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          }
        ]
      },
      "system" : "urn:ietf:rfc:3986",
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            "code" : "endorser",
            "display" : "Endorser"
          }
        ]
      },
      "system" : "https://madie.cms.gov/measure/cbeId",
      "value" : "3592e",
      "assigner" : {
        "display" : "CMS Consensus Based Entity"
      }
    },
    {
      "use" : "official",
      "type" : {
        "coding" : [
          {
            "system" : "http://hl7.org/fhir/us/cqfmeasures/CodeSystem/identifier-type",
            "code" : "publisher",
            "display" : "Publisher"
          }
        ]
      },
      "system" : "https://madie.cms.gov/measure/cmsId",
      "value" : "986FHIR",
      "assigner" : {
        "display" : "CMS"
      }
    }
  ],
  "version" : "0.2.000",
  "name" : "GlobalMalnutritionCompositeFHIR",
  "title" : "Global Malnutrition Composite ScoreFHIR",
  "status" : "active",
  "experimental" : true,
  "date" : "2024-09-09T19:21:02+00:00",
  "publisher" : "Academy of Nutrition and Dietetics",
  "contact" : [
    {
      "telecom" : [
        {
          "system" : "url",
          "value" : "www.eatrightpro.org"
        }
      ]
    }
  ],
  "description" : "This measure assesses the percentage of hospitalizations of adults aged 65 years and older at the start of the inpatient encounter during the measurement period, with a length of stay equal to or greater than 24 hours, who received optimal malnutrition care where care performed was appropriate to the patient's level of malnutrition risk and severity. Malnutrition care best practices recommend that for each hospitalization, adult inpatients are (1) screened for malnutrition risk or for a hospital dietitian referral order to be placed, (2) assessed by a registered dietitian (RD) or registered dietitian nutritionist (RDN) to confirm findings of malnutrition risk, and if identified with a \"moderate\" or \"severe\" malnutrition status in the current performed malnutrition assessment, (3) receive a current \"moderate\" or \"severe\" malnutrition diagnosis by a physician or eligible provider as defined by the Centers for Medicare & Medicaid Services (CMS), and (4) have a current nutrition care plan performed by an RD/RDN.",
  "useContext" : [
    {
      "code" : {
        "system" : "http://terminology.hl7.org/CodeSystem/usage-context-type",
        "code" : "venue",
        "display" : "Venue"
      },
      "valueCodeableConcept" : {
        "coding" : [
          {
            "system" : "http://hl7.org/fhir/us/cqfmeasures/CodeSystem/intended-venue-codes",
            "code" : "eh",
            "display" : "EH"
          }
        ]
      }
    }
  ],
  "purpose" : "UNKNOWN",
  "usage" : "This measure is constructed of four clinically eligible components that are aggregated as an arithmetic average of eligible hospitalizations and expressed as a percentage. The four populations used to calculate the four components may differ and the measure observations for the four components do not need to be performed sequentially. \n\nThis eCQM is an episode-based measure. An episode is defined as each inpatient hospitalization or encounter with a length of stay of greater than or equal to 24 hours among individuals 65 years of age and older at the start of the inpatient encounter. \n\nThis FHIR-based measure has been derived from the QDM-based measure: CMS986v4.\n\nPlease refer to the HL7 QI-Core Implementation Guide\n(https://hl7.org/fhir/us/qicore/STU4.1.1/) for more information on QI-Core and\nmapping recommendations from QDM to QI-Core\n4.1.1 (https://hl7.org/fhir/us/qicore/STU4.1.1/qdm-to-qicore.html).",
  "copyright" : "Copyright (C) Academy of Nutrition and Dietetics 2024\n\nLimited 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.\n\nLOINC(R) copyright 2004-2023 Regenstrief Institute, Inc. \n\nICD-10 copyright 2023 World Health Organisation.\n\nThis material contains SNOMED Clinical Terms (R) (SNOMED CT [R]) copyright 2004-2023. International Health Terminology Standards Development Organisation . All Rights Reserved.",
  "effectivePeriod" : {
    "start" : "2026-01-01",
    "end" : "2026-12-31"
  },
  "author" : [
    {
      "name" : "Academy of Nutrition and Dietetics",
      "telecom" : [
        {
          "system" : "url",
          "value" : "www.eatrightpro.org"
        }
      ]
    }
  ],
  "library" : [
    "https://madie.cms.gov/Library/GlobalMalnutritionCompositeFHIR"
  ],
  "disclaimer" : "This measure and the specifications are subject to further revisions.  \n\nThis performance measure is not a clinical guideline, does not establish a standard of medical care, and has not been tested for all potential applications. \n\nTHE MEASURE AND SPECIFICATIONS ARE PROVIDED \"AS IS\" WITHOUT WARRANTY OF ANY KIND. \n \nDue to technical limitations, copyright is indicated by (C) or [C], registered trademarks are indicated by (R) or [R] and unregistered trademarks are indicated by (TM) or [TM].",
  "scoring" : {
    "coding" : [
      {
        "system" : "http://terminology.hl7.org/CodeSystem/measure-scoring",
        "code" : "continuous-variable",
        "display" : "Continuous Variable"
      }
    ]
  },
  "rationale" : "The components of this measure are supported by clinical guidance that recommends the following: (1) malnutrition screening for patients admitted into the acute inpatient care setting; (2) nutrition assessment for patients identified at risk for malnutrition or with a hospital dietitian referral order to form the basis for appropriate nutrition interventions; (3) appropriate recognition, diagnosis, and documentation of the nutrition status of a patient in order to (4) address their condition with an appropriate plan of care and communicate patient needs to other care providers (Academy of Nutrition and Dietetics, 2017).\n\nThe process for risk identification, assessment, diagnosis, and treatment of malnutrition necessitates a multi-disciplinary care team that begins with the identification of an initial risk population for a more thorough assessment by the RD/RDN. The RD/RDN, in turn, provides the necessary treatment recommendations to address nutritional status utilizing a nutrition diagnosis and care plan, along with the clinical indicators that inform a medical diagnosis of malnutrition completed by a physician or eligible provider as defined by CMS. The four measure observations individually will only provide a fraction of the necessary information on quality of care for patients at risk for or with malnutrition. For example, knowing which patients have been assessed out of those who were initially identified as at risk, but not knowing if the appropriate proportion of patients were screened upon admission, would be an insufficient assessment of quality of care.\n\nImplementation of this measure supports timely malnutrition risk screening and hand off to RDNs for appropriate nutrition assessment for identified patients during the current hospitalization. For patients identified with a moderate or severe malnutrition by the nutrition assessment, best practice also recommends a medical diagnosis by a physician or other eligible clinician and the execution of the nutrition care plan by an RD/RDN. Evidence demonstrates that implementing a standardized protocol for screening, assessment, diagnosis, and care planning results in better identification of malnourished patients and subsequent improvements in rates of associated nutrition interventions. Outcomes modeling, and those reported in other studies, also demonstrate the benefits to patient outcomes, including reduced risk of 30-day readmissions, length of hospital stays, and complications, as well as improved quality of life after hospitalization (Sriram, 2017).",
  "clinicalRecommendationStatement" : "American Society for Parenteral and Enteral Nutrition (ASPEN) clinical guidelines on nutrition screening, assessment, and intervention in adults indicate that screening for nutrition risk is suggested for hospitalized patients (Mueller, et al., 2011).\n\nThis guideline places nutrition assessment and screening in the context of intervention as part of nutrition care. Screening those individuals at risk for malnutrition is the first step in nutrition care as risk for malnutrition, identified by nutrition screening, is associated with longer length of hospital stay, complications, and mortality. Malnutrition screening is also a predictor of mortality risk. \n\nMalnourished patients, identified by nutrition assessment tools, have more complications and longer hospitalizations than do patients with optimal nutrition status. Such patients, identified by nutrition assessment tools, have more infectious and noninfectious complications, longer hospital length of stay, and greater mortality. \n\nNutrition intervention is recommended for patients identified by assessment as at risk for malnutrition or malnourished. Nutrition intervention with associated monitoring and evaluation plants in patients identified as at risk for malnutrition or malnourished improves clinical outcomes. Nutrition interventions and their associated monitoring and evaluation plans in malnourished patients are associated with improved nutrition status, nutrient intake, physical function, and quality of life. Hospital readmissions, inpatient length of stay, and complications were reduced with increased nutrition support interventions.",
  "guidance" : "This measure is constructed of four clinically eligible components that are aggregated as an arithmetic average of eligible hospitalizations and expressed as a percentage. The four populations used to calculate the four components may differ and the measure observations for the four components do not need to be performed sequentially. \n\nThis eCQM is an episode-based measure. An episode is defined as each inpatient hospitalization or encounter with a length of stay of greater than or equal to 24 hours among individuals 65 years of age and older at the start of the inpatient encounter. \n\nThis FHIR-based measure has been derived from the QDM-based measure: CMS986v4.\n\nPlease refer to the HL7 QI-Core Implementation Guide\n(https://hl7.org/fhir/us/qicore/STU4.1.1/) for more information on QI-Core and\nmapping recommendations from QDM to QI-Core\n4.1.1 (https://hl7.org/fhir/us/qicore/STU4.1.1/qdm-to-qicore.html).",
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        },
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      "description" : "Population Criteria 1 ",
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                "code" : "initial-population",
                "display" : "Initial Population"
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            "expression" : "Initial Population"
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            ]
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          "description" : "Measure",
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            "expression" : "Measure Population"
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        {
          "id" : "087da320-e1ff-48ff-9b16-3990ff169148",
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          "description" : "Screening",
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        },
        {
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          "valueCode" : "Encounter"
        },
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      "population" : [
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            ]
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        {
          "id" : "a816b04b-5147-476c-9136-819b5734be37",
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              "valueString" : "Count"
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              }
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          },
          "description" : "Assessment",
          "criteria" : {
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            "expression" : "Measure Observation 2"
          }
        }
      ]
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    {
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        },
        {
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        },
        {
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                "display" : "Initial Population"
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            ]
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        {
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                "display" : "Measure Population"
              }
            ]
          },
          "description" : "Measure",
          "criteria" : {
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            "expression" : "Measure Population"
          }
        },
        {
          "id" : "f936bb5d-3610-453b-abb1-d7358aca957a",
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          "description" : "Diagnosis",
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            {
              "url" : "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-criteriaReference",
              "valueString" : "aaabf807-f476-4158-96dc-d6f9e2e360c4"
            }
          ],
          "code" : {
            "coding" : [
              {
                "system" : "http://terminology.hl7.org/CodeSystem/measure-population",
                "code" : "measure-observation",
                "display" : "Measure Observation"
              }
            ]
          },
          "description" : "Care Plan",
          "criteria" : {
            "language" : "text/cql-identifier",
            "expression" : "Measure Observation 4"
          }
        }
      ]
    },
    {
      "id" : "6644d75da7a1805d3b7375b8",
      "extension" : [
        {
          "url" : "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-scoring",
          "valueCodeableConcept" : {
            "coding" : [
              {
                "system" : "http://terminology.hl7.org/CodeSystem/measure-scoring",
                "code" : "continuous-variable",
                "display" : "Continuous Variable"
              }
            ]
          }
        },
        {
          "url" : "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-populationBasis",
          "valueCode" : "Encounter"
        },
        {
          "url" : "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-type",
          "valueCodeableConcept" : {
            "coding" : [
              {
                "system" : "http://terminology.hl7.org/CodeSystem/measure-type",
                "code" : "outcome",
                "display" : "Outcome"
              }
            ]
          }
        }
      ],
      "population" : [
        {
          "id" : "d3214243-5af2-4430-84a1-861477bee9e3",
          "code" : {
            "coding" : [
              {
                "system" : "http://terminology.hl7.org/CodeSystem/measure-population",
                "code" : "initial-population",
                "display" : "Initial Population"
              }
            ]
          },
          "description" : "Initial",
          "criteria" : {
            "language" : "text/cql-identifier",
            "expression" : "Initial Population"
          }
        },
        {
          "id" : "7137d595-07cf-4680-a21e-b5380d5e6f20",
          "code" : {
            "coding" : [
              {
                "system" : "http://terminology.hl7.org/CodeSystem/measure-population",
                "code" : "measure-population",
                "display" : "Measure Population"
              }
            ]
          },
          "description" : "Measure",
          "criteria" : {
            "language" : "text/cql-identifier",
            "expression" : "Measure Population"
          }
        },
        {
          "id" : "b6dc0a60-e3dc-4ef4-8f58-8728a69cba3c",
          "extension" : [
            {
              "url" : "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-aggregateMethod",
              "valueString" : "Sum"
            },
            {
              "url" : "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-criteriaReference",
              "valueString" : "7137d595-07cf-4680-a21e-b5380d5e6f20"
            }
          ],
          "code" : {
            "coding" : [
              {
                "system" : "http://terminology.hl7.org/CodeSystem/measure-population",
                "code" : "measure-observation",
                "display" : "Measure Observation"
              }
            ]
          },
          "description" : "Total Score",
          "criteria" : {
            "language" : "text/cql-identifier",
            "expression" : "Measure Observation Total Malnutrition Components Score"
          }
        }
      ]
    },
    {
      "id" : "6644d75da7a1805d3b7375b9",
      "extension" : [
        {
          "url" : "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-scoring",
          "valueCodeableConcept" : {
            "coding" : [
              {
                "system" : "http://terminology.hl7.org/CodeSystem/measure-scoring",
                "code" : "continuous-variable",
                "display" : "Continuous Variable"
              }
            ]
          }
        },
        {
          "url" : "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-populationBasis",
          "valueCode" : "Encounter"
        },
        {
          "url" : "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-type",
          "valueCodeableConcept" : {
            "coding" : [
              {
                "system" : "http://terminology.hl7.org/CodeSystem/measure-type",
                "code" : "outcome",
                "display" : "Outcome"
              }
            ]
          }
        }
      ],
      "population" : [
        {
          "id" : "bd53026c-9027-4fdb-b5e6-d818dfb017f4",
          "code" : {
            "coding" : [
              {
                "system" : "http://terminology.hl7.org/CodeSystem/measure-population",
                "code" : "initial-population",
                "display" : "Initial Population"
              }
            ]
          },
          "description" : "Initial",
          "criteria" : {
            "language" : "text/cql-identifier",
            "expression" : "Initial Population"
          }
        },
        {
          "id" : "5be2bfc9-e31c-4253-bc4c-395baa4b101b",
          "code" : {
            "coding" : [
              {
                "system" : "http://terminology.hl7.org/CodeSystem/measure-population",
                "code" : "measure-population",
                "display" : "Measure Population"
              }
            ]
          },
          "description" : "Measure",
          "criteria" : {
            "language" : "text/cql-identifier",
            "expression" : "Measure Population"
          }
        },
        {
          "id" : "dd53fd31-7801-4b1f-ad36-8e688706d0eb",
          "extension" : [
            {
              "url" : "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-aggregateMethod",
              "valueString" : "Average"
            },
            {
              "url" : "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-criteriaReference",
              "valueString" : "5be2bfc9-e31c-4253-bc4c-395baa4b101b"
            }
          ],
          "code" : {
            "coding" : [
              {
                "system" : "http://terminology.hl7.org/CodeSystem/measure-population",
                "code" : "measure-observation",
                "display" : "Measure Observation"
              }
            ]
          },
          "description" : "GMCS Percentage",
          "criteria" : {
            "language" : "text/cql-identifier",
            "expression" : "Measure Observation Total Malnutrition Composite Score as Percentage"
          }
        }
      ]
    }
  ]
}

XIG built as of ??metadata-date??. Found ??metadata-resources?? resources in ??metadata-packages?? packages.