FHIR IG Statistics: Measure/CMS986FHIRMalnutritionScore

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Narrative

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

define "Initial Population":
  [Encounter: "Encounter Inpatient"] EncounterInpatient
    where EncounterInpatient.period ends during day of "Measurement Period"
      and AgeInYearsAt(date from start of EncounterInpatient.period) >= 18
      and ( duration in hours of EncounterInpatient.period >= 24 )
      and EncounterInpatient.status = 'finished'

define "Initial Population":
  [Encounter: "Encounter Inpatient"] EncounterInpatient
    where EncounterInpatient.period ends during day of "Measurement Period"
      and AgeInYearsAt(date from start of EncounterInpatient.period) >= 18
      and ( duration in hours of EncounterInpatient.period >= 24 )
      and EncounterInpatient.status = 'finished'

define "Measure Population":
  "Initial Population"

define "Measure Population":
  "Initial Population"

define "Measure Population Exclusion":
  "Encounter with Discharge for Hospice Care"
    union "Encounter with Hospice during Eligible Encounter"

define function "Measure Observation 1"(MalnutritionRiskScreening Encounter):
  if "Encounter with Malnutrition Risk Screening or with Dietitian Referral" contains MalnutritionRiskScreening then 1 
    else 0

define function "Measure Observation 1"(MalnutritionRiskScreening Encounter):
  if "Encounter with Malnutrition Risk Screening or with Dietitian Referral" contains MalnutritionRiskScreening then 1 
    else 0

define "Initial Population":
  [Encounter: "Encounter Inpatient"] EncounterInpatient
    where EncounterInpatient.period ends during day of "Measurement Period"
      and AgeInYearsAt(date from start of EncounterInpatient.period) >= 18
      and ( duration in hours of EncounterInpatient.period >= 24 )
      and EncounterInpatient.status = 'finished'

define "Initial Population":
  [Encounter: "Encounter Inpatient"] EncounterInpatient
    where EncounterInpatient.period ends during day of "Measurement Period"
      and AgeInYearsAt(date from start of EncounterInpatient.period) >= 18
      and ( duration in hours of EncounterInpatient.period >= 24 )
      and EncounterInpatient.status = 'finished'

define "Measure Population":
  "Initial Population"

define "Measure Population":
  "Initial Population"

define "Measure Population Exclusion":
  "Encounter with Discharge for Hospice Care"
    union "Encounter with Hospice during Eligible Encounter"

define function "Measure Observation 2"(NutritionAssessment Encounter):
  if "Encounter with Malnutrition Not At Risk Screening and without Dietitian Referral" contains NutritionAssessment then 0 
    else if "Encounter with Malnutrition Risk Screening At Risk or with Dietitian Referral" contains NutritionAssessment then if "Encounter With Most Recent Nutrition Assessment And Identified Status" contains NutritionAssessment then 1 
    else 0 
    else 0

define function "Measure Observation 2"(NutritionAssessment Encounter):
  if "Encounter with Malnutrition Not At Risk Screening and without Dietitian Referral" contains NutritionAssessment then 0 
    else if "Encounter with Malnutrition Risk Screening At Risk or with Dietitian Referral" contains NutritionAssessment then if "Encounter With Most Recent Nutrition Assessment And Identified Status" contains NutritionAssessment then 1 
    else 0 
    else 0

define "Initial Population":
  [Encounter: "Encounter Inpatient"] EncounterInpatient
    where EncounterInpatient.period ends during day of "Measurement Period"
      and AgeInYearsAt(date from start of EncounterInpatient.period) >= 18
      and ( duration in hours of EncounterInpatient.period >= 24 )
      and EncounterInpatient.status = 'finished'

define "Initial Population":
  [Encounter: "Encounter Inpatient"] EncounterInpatient
    where EncounterInpatient.period ends during day of "Measurement Period"
      and AgeInYearsAt(date from start of EncounterInpatient.period) >= 18
      and ( duration in hours of EncounterInpatient.period >= 24 )
      and EncounterInpatient.status = 'finished'

define "Measure Population":
  "Initial Population"

define "Measure Population":
  "Initial Population"

define "Measure Population Exclusion":
  "Encounter with Discharge for Hospice Care"
    union "Encounter with Hospice during Eligible Encounter"

define function "Measure Observation 3"(MalnutritionDiagnosis Encounter):
  if "Encounter with Malnutrition Not At Risk Screening and without Dietitian Referral" contains MalnutritionDiagnosis then 0 
    else if "Encounter with Malnutrition Risk Screening At Risk or with Dietitian Referral" contains MalnutritionDiagnosis then if "Encounter with Malnutrition Diagnosis" contains MalnutritionDiagnosis then if "Encounter With Most Recent Nutrition Assessment Status of Not or Mildly Malnourished" contains MalnutritionDiagnosis then 0 
    else if "Encounter With Most Recent Nutrition Assessment Status of Moderately Or Severely Malnourished" contains MalnutritionDiagnosis then 1 
    else 0 
    else 0 
    else 0

define function "Measure Observation 3"(MalnutritionDiagnosis Encounter):
  if "Encounter with Malnutrition Not At Risk Screening and without Dietitian Referral" contains MalnutritionDiagnosis then 0 
    else if "Encounter with Malnutrition Risk Screening At Risk or with Dietitian Referral" contains MalnutritionDiagnosis then if "Encounter with Malnutrition Diagnosis" contains MalnutritionDiagnosis then if "Encounter With Most Recent Nutrition Assessment Status of Not or Mildly Malnourished" contains MalnutritionDiagnosis then 0 
    else if "Encounter With Most Recent Nutrition Assessment Status of Moderately Or Severely Malnourished" contains MalnutritionDiagnosis then 1 
    else 0 
    else 0 
    else 0

define "Initial Population":
  [Encounter: "Encounter Inpatient"] EncounterInpatient
    where EncounterInpatient.period ends during day of "Measurement Period"
      and AgeInYearsAt(date from start of EncounterInpatient.period) >= 18
      and ( duration in hours of EncounterInpatient.period >= 24 )
      and EncounterInpatient.status = 'finished'

define "Initial Population":
  [Encounter: "Encounter Inpatient"] EncounterInpatient
    where EncounterInpatient.period ends during day of "Measurement Period"
      and AgeInYearsAt(date from start of EncounterInpatient.period) >= 18
      and ( duration in hours of EncounterInpatient.period >= 24 )
      and EncounterInpatient.status = 'finished'

define "Measure Population":
  "Initial Population"

define "Measure Population":
  "Initial Population"

define "Measure Population Exclusion":
  "Encounter with Discharge for Hospice Care"
    union "Encounter with Hospice during Eligible Encounter"

define function "Measure Observation 4"(NutritionCarePlan Encounter):
  if "Encounter with Malnutrition Not At Risk Screening and without Dietitian Referral" contains NutritionCarePlan then 0 
    else if "Encounter with Malnutrition Risk Screening At Risk or with Dietitian Referral" contains NutritionCarePlan then if "Encounter with Nutrition Care Plan" contains NutritionCarePlan then if "Encounter With Most Recent Nutrition Assessment Status of Not or Mildly Malnourished" contains NutritionCarePlan then 0 
    else if "Encounter With Most Recent Nutrition Assessment Status of Moderately Or Severely Malnourished" contains NutritionCarePlan then 1 
    else 0 
    else 0 
    else 0

define function "Measure Observation 4"(NutritionCarePlan Encounter):
  if "Encounter with Malnutrition Not At Risk Screening and without Dietitian Referral" contains NutritionCarePlan then 0 
    else if "Encounter with Malnutrition Risk Screening At Risk or with Dietitian Referral" contains NutritionCarePlan then if "Encounter with Nutrition Care Plan" contains NutritionCarePlan then if "Encounter With Most Recent Nutrition Assessment Status of Not or Mildly Malnourished" contains NutritionCarePlan then 0 
    else if "Encounter With Most Recent Nutrition Assessment Status of Moderately Or Severely Malnourished" contains NutritionCarePlan then 1 
    else 0 
    else 0 
    else 0

define "Initial Population":
  [Encounter: "Encounter Inpatient"] EncounterInpatient
    where EncounterInpatient.period ends during day of "Measurement Period"
      and AgeInYearsAt(date from start of EncounterInpatient.period) >= 18
      and ( duration in hours of EncounterInpatient.period >= 24 )
      and EncounterInpatient.status = 'finished'

define "Initial Population":
  [Encounter: "Encounter Inpatient"] EncounterInpatient
    where EncounterInpatient.period ends during day of "Measurement Period"
      and AgeInYearsAt(date from start of EncounterInpatient.period) >= 18
      and ( duration in hours of EncounterInpatient.period >= 24 )
      and EncounterInpatient.status = 'finished'

define "Measure Population":
  "Initial Population"

define "Measure Population":
  "Initial Population"

define "Measure Population Exclusion":
  "Encounter with Discharge for Hospice Care"
    union "Encounter with Hospice during Eligible Encounter"

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) })

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) })

define "Initial Population":
  [Encounter: "Encounter Inpatient"] EncounterInpatient
    where EncounterInpatient.period ends during day of "Measurement Period"
      and AgeInYearsAt(date from start of EncounterInpatient.period) >= 18
      and ( duration in hours of EncounterInpatient.period >= 24 )
      and EncounterInpatient.status = 'finished'

define "Initial Population":
  [Encounter: "Encounter Inpatient"] EncounterInpatient
    where EncounterInpatient.period ends during day of "Measurement Period"
      and AgeInYearsAt(date from start of EncounterInpatient.period) >= 18
      and ( duration in hours of EncounterInpatient.period >= 24 )
      and EncounterInpatient.status = 'finished'

define "Measure Population":
  "Initial Population"

define "Measure Population":
  "Initial Population"

define "Measure Population Exclusion":
  "Encounter with Discharge for Hospice Care"
    union "Encounter with Hospice during Eligible Encounter"

define function "Measure Observation Total Malnutrition Care Score as Percentage"(QualifyingEncounter Encounter):
  100 * ( "Measure Observation Total Malnutrition Components Score"(QualifyingEncounter) / "Total Malnutrition Care Score Eligible Occurrences"(QualifyingEncounter) )

define "SDE Race":
  Patient.race R
    return Tuple {
      codes: R.ombCategory union R.detailed,
      display: R.text
    }

define "SDE Sex":
  case
    when Patient.sex = '248153007' then "Male (finding)"
    when Patient.sex = '248152002' then "Female (finding)"
    else null
  end

define "SDE Payer":
  [Coverage: type in "Payer Type"] Payer
    return {
      code: Payer.type,
      period: Payer.period
    }

define "SDE Ethnicity":
  Patient.ethnicity E
    return Tuple {
      codes: { E.ombCategory } union E.detailed,
      display: E.text
    }

/*
@description: Hospitalization with Observation returns the total interval from the start of any immediately prior emergency department visit through the observation visit to the discharge of the given encounter
*/
define fluent function hospitalizationWithObservation(TheEncounter Encounter ):
  TheEncounter Visit
  		let ObsVisit: Last([Encounter: "Observation Services"] LastObs
  				where LastObs.status = 'finished'
            and LastObs.period ends 1 hour or less on or before start of Visit.period
  				sort by end of period
  			),
  			VisitStart: Coalesce(start of ObsVisit.period, start of Visit.period),
  			EDVisit: Last([Encounter: "Emergency Department Visit"] LastED
  				where LastED.status = 'finished'
            and LastED.period ends 1 hour or less on or before VisitStart
  				sort by end of period
  			)
  		return Interval[Coalesce(start of EDVisit.period, VisitStart), end of Visit.period]

/*
@description: Converts the given [Period](https://hl7.org/fhir/datatypes.html#Period)
value to a CQL DateTime Interval
@comment: If the start value of the given period is unspecified, the starting
boundary of the resulting interval will be open (meaning the start of the interval
is unknown, as opposed to interpreted as the beginning of time).
*/
define function ToInterval(period FHIR.Period):
    if period is null then
        null
    else
        if period."start" is null then
            Interval(period."start".value, period."end".value]
        else
            Interval[period."start".value, period."end".value]

define function ToString(value uri): value.value

/*
@description: Converts the given FHIR [Coding](https://hl7.org/fhir/datatypes.html#Coding) value to a CQL Code.
*/
define function ToCode(coding FHIR.Coding):
    if coding is null then
        null
    else
        System.Code {
          code: coding.code.value,
          system: coding.system.value,
          version: coding.version.value,
          display: coding.display.value
        }

/*
@description: Converts the given FHIR [CodeableConcept](https://hl7.org/fhir/datatypes.html#CodeableConcept) value to a CQL Concept.
*/
define function ToConcept(concept FHIR.CodeableConcept):
    if concept is null then
        null
    else
        System.Concept {
            codes: concept.coding C return ToCode(C),
            display: concept.text.value
        }

/*
@description: Normalizes a value that is a choice of timing-valued types to an equivalent interval
@comment: Normalizes a choice type of DateTime, Quanitty, Interval<DateTime>, or Interval<Quantity> types
to an equivalent interval. This selection of choice types is a superset of the majority of choice types that are used as possible
representations for timing-valued elements in QICore, allowing this function to be used across any resource.
The input can be provided as a DateTime, Quantity, Interval<DateTime> or Interval<Quantity>.
The intent of this function is to provide a clear and concise mechanism to treat single
elements that have multiple possible representations as intervals so that logic doesn't have to account
for the variability. More complex calculations (such as medication request period or dispense period
calculation) need specific guidance and consideration. That guidance may make use of this function, but
the focus of this function is on single element calculations where the semantics are unambiguous.
If the input is a DateTime, the result a DateTime Interval beginning and ending on that DateTime.
If the input is a Quantity, the quantity is expected to be a calendar-duration interpreted as an Age,
and the result is a DateTime Interval beginning on the Date the patient turned that age and ending immediately before one year later.
If the input is a DateTime Interval, the result is the input.
If the input is a Quantity Interval, the quantities are expected to be calendar-durations interpreted as an Age, and the result
is a DateTime Interval beginning on the date the patient turned the age given as the start of the quantity interval, and ending
immediately before one year later than the date the patient turned the age given as the end of the quantity interval.
If the input is a Timing, an error will be thrown indicating that Timing calculations are not implemented. Any other input will reslt in a null DateTime Interval
*/
define fluent function toInterval(choice Choice<DateTime, Quantity, Interval<DateTime>, Interval<Quantity>, Timing>):
  case
	  when choice is DateTime then
    	Interval[choice as DateTime, choice as DateTime]
		when choice is Interval<DateTime> then
  		choice as Interval<DateTime>
		when choice is Quantity then
		  Interval[Patient.birthDate + (choice as Quantity),
			  Patient.birthDate + (choice as Quantity) + 1 year)
		when choice is Interval<Quantity> then
		  Interval[Patient.birthDate + (choice.low as Quantity),
			  Patient.birthDate + (choice.high as Quantity) + 1 year)
		when choice is Timing then
      Message(null, true, 'NOT_IMPLEMENTED', 'Error', 'Calculation of an interval from a Timing value is not supported') as Interval<DateTime>
		else
			null as Interval<DateTime>
	end

/*
@description: Given an interval, returns the ending point if the interval has an ending boundary specified,
otherwise, returns the starting point
*/
define fluent function latest(choice Choice<DateTime, Quantity, Interval<DateTime>, Interval<Quantity>> ):
  (choice.toInterval()) period
    return
      if (period."hasEnd"()) then end of period
      else start of period

/*
@description: Given an interval, returns true if the interval has an ending boundary specified
(i.e. the end of the interval is not null and not the maximum DateTime value)
*/
define fluent function hasEnd(period Interval<DateTime> ):
  not (
    end of period is null
      or end of period = maximum DateTime
  )

/*
@description: Returns an interval representing the normalized prevalence period of a given Condition.
@comment: Uses the ToInterval and ToAbatementInterval functions to determine the widest potential interval from
onset to abatement as specified in the given Condition. If the condition is active, or has an abatement date the resulting 
interval will have a closed ending boundary. Otherwise, the resulting interval will have an open ending boundary.
*/
define fluent function prevalenceInterval(condition Choice<"ConditionEncounterDiagnosis", "ConditionProblemsHealthConcerns">):
if condition.clinicalStatus ~ "active"
  or condition.clinicalStatus ~ "recurrence"
  or condition.clinicalStatus ~ "relapse" then
  Interval[start of condition.onset.toInterval(), end of condition.abatementInterval()]
else
    (end of condition.abatementInterval()) abatementDate
    return if abatementDate is null then
      Interval[start of condition.onset.toInterval(), abatementDate)
    else
      Interval[start of condition.onset.toInterval(), abatementDate]

/*
@description: Returns an interval representing the normalized abatement of a given Condition.
@comment: If the abatement element of the Condition is represented as a DateTime, the result
is an interval beginning and ending on that DateTime.
If the abatement is represented as a Quantity, the quantity is expected to be a calendar-duration and is interpreted as the age of the patient. The
result is an interval from the date the patient turned that age to immediately before one year later.
If the abatement is represented as a Quantity Interval, the quantities are expected to be calendar-durations and are interpreted as an age range during
which the abatement occurred. The result is an interval from the date the patient turned the starting age of the quantity interval, and ending immediately
before one year later than the date the patient turned the ending age of the quantity interval.
*/
define fluent function abatementInterval(condition Choice<"ConditionEncounterDiagnosis", "ConditionProblemsHealthConcerns">):
	if condition.abatement is DateTime then
	  Interval[condition.abatement as DateTime, condition.abatement as DateTime]
	else if condition.abatement is Quantity then
		Interval[Patient.birthDate + (condition.abatement as Quantity),
			Patient.birthDate + (condition.abatement as Quantity) + 1 year)
	else if condition.abatement is Interval<Quantity> then
	  Interval[Patient.birthDate + (condition.abatement.low as Quantity),
		  Patient.birthDate + (condition.abatement.high as Quantity) + 1 year)
	else if condition.abatement is Interval<DateTime> then
	  Interval[condition.abatement.low, condition.abatement.high)
	else null as Interval<DateTime>

/*
@description: Returns true if any of the given references are to the given resource
@comment: Returns true if the `id` element of the given resource exactly equals the tail of any of the given references.
NOTE: This function assumes resources from the same source server.
*/
define fluent function references(references List<Reference>, resource Resource):
  exists (references R where R.references(resource))

/*
@description: Returns true if the given reference is to the given resource
@comment: Returns true if the `id` element of the given resource exactly equals the tail of the given reference.
NOTE: This function assumes resources from the same source server.
*/
define fluent function references(reference Reference, resource Resource):
  resource.id = Last(Split(reference.reference, '/'))

/*
@description: Given an interval, return the starting point if the interval has a starting boundary specified,
otherwise, return the ending point
*/
define fluent function earliest(choice Choice<DateTime, Quantity, Interval<DateTime>, Interval<Quantity>> ):
  (choice.toInterval()) period
    return
      if (period."hasStart"()) then start of period
      else end of period

/*
@description: Given an interval, return true if the interval has a starting boundary specified
(i.e. the start of the interval is not null and not the minimum DateTime value)
*/
define fluent function hasStart(period Interval<DateTime> ):
  not ( start of period is null
      or start of period = minimum DateTime
  )

define "Initial Population":
  [Encounter: "Encounter Inpatient"] EncounterInpatient
    where EncounterInpatient.period ends during day of "Measurement Period"
      and AgeInYearsAt(date from start of EncounterInpatient.period) >= 18
      and ( duration in hours of EncounterInpatient.period >= 24 )
      and EncounterInpatient.status = 'finished'

define "Measure Population":
  "Initial Population"

define "Encounter with Discharge for Hospice Care":
  "Measure Population" QualifyingEncounter
    where QualifyingEncounter.hospitalization.dischargeDisposition in "Hospice Care Referral or Admission"

define "Intervention Hospice Care":
  ( ["ServiceRequest": code in "Hospice Status"] HospiceStatusOrder
      where HospiceStatusOrder.status in { 'active', 'completed', 'on-hold' }
        and HospiceStatusOrder.intent in { 'order', 'original-order', 'reflex-order', 'filler-order', 'instance-order' }
        and HospiceStatusOrder.doNotPerform is not true
  )
    union ( ["Procedure": "Hospice Status"] HospiceStatusPerformed
        where HospiceStatusPerformed.status in { 'completed', 'in-progress' }
    )

define "Encounter with Hospice during Eligible Encounter":
  "Measure Population" QualifyingEncounter
    with "Intervention Hospice Care" HospiceStatus
      such that Coalesce(start of HospiceStatus.performed.toInterval(), HospiceStatus.authoredOn) during day of QualifyingEncounter.hospitalizationWithObservation ( )

define "Measure Population Exclusion":
  "Encounter with Discharge for Hospice Care"
    union "Encounter with Hospice during Eligible Encounter"

define "SDE Race":
  SDE."SDE Race"

define "SDE Sex":
  SDE."SDE Sex"

define "Encounter with Malnutrition Risk Screening":
  "Measure Population" QualifyingEncounter
    with ["ObservationScreeningAssessment": "Malnutrition Risk Screening"] MalnutritionRiskScreening
      such that ( MalnutritionRiskScreening.status in { 'final', 'amended', 'corrected' }
          and MalnutritionRiskScreening.effective.toInterval ( ) during QualifyingEncounter.hospitalizationWithObservation ( )
          and ( MalnutritionRiskScreening.value as Concept in "Malnutrition Screening Finding of Not At Risk Result"
              or MalnutritionRiskScreening.value as Concept in "Malnutrition Screening Finding of At Risk Result"
          )
      )
    return QualifyingEncounter

define "Intervention Dietitian Referral":
  ( ["ServiceRequest": code in "Dietitian Referral"] DietitianReferralOrder
      where DietitianReferralOrder.status in { 'active', 'completed', 'on-hold' }
        and DietitianReferralOrder.intent in { 'order', 'original-order', 'reflex-order', 'filler-order', 'instance-order' }
        and DietitianReferralOrder.doNotPerform is not true
  )
    union ( ["Procedure": "Dietitian Referral"] DietitianReferralPerformed
        where DietitianReferralPerformed.status in { 'completed', 'in-progress' }
    )

define "Encounter with Dietitian Referral":
  "Measure Population" QualifyingEncounter
    with "Intervention Dietitian Referral" DietitianReferral
      such that Coalesce(start of DietitianReferral.performed.toInterval(), DietitianReferral.authoredOn) during day of QualifyingEncounter.hospitalizationWithObservation ( )

define "Encounter with Malnutrition Risk Screening or with Dietitian Referral":
  "Measure Population" QualifyingEncounter
    where ( "Encounter with Malnutrition Risk Screening" contains QualifyingEncounter
        or "Encounter with Dietitian Referral" contains QualifyingEncounter
    )
    return QualifyingEncounter

define "Encounter with Malnutrition Risk Screening Not At Risk":
  "Measure Population" QualifyingEncounter
    with ["ObservationScreeningAssessment": "Malnutrition Risk Screening"] MalnutritionRiskScreening
      such that MalnutritionRiskScreening.status in { 'final', 'amended', 'corrected' }
        and MalnutritionRiskScreening.effective.toInterval ( ) during QualifyingEncounter.hospitalizationWithObservation ( )
        and ( MalnutritionRiskScreening.value as Concept in "Malnutrition Screening Finding of Not At Risk Result" )
    return QualifyingEncounter

define "Encounter with Malnutrition Not At Risk Screening and without Dietitian Referral":
  "Measure Population" QualifyingEncounter
    where "Encounter with Malnutrition Risk Screening Not At Risk" contains QualifyingEncounter
      and not exists ( "Encounter with Dietitian Referral" )
    return QualifyingEncounter

define "Encounter with Malnutrition Risk Screening At Risk":
  "Measure Population" QualifyingEncounter
    with ["ObservationScreeningAssessment": "Malnutrition Risk Screening"] MalnutritionRiskScreening
      such that MalnutritionRiskScreening.status in { 'final', 'amended', 'corrected' }
        and MalnutritionRiskScreening.effective.toInterval ( ) during QualifyingEncounter.hospitalizationWithObservation ( )
        and ( MalnutritionRiskScreening.value as Concept in "Malnutrition Screening Finding of At Risk Result" )
    return QualifyingEncounter

define "Encounter with Malnutrition Risk Screening At Risk or with Dietitian Referral":
  "Measure Population" QualifyingEncounter
    where "Encounter with Malnutrition Risk Screening At Risk" contains QualifyingEncounter
      or "Encounter with Dietitian Referral" contains QualifyingEncounter
    return QualifyingEncounter

define "Nutrition Assessment Performed":
  from
    "Measure Population" QualifyingEncounter,
    ["ObservationScreeningAssessment": "Nutrition Assessment"] NutritionAssessment
    let NAssessLatest: NutritionAssessment.effective.latest ( )
    where "Nutrition Assessment" contains NutritionAssessment.code as Concept
      and NutritionAssessment.status in { 'final', 'amended', 'corrected' }
      and NutritionAssessment.effective.toInterval ( ) during QualifyingEncounter.hospitalizationWithObservation ( )
      and NutritionAssessment.value is not null
    return Tuple {
      HospEncId: QualifyingEncounter.id,
      HospitalizationPeriod: QualifyingEncounter.hospitalizationWithObservation ( ),
      NutrAssessCode: NutritionAssessment.code as Concept,
      NutrAssessId: NutritionAssessment.id,
      NutrAssessResult: NutritionAssessment.value,
      NutrAssessTimingEff: NutritionAssessment.effective,
      NutrAssessTimingInt: NutritionAssessment.effective.toInterval ( ),
      NutrAssessTimingLatest: NAssessLatest
    }
    sort by NutrAssessTimingLatest asc

define "Encounter With Most Recent Nutrition Assessment And Identified Status":
  "Measure Population" QualifyingEncounter
    with ["ObservationScreeningAssessment": "Nutrition Assessment"] NutritionAssessment
      such that ( NutritionAssessment.status in { 'final', 'amended', 'corrected' }
          and NutritionAssessment.effective.toInterval ( ) during QualifyingEncounter.hospitalizationWithObservation ( )
          and ( NutritionAssessment.value as Concept in "Nutrition Assessment Status Finding of Well Nourished or Not Malnourished or Mildly Malnourished"
              or ( NutritionAssessment.value as Concept in "Nutrition Assessment Status Finding of Moderately Malnourished" )
              or ( NutritionAssessment.value as Concept in "Nutrition Assessment Status Finding of Severely Malnourished" )
          )
          and ( exists ( "Encounter with Malnutrition Risk Screening At Risk" )
              or exists ( "Encounter with Dietitian Referral" )
          )
          and NutritionAssessment.effective.latest ( ) same day as "Last Nutrition Assessment Day During Encounter"(QualifyingEncounter)
      )
    return QualifyingEncounter

define "Has Malnutrition Diagnosis":
  [ConditionProblemsHealthConcerns: "Malnutrition Diagnosis"] MalnutritionDiagnosis
    where MalnutritionDiagnosis.prevalenceInterval ( ) overlaps "Measurement Period"

define "Encounter With Encounter Diagnosis Of Malnutrition Diagnosis":
  "Measure Population" QualifyingEncounter
    where QualifyingEncounter.reasonCode in "Malnutrition Diagnosis"
      or exists ( [ConditionEncounterDiagnosis: "Malnutrition Diagnosis"] EncounterDiagnosis
          where QualifyingEncounter.reasonReference.references ( EncounterDiagnosis )
      )

define "Encounter with Malnutrition Diagnosis":
  "Measure Population" QualifyingEncounter
    where exists ( "Has Malnutrition Diagnosis" MalnutritionDiagnosis
        where MalnutritionDiagnosis.prevalenceInterval ( ) overlaps day of QualifyingEncounter.hospitalizationWithObservation ( )
    )
      or exists "Encounter With Encounter Diagnosis Of Malnutrition Diagnosis"

define "Encounter With Most Recent Nutrition Assessment Status of Not or Mildly Malnourished":
  "Measure Population" QualifyingEncounter
    with ["ObservationScreeningAssessment": "Nutrition Assessment"] NutritionAssessment
      such that ( NutritionAssessment.status in { 'final', 'amended', 'corrected' }
          and NutritionAssessment.effective.toInterval ( ) during QualifyingEncounter.hospitalizationWithObservation ( )
          and ( NutritionAssessment.value as Concept in "Nutrition Assessment Status Finding of Well Nourished or Not Malnourished or Mildly Malnourished" )
          and NutritionAssessment.effective.latest ( ) same day as "Last Nutrition Assessment Day During Encounter"(QualifyingEncounter)
      )
    return QualifyingEncounter

define "Encounter With Most Recent Nutrition Assessment Status of Moderately Or Severely Malnourished":
  "Measure Population" QualifyingEncounter
    with ["ObservationScreeningAssessment": "Nutrition Assessment"] NutritionAssessment
      such that NutritionAssessment.status in { 'final', 'amended', 'corrected' }
        and NutritionAssessment.effective.toInterval ( ) during QualifyingEncounter.hospitalizationWithObservation ( )
        and ( NutritionAssessment.value as Concept in "Nutrition Assessment Status Finding of Moderately Malnourished"
            or NutritionAssessment.value as Concept in "Nutrition Assessment Status Finding of Severely Malnourished"
        )
        and NutritionAssessment.effective.latest ( ) same day as "Last Nutrition Assessment Day During Encounter"(QualifyingEncounter)
    return QualifyingEncounter

define "Encounter with Nutrition Care Plan":
  "Measure Population" QualifyingEncounter
    with ["Procedure": "Nutrition Care Plan"] NutritionCarePlan
      such that NutritionCarePlan.status in { 'completed', 'in-progress' }
        and NutritionCarePlan.performed.earliest ( ) during QualifyingEncounter.hospitalizationWithObservation ( )
    return QualifyingEncounter

define "SDE Payer Type":
  SDE."SDE Payer"

define "Initial Population":
  [Encounter: "Encounter Inpatient"] EncounterInpatient
    where EncounterInpatient.period ends during day of "Measurement Period"
      and AgeInYearsAt(date from start of EncounterInpatient.period) >= 18
      and ( duration in hours of EncounterInpatient.period >= 24 )
      and EncounterInpatient.status = 'finished'

define "SDE Ethnicity":
  SDE."SDE Ethnicity"

define "Measure Population":
  "Initial Population"

define function "Measure Observation 1"(MalnutritionRiskScreening Encounter):
  if "Encounter with Malnutrition Risk Screening or with Dietitian Referral" contains MalnutritionRiskScreening then 1 
    else 0

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) })

define function "Measure Observation 1"(MalnutritionRiskScreening Encounter):
  if "Encounter with Malnutrition Risk Screening or with Dietitian Referral" contains MalnutritionRiskScreening then 1 
    else 0

define function "Measure Observation 2"(NutritionAssessment Encounter):
  if "Encounter with Malnutrition Not At Risk Screening and without Dietitian Referral" contains NutritionAssessment then 0 
    else if "Encounter with Malnutrition Risk Screening At Risk or with Dietitian Referral" contains NutritionAssessment then if "Encounter With Most Recent Nutrition Assessment And Identified Status" contains NutritionAssessment then 1 
    else 0 
    else 0

define function "Last Nutrition Assessment Day During Encounter"(QualifyingEncounter Encounter):
  Last("Nutrition Assessment Performed" NutritionAssessmentTuple
      where NutritionAssessmentTuple.HospEncId = QualifyingEncounter.id
      return NutritionAssessmentTuple.NutrAssessTimingLatest
      sort asc
  )

define function "Measure Observation 3"(MalnutritionDiagnosis Encounter):
  if "Encounter with Malnutrition Not At Risk Screening and without Dietitian Referral" contains MalnutritionDiagnosis then 0 
    else if "Encounter with Malnutrition Risk Screening At Risk or with Dietitian Referral" contains MalnutritionDiagnosis then if "Encounter with Malnutrition Diagnosis" contains MalnutritionDiagnosis then if "Encounter With Most Recent Nutrition Assessment Status of Not or Mildly Malnourished" contains MalnutritionDiagnosis then 0 
    else if "Encounter With Most Recent Nutrition Assessment Status of Moderately Or Severely Malnourished" contains MalnutritionDiagnosis then 1 
    else 0 
    else 0 
    else 0

define function "Measure Observation 4"(NutritionCarePlan Encounter):
  if "Encounter with Malnutrition Not At Risk Screening and without Dietitian Referral" contains NutritionCarePlan then 0 
    else if "Encounter with Malnutrition Risk Screening At Risk or with Dietitian Referral" contains NutritionCarePlan then if "Encounter with Nutrition Care Plan" contains NutritionCarePlan then if "Encounter With Most Recent Nutrition Assessment Status of Not or Mildly Malnourished" contains NutritionCarePlan then 0 
    else if "Encounter With Most Recent Nutrition Assessment Status of Moderately Or Severely Malnourished" contains NutritionCarePlan then 1 
    else 0 
    else 0 
    else 0

define function "Measure Observation 3"(MalnutritionDiagnosis Encounter):
  if "Encounter with Malnutrition Not At Risk Screening and without Dietitian Referral" contains MalnutritionDiagnosis then 0 
    else if "Encounter with Malnutrition Risk Screening At Risk or with Dietitian Referral" contains MalnutritionDiagnosis then if "Encounter with Malnutrition Diagnosis" contains MalnutritionDiagnosis then if "Encounter With Most Recent Nutrition Assessment Status of Not or Mildly Malnourished" contains MalnutritionDiagnosis then 0 
    else if "Encounter With Most Recent Nutrition Assessment Status of Moderately Or Severely Malnourished" contains MalnutritionDiagnosis then 1 
    else 0 
    else 0 
    else 0

define function "Measure Observation 2"(NutritionAssessment Encounter):
  if "Encounter with Malnutrition Not At Risk Screening and without Dietitian Referral" contains NutritionAssessment then 0 
    else if "Encounter with Malnutrition Risk Screening At Risk or with Dietitian Referral" contains NutritionAssessment then if "Encounter With Most Recent Nutrition Assessment And Identified Status" contains NutritionAssessment then 1 
    else 0 
    else 0

define function "Measure Observation 4"(NutritionCarePlan Encounter):
  if "Encounter with Malnutrition Not At Risk Screening and without Dietitian Referral" contains NutritionCarePlan then 0 
    else if "Encounter with Malnutrition Risk Screening At Risk or with Dietitian Referral" contains NutritionCarePlan then if "Encounter with Nutrition Care Plan" contains NutritionCarePlan then if "Encounter With Most Recent Nutrition Assessment Status of Not or Mildly Malnourished" contains NutritionCarePlan then 0 
    else if "Encounter With Most Recent Nutrition Assessment Status of Moderately Or Severely Malnourished" contains NutritionCarePlan then 1 
    else 0 
    else 0 
    else 0

define function "Measure Observation Total Malnutrition Care Score as Percentage"(QualifyingEncounter Encounter):
  100 * ( "Measure Observation Total Malnutrition Components Score"(QualifyingEncounter) / "Total Malnutrition Care Score Eligible Occurrences"(QualifyingEncounter) )

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) })

define function "Total Malnutrition Care Score Eligible Occurrences"(QualifyingEncounter Encounter):
  if ( ( "Encounter with Malnutrition Risk Screening or with Dietitian Referral" contains QualifyingEncounter )
      and ( "Encounter with Malnutrition Risk Screening Not At Risk" contains QualifyingEncounter )
  )
    and not ( "Encounter with Dietitian Referral" contains QualifyingEncounter ) then 1 
    else if ( ( ( "Encounter with Malnutrition Risk Screening or with Dietitian Referral" contains QualifyingEncounter )
        and ( "Encounter with Malnutrition Risk Screening At Risk" contains QualifyingEncounter )
    )
      or ( "Encounter with Dietitian Referral" contains QualifyingEncounter )
  )
    and ( "Encounter With Most Recent Nutrition Assessment Status of Not or Mildly Malnourished" contains QualifyingEncounter )
    or not ( "Encounter With Most Recent Nutrition Assessment And Identified Status" contains QualifyingEncounter ) then 2 
    else 4

Source

{
  "resourceType": "Measure",
  "id": "CMS986FHIRMalnutritionScore",
  "meta": {
    "profile": [
      "http://hl7.org/fhir/uv/crmi/StructureDefinition/crmi-shareablemeasure",
      "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/computable-measure-cqfm",
      "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/publishable-measure-cqfm",
      "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/executable-measure-cqfm",
      "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cql-measure-cqfm",
      "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/elm-measure-cqfm",
      "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cv-measure-cqfm"
    ]
  },
  "text": {
    "status": "extensions",
    "div": "<!-- snip (see above) -->"
  },
  "contained": [
    {
      "resourceType": "Library",
      "id": "effective-data-requirements",
      "extension": [
        {
          "url": "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-directReferenceCode",
          "valueCoding": {
            "system": "http://snomed.info/sct",
            "code": "248153007",
            "display": "Male (finding)"
          }
        },
        {
          "url": "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-directReferenceCode",
          "valueCoding": {
            "system": "http://snomed.info/sct",
            "code": "248152002",
            "display": "Female (finding)"
          }
        },
        {
          "url": "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-directReferenceCode",
          "valueCoding": {
            "system": "http://terminology.hl7.org/CodeSystem/condition-clinical",
            "code": "active",
            "display": "Active"
          }
        },
        {
          "url": "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-directReferenceCode",
          "valueCoding": {
            "system": "http://terminology.hl7.org/CodeSystem/condition-clinical",
            "code": "recurrence",
            "display": "Recurrence"
          }
        },
        {
          "url": "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-directReferenceCode",
          "valueCoding": {
            "system": "http://terminology.hl7.org/CodeSystem/condition-clinical",
            "code": "relapse",
            "display": "Relapse"
          }
        },
        {
          "extension": [
            {
              "url": "libraryName",
              "valueString": "CMS986FHIRMalnutritionScore"
            },
            {
              "url": "name",
              "valueString": "Initial Population"
            },
            {
              "url": "statement",
              "valueString": "define \"Initial Population\":\n  [Encounter: \"Encounter Inpatient\"] EncounterInpatient\n    where EncounterInpatient.period ends during day of \"Measurement Period\"\n      and AgeInYearsAt(date from start of EncounterInpatient.period) >= 18\n      and ( duration in hours of EncounterInpatient.period >= 24 )\n      and EncounterInpatient.status = 'finished'"
            },
            {
              "url": "displaySequence",
              "valueInteger": 0
            }
          ],
          "url": "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition"
        },
        {
          "extension": [
            {
              "url": "libraryName",
              "valueString": "CMS986FHIRMalnutritionScore"
            },
            {
              "url": "name",
              "valueString": "Measure Population"
            },
            {
              "url": "statement",
              "valueString": "define \"Measure Population\":\n  \"Initial Population\""
            },
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          ],
          "url": "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition"
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        {
          "extension": [
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              "url": "libraryName",
              "valueString": "CMS986FHIRMalnutritionScore"
            },
            {
              "url": "name",
              "valueString": "Encounter with Discharge for Hospice Care"
            },
            {
              "url": "statement",
              "valueString": "define \"Encounter with Discharge for Hospice Care\":\n  \"Measure Population\" QualifyingEncounter\n    where QualifyingEncounter.hospitalization.dischargeDisposition in \"Hospice Care Referral or Admission\""
            },
            {
              "url": "displaySequence",
              "valueInteger": 2
            }
          ],
          "url": "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition"
        },
        {
          "extension": [
            {
              "url": "libraryName",
              "valueString": "CMS986FHIRMalnutritionScore"
            },
            {
              "url": "name",
              "valueString": "Intervention Hospice Care"
            },
            {
              "url": "statement",
              "valueString": "define \"Intervention Hospice Care\":\n  ( [\"ServiceRequest\": code in \"Hospice Status\"] HospiceStatusOrder\n      where HospiceStatusOrder.status in { 'active', 'completed', 'on-hold' }\n        and HospiceStatusOrder.intent in { 'order', 'original-order', 'reflex-order', 'filler-order', 'instance-order' }\n        and HospiceStatusOrder.doNotPerform is not true\n  )\n    union ( [\"Procedure\": \"Hospice Status\"] HospiceStatusPerformed\n        where HospiceStatusPerformed.status in { 'completed', 'in-progress' }\n    )"
            },
            {
              "url": "displaySequence",
              "valueInteger": 3
            }
          ],
          "url": "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition"
        },
        {
          "extension": [
            {
              "url": "libraryName",
              "valueString": "CMS986FHIRMalnutritionScore"
            },
            {
              "url": "name",
              "valueString": "Encounter with Hospice during Eligible Encounter"
            },
            {
              "url": "statement",
              "valueString": "define \"Encounter with Hospice during Eligible Encounter\":\n  \"Measure Population\" QualifyingEncounter\n    with \"Intervention Hospice Care\" HospiceStatus\n      such that Coalesce(start of HospiceStatus.performed.toInterval(), HospiceStatus.authoredOn) during day of QualifyingEncounter.hospitalizationWithObservation ( )"
            },
            {
              "url": "displaySequence",
              "valueInteger": 4
            }
          ],
          "url": "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition"
        },
        {
          "extension": [
            {
              "url": "libraryName",
              "valueString": "CMS986FHIRMalnutritionScore"
            },
            {
              "url": "name",
              "valueString": "Measure Population Exclusion"
            },
            {
              "url": "statement",
              "valueString": "define \"Measure Population Exclusion\":\n  \"Encounter with Discharge for Hospice Care\"\n    union \"Encounter with Hospice during Eligible Encounter\""
            },
            {
              "url": "displaySequence",
              "valueInteger": 5
            }
          ],
          "url": "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition"
        },
        {
          "extension": [
            {
              "url": "libraryName",
              "valueString": "SupplementalDataElements"
            },
            {
              "url": "name",
              "valueString": "SDE Race"
            },
            {
              "url": "statement",
              "valueString": "define \"SDE Race\":\n  Patient.race R\n    return Tuple {\n      codes: R.ombCategory union R.detailed,\n      display: R.text\n    }"
            },
            {
              "url": "displaySequence",
              "valueInteger": 6
            }
          ],
          "url": "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition"
        },
        {
          "extension": [
            {
              "url": "libraryName",
              "valueString": "CMS986FHIRMalnutritionScore"
            },
            {
              "url": "name",
              "valueString": "SDE Race"
            },
            {
              "url": "statement",
              "valueString": "define \"SDE Race\":\n  SDE.\"SDE Race\""
            },
            {
              "url": "displaySequence",
              "valueInteger": 7
            }
          ],
          "url": "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition"
        },
        {
          "extension": [
            {
              "url": "libraryName",
              "valueString": "SupplementalDataElements"
            },
            {
              "url": "name",
              "valueString": "SDE Sex"
            },
            {
              "url": "statement",
              "valueString": "define \"SDE Sex\":\n  case\n    when Patient.sex = '248153007' then \"Male (finding)\"\n    when Patient.sex = '248152002' then \"Female (finding)\"\n    else null\n  end"
            },
            {
              "url": "displaySequence",
              "valueInteger": 8
            }
          ],
          "url": "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition"
        },
        {
          "extension": [
            {
              "url": "libraryName",
              "valueString": "CMS986FHIRMalnutritionScore"
            },
            {
              "url": "name",
              "valueString": "SDE Sex"
            },
            {
              "url": "statement",
              "valueString": "define \"SDE Sex\":\n  SDE.\"SDE Sex\""
            },
            {
              "url": "displaySequence",
              "valueInteger": 9
            }
          ],
          "url": "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition"
        },
        {
          "extension": [
            {
              "url": "libraryName",
              "valueString": "CMS986FHIRMalnutritionScore"
            },
            {
              "url": "name",
              "valueString": "Encounter with Malnutrition Risk Screening"
            },
            {
              "url": "statement",
              "valueString": "define \"Encounter with Malnutrition Risk Screening\":\n  \"Measure Population\" QualifyingEncounter\n    with [\"ObservationScreeningAssessment\": \"Malnutrition Risk Screening\"] MalnutritionRiskScreening\n      such that ( MalnutritionRiskScreening.status in { 'final', 'amended', 'corrected' }\n          and MalnutritionRiskScreening.effective.toInterval ( ) during QualifyingEncounter.hospitalizationWithObservation ( )\n          and ( MalnutritionRiskScreening.value as Concept in \"Malnutrition Screening Finding of Not At Risk Result\"\n              or MalnutritionRiskScreening.value as Concept in \"Malnutrition Screening Finding of At Risk Result\"\n          )\n      )\n    return QualifyingEncounter"
            },
            {
              "url": "displaySequence",
              "valueInteger": 10
            }
          ],
          "url": "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition"
        },
        {
          "extension": [
            {
              "url": "libraryName",
              "valueString": "CMS986FHIRMalnutritionScore"
            },
            {
              "url": "name",
              "valueString": "Intervention Dietitian Referral"
            },
            {
              "url": "statement",
              "valueString": "define \"Intervention Dietitian Referral\":\n  ( [\"ServiceRequest\": code in \"Dietitian Referral\"] DietitianReferralOrder\n      where DietitianReferralOrder.status in { 'active', 'completed', 'on-hold' }\n        and DietitianReferralOrder.intent in { 'order', 'original-order', 'reflex-order', 'filler-order', 'instance-order' }\n        and DietitianReferralOrder.doNotPerform is not true\n  )\n    union ( [\"Procedure\": \"Dietitian Referral\"] DietitianReferralPerformed\n        where DietitianReferralPerformed.status in { 'completed', 'in-progress' }\n    )"
            },
            {
              "url": "displaySequence",
              "valueInteger": 11
            }
          ],
          "url": "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition"
        },
        {
          "extension": [
            {
              "url": "libraryName",
              "valueString": "CMS986FHIRMalnutritionScore"
            },
            {
              "url": "name",
              "valueString": "Encounter with Dietitian Referral"
            },
            {
              "url": "statement",
              "valueString": "define \"Encounter with Dietitian Referral\":\n  \"Measure Population\" QualifyingEncounter\n    with \"Intervention Dietitian Referral\" DietitianReferral\n      such that Coalesce(start of DietitianReferral.performed.toInterval(), DietitianReferral.authoredOn) during day of QualifyingEncounter.hospitalizationWithObservation ( )"
            },
            {
              "url": "displaySequence",
              "valueInteger": 12
            }
          ],
          "url": "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition"
        },
        {
          "extension": [
            {
              "url": "libraryName",
              "valueString": "CMS986FHIRMalnutritionScore"
            },
            {
              "url": "name",
              "valueString": "Encounter with Malnutrition Risk Screening or with Dietitian Referral"
            },
            {
              "url": "statement",
              "valueString": "define \"Encounter with Malnutrition Risk Screening or with Dietitian Referral\":\n  \"Measure Population\" QualifyingEncounter\n    where ( \"Encounter with Malnutrition Risk Screening\" contains QualifyingEncounter\n        or \"Encounter with Dietitian Referral\" contains QualifyingEncounter\n    )\n    return QualifyingEncounter"
            },
            {
              "url": "displaySequence",
              "valueInteger": 13
            }
          ],
          "url": "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition"
        },
        {
          "extension": [
            {
              "url": "libraryName",
              "valueString": "CMS986FHIRMalnutritionScore"
            },
            {
              "url": "name",
              "valueString": "Encounter with Malnutrition Risk Screening Not At Risk"
            },
            {
              "url": "statement",
              "valueString": "define \"Encounter with Malnutrition Risk Screening Not At Risk\":\n  \"Measure Population\" QualifyingEncounter\n    with [\"ObservationScreeningAssessment\": \"Malnutrition Risk Screening\"] MalnutritionRiskScreening\n      such that MalnutritionRiskScreening.status in { 'final', 'amended', 'corrected' }\n        and MalnutritionRiskScreening.effective.toInterval ( ) during QualifyingEncounter.hospitalizationWithObservation ( )\n        and ( MalnutritionRiskScreening.value as Concept in \"Malnutrition Screening Finding of Not At Risk Result\" )\n    return QualifyingEncounter"
            },
            {
              "url": "displaySequence",
              "valueInteger": 14
            }
          ],
          "url": "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition"
        },
        {
          "extension": [
            {
              "url": "libraryName",
              "valueString": "CMS986FHIRMalnutritionScore"
            },
            {
              "url": "name",
              "valueString": "Encounter with Malnutrition Not At Risk Screening and without Dietitian Referral"
            },
            {
              "url": "statement",
              "valueString": "define \"Encounter with Malnutrition Not At Risk Screening and without Dietitian Referral\":\n  \"Measure Population\" QualifyingEncounter\n    where \"Encounter with Malnutrition Risk Screening Not At Risk\" contains QualifyingEncounter\n      and not exists ( \"Encounter with Dietitian Referral\" )\n    return QualifyingEncounter"
            },
            {
              "url": "displaySequence",
              "valueInteger": 15
            }
          ],
          "url": "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition"
        },
        {
          "extension": [
            {
              "url": "libraryName",
              "valueString": "CMS986FHIRMalnutritionScore"
            },
            {
              "url": "name",
              "valueString": "Encounter with Malnutrition Risk Screening At Risk"
            },
            {
              "url": "statement",
              "valueString": "define \"Encounter with Malnutrition Risk Screening At Risk\":\n  \"Measure Population\" QualifyingEncounter\n    with [\"ObservationScreeningAssessment\": \"Malnutrition Risk Screening\"] MalnutritionRiskScreening\n      such that MalnutritionRiskScreening.status in { 'final', 'amended', 'corrected' }\n        and MalnutritionRiskScreening.effective.toInterval ( ) during QualifyingEncounter.hospitalizationWithObservation ( )\n        and ( MalnutritionRiskScreening.value as Concept in \"Malnutrition Screening Finding of At Risk Result\" )\n    return QualifyingEncounter"
            },
            {
              "url": "displaySequence",
              "valueInteger": 16
            }
          ],
          "url": "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition"
        },
        {
          "extension": [
            {
              "url": "libraryName",
              "valueString": "CMS986FHIRMalnutritionScore"
            },
            {
              "url": "name",
              "valueString": "Encounter with Malnutrition Risk Screening At Risk or with Dietitian Referral"
            },
            {
              "url": "statement",
              "valueString": "define \"Encounter with Malnutrition Risk Screening At Risk or with Dietitian Referral\":\n  \"Measure Population\" QualifyingEncounter\n    where \"Encounter with Malnutrition Risk Screening At Risk\" contains QualifyingEncounter\n      or \"Encounter with Dietitian Referral\" contains QualifyingEncounter\n    return QualifyingEncounter"
            },
            {
              "url": "displaySequence",
              "valueInteger": 17
            }
          ],
          "url": "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition"
        },
        {
          "extension": [
            {
              "url": "libraryName",
              "valueString": "CMS986FHIRMalnutritionScore"
            },
            {
              "url": "name",
              "valueString": "Nutrition Assessment Performed"
            },
            {
              "url": "statement",
              "valueString": "define \"Nutrition Assessment Performed\":\n  from\n    \"Measure Population\" QualifyingEncounter,\n    [\"ObservationScreeningAssessment\": \"Nutrition Assessment\"] NutritionAssessment\n    let NAssessLatest: NutritionAssessment.effective.latest ( )\n    where \"Nutrition Assessment\" contains NutritionAssessment.code as Concept\n      and NutritionAssessment.status in { 'final', 'amended', 'corrected' }\n      and NutritionAssessment.effective.toInterval ( ) during QualifyingEncounter.hospitalizationWithObservation ( )\n      and NutritionAssessment.value is not null\n    return Tuple {\n      HospEncId: QualifyingEncounter.id,\n      HospitalizationPeriod: QualifyingEncounter.hospitalizationWithObservation ( ),\n      NutrAssessCode: NutritionAssessment.code as Concept,\n      NutrAssessId: NutritionAssessment.id,\n      NutrAssessResult: NutritionAssessment.value,\n      NutrAssessTimingEff: NutritionAssessment.effective,\n      NutrAssessTimingInt: NutritionAssessment.effective.toInterval ( ),\n      NutrAssessTimingLatest: NAssessLatest\n    }\n    sort by NutrAssessTimingLatest asc"
            },
            {
              "url": "displaySequence",
              "valueInteger": 18
            }
          ],
          "url": "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition"
        },
        {
          "extension": [
            {
              "url": "libraryName",
              "valueString": "CMS986FHIRMalnutritionScore"
            },
            {
              "url": "name",
              "valueString": "Encounter With Most Recent Nutrition Assessment And Identified Status"
            },
            {
              "url": "statement",
              "valueString": "define \"Encounter With Most Recent Nutrition Assessment And Identified Status\":\n  \"Measure Population\" QualifyingEncounter\n    with [\"ObservationScreeningAssessment\": \"Nutrition Assessment\"] NutritionAssessment\n      such that ( NutritionAssessment.status in { 'final', 'amended', 'corrected' }\n          and NutritionAssessment.effective.toInterval ( ) during QualifyingEncounter.hospitalizationWithObservation ( )\n          and ( NutritionAssessment.value as Concept in \"Nutrition Assessment Status Finding of Well Nourished or Not Malnourished or Mildly Malnourished\"\n              or ( NutritionAssessment.value as Concept in \"Nutrition Assessment Status Finding of Moderately Malnourished\" )\n              or ( NutritionAssessment.value as Concept in \"Nutrition Assessment Status Finding of Severely Malnourished\" )\n          )\n          and ( exists ( \"Encounter with Malnutrition Risk Screening At Risk\" )\n              or exists ( \"Encounter with Dietitian Referral\" )\n          )\n          and NutritionAssessment.effective.latest ( ) same day as \"Last Nutrition Assessment Day During Encounter\"(QualifyingEncounter)\n      )\n    return QualifyingEncounter"
            },
            {
              "url": "displaySequence",
              "valueInteger": 19
            }
          ],
          "url": "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition"
        },
        {
          "extension": [
            {
              "url": "libraryName",
              "valueString": "CMS986FHIRMalnutritionScore"
            },
            {
              "url": "name",
              "valueString": "Has Malnutrition Diagnosis"
            },
            {
              "url": "statement",
              "valueString": "define \"Has Malnutrition Diagnosis\":\n  [ConditionProblemsHealthConcerns: \"Malnutrition Diagnosis\"] MalnutritionDiagnosis\n    where MalnutritionDiagnosis.prevalenceInterval ( ) overlaps \"Measurement Period\""
            },
            {
              "url": "displaySequence",
              "valueInteger": 20
            }
          ],
          "url": "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition"
        },
        {
          "extension": [
            {
              "url": "libraryName",
              "valueString": "CMS986FHIRMalnutritionScore"
            },
            {
              "url": "name",
              "valueString": "Encounter With Encounter Diagnosis Of Malnutrition Diagnosis"
            },
            {
              "url": "statement",
              "valueString": "define \"Encounter With Encounter Diagnosis Of Malnutrition Diagnosis\":\n  \"Measure Population\" QualifyingEncounter\n    where QualifyingEncounter.reasonCode in \"Malnutrition Diagnosis\"\n      or exists ( [ConditionEncounterDiagnosis: \"Malnutrition Diagnosis\"] EncounterDiagnosis\n          where QualifyingEncounter.reasonReference.references ( EncounterDiagnosis )\n      )"
            },
            {
              "url": "displaySequence",
              "valueInteger": 21
            }
          ],
          "url": "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition"
        },
        {
          "extension": [
            {
              "url": "libraryName",
              "valueString": "CMS986FHIRMalnutritionScore"
            },
            {
              "url": "name",
              "valueString": "Encounter with Malnutrition Diagnosis"
            },
            {
              "url": "statement",
              "valueString": "define \"Encounter with Malnutrition Diagnosis\":\n  \"Measure Population\" QualifyingEncounter\n    where exists ( \"Has Malnutrition Diagnosis\" MalnutritionDiagnosis\n        where MalnutritionDiagnosis.prevalenceInterval ( ) overlaps day of QualifyingEncounter.hospitalizationWithObservation ( )\n    )\n      or exists \"Encounter With Encounter Diagnosis Of Malnutrition Diagnosis\""
            },
            {
              "url": "displaySequence",
              "valueInteger": 22
            }
          ],
          "url": "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition"
        },
        {
          "extension": [
            {
              "url": "libraryName",
              "valueString": "CMS986FHIRMalnutritionScore"
            },
            {
              "url": "name",
              "valueString": "Encounter With Most Recent Nutrition Assessment Status of Not or Mildly Malnourished"
            },
            {
              "url": "statement",
              "valueString": "define \"Encounter With Most Recent Nutrition Assessment Status of Not or Mildly Malnourished\":\n  \"Measure Population\" QualifyingEncounter\n    with [\"ObservationScreeningAssessment\": \"Nutrition Assessment\"] NutritionAssessment\n      such that ( NutritionAssessment.status in { 'final', 'amended', 'corrected' }\n          and NutritionAssessment.effective.toInterval ( ) during QualifyingEncounter.hospitalizationWithObservation ( )\n          and ( NutritionAssessment.value as Concept in \"Nutrition Assessment Status Finding of Well Nourished or Not Malnourished or Mildly Malnourished\" )\n          and NutritionAssessment.effective.latest ( ) same day as \"Last Nutrition Assessment Day During Encounter\"(QualifyingEncounter)\n      )\n    return QualifyingEncounter"
            },
            {
              "url": "displaySequence",
              "valueInteger": 23
            }
          ],
          "url": "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition"
        },
        {
          "extension": [
            {
              "url": "libraryName",
              "valueString": "CMS986FHIRMalnutritionScore"
            },
            {
              "url": "name",
              "valueString": "Encounter With Most Recent Nutrition Assessment Status of Moderately Or Severely Malnourished"
            },
            {
              "url": "statement",
              "valueString": "define \"Encounter With Most Recent Nutrition Assessment Status of Moderately Or Severely Malnourished\":\n  \"Measure Population\" QualifyingEncounter\n    with [\"ObservationScreeningAssessment\": \"Nutrition Assessment\"] NutritionAssessment\n      such that NutritionAssessment.status in { 'final', 'amended', 'corrected' }\n        and NutritionAssessment.effective.toInterval ( ) during QualifyingEncounter.hospitalizationWithObservation ( )\n        and ( NutritionAssessment.value as Concept in \"Nutrition Assessment Status Finding of Moderately Malnourished\"\n            or NutritionAssessment.value as Concept in \"Nutrition Assessment Status Finding of Severely Malnourished\"\n        )\n        and NutritionAssessment.effective.latest ( ) same day as \"Last Nutrition Assessment Day During Encounter\"(QualifyingEncounter)\n    return QualifyingEncounter"
            },
            {
              "url": "displaySequence",
              "valueInteger": 24
            }
          ],
          "url": "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition"
        },
        {
          "extension": [
            {
              "url": "libraryName",
              "valueString": "CMS986FHIRMalnutritionScore"
            },
            {
              "url": "name",
              "valueString": "Encounter with Nutrition Care Plan"
            },
            {
              "url": "statement",
              "valueString": "define \"Encounter with Nutrition Care Plan\":\n  \"Measure Population\" QualifyingEncounter\n    with [\"Procedure\": \"Nutrition Care Plan\"] NutritionCarePlan\n      such that NutritionCarePlan.status in { 'completed', 'in-progress' }\n        and NutritionCarePlan.performed.earliest ( ) during QualifyingEncounter.hospitalizationWithObservation ( )\n    return QualifyingEncounter"
            },
            {
              "url": "displaySequence",
              "valueInteger": 25
            }
          ],
          "url": "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition"
        },
        {
          "extension": [
            {
              "url": "libraryName",
              "valueString": "SupplementalDataElements"
            },
            {
              "url": "name",
              "valueString": "SDE Payer"
            },
            {
              "url": "statement",
              "valueString": "define \"SDE Payer\":\n  [Coverage: type in \"Payer Type\"] Payer\n    return {\n      code: Payer.type,\n      period: Payer.period\n    }"
            },
            {
              "url": "displaySequence",
              "valueInteger": 26
            }
          ],
          "url": "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition"
        },
        {
          "extension": [
            {
              "url": "libraryName",
              "valueString": "CMS986FHIRMalnutritionScore"
            },
            {
              "url": "name",
              "valueString": "SDE Payer Type"
            },
            {
              "url": "statement",
              "valueString": "define \"SDE Payer Type\":\n  SDE.\"SDE Payer\""
            },
            {
              "url": "displaySequence",
              "valueInteger": 27
            }
          ],
          "url": "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition"
        },
        {
          "extension": [
            {
              "url": "libraryName",
              "valueString": "CMS986FHIRMalnutritionScore"
            },
            {
              "url": "name",
              "valueString": "Initial Population"
            },
            {
              "url": "statement",
              "valueString": "define \"Initial Population\":\n  [Encounter: \"Encounter Inpatient\"] EncounterInpatient\n    where EncounterInpatient.period ends during day of \"Measurement Period\"\n      and AgeInYearsAt(date from start of EncounterInpatient.period) >= 18\n      and ( duration in hours of EncounterInpatient.period >= 24 )\n      and EncounterInpatient.status = 'finished'"
            },
            {
              "url": "displaySequence",
              "valueInteger": 28
            }
          ],
          "url": "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition"
        },
        {
          "extension": [
            {
              "url": "libraryName",
              "valueString": "SupplementalDataElements"
            },
            {
              "url": "name",
              "valueString": "SDE Ethnicity"
            },
            {
              "url": "statement",
              "valueString": "define \"SDE Ethnicity\":\n  Patient.ethnicity E\n    return Tuple {\n      codes: { E.ombCategory } union E.detailed,\n      display: E.text\n    }"
            },
            {
              "url": "displaySequence",
              "valueInteger": 29
            }
          ],
          "url": "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition"
        },
        {
          "extension": [
            {
              "url": "libraryName",
              "valueString": "CMS986FHIRMalnutritionScore"
            },
            {
              "url": "name",
              "valueString": "SDE Ethnicity"
            },
            {
              "url": "statement",
              "valueString": "define \"SDE Ethnicity\":\n  SDE.\"SDE Ethnicity\""
            },
            {
              "url": "displaySequence",
              "valueInteger": 30
            }
          ],
          "url": "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition"
        },
        {
          "extension": [
            {
              "url": "libraryName",
              "valueString": "CMS986FHIRMalnutritionScore"
            },
            {
              "url": "name",
              "valueString": "Measure Population"
            },
            {
              "url": "statement",
              "valueString": "define \"Measure Population\":\n  \"Initial Population\""
            },
            {
              "url": "displaySequence",
              "valueInteger": 31
            }
          ],
          "url": "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition"
        },
        {
          "extension": [
            {
              "url": "libraryName",
              "valueString": "FHIRHelpers"
            },
            {
              "url": "name",
              "valueString": "ToInterval"
            },
            {
              "url": "statement",
              "valueString": "/*\n@description: Converts the given [Period](https://hl7.org/fhir/datatypes.html#Period)\nvalue to a CQL DateTime Interval\n@comment: If the start value of the given period is unspecified, the starting\nboundary of the resulting interval will be open (meaning the start of the interval\nis unknown, as opposed to interpreted as the beginning of time).\n*/\ndefine function ToInterval(period FHIR.Period):\n    if period is null then\n        null\n    else\n        if period.\"start\" is null then\n            Interval(period.\"start\".value, period.\"end\".value]\n        else\n            Interval[period.\"start\".value, period.\"end\".value]"
            },
            {
              "url": "displaySequence",
              "valueInteger": 32
            }
          ],
          "url": "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition"
        },
        {
          "extension": [
            {
              "url": "libraryName",
              "valueString": "QICoreCommon"
            },
            {
              "url": "name",
              "valueString": "toInterval"
            },
            {
              "url": "statement",
              "valueString": "/*\n@description: Normalizes a value that is a choice of timing-valued types to an equivalent interval\n@comment: Normalizes a choice type of DateTime, Quanitty, Interval<DateTime>, or Interval<Quantity> types\nto an equivalent interval. This selection of choice types is a superset of the majority of choice types that are used as possible\nrepresentations for timing-valued elements in QICore, allowing this function to be used across any resource.\nThe input can be provided as a DateTime, Quantity, Interval<DateTime> or Interval<Quantity>.\nThe intent of this function is to provide a clear and concise mechanism to treat single\nelements that have multiple possible representations as intervals so that logic doesn't have to account\nfor the variability. More complex calculations (such as medication request period or dispense period\ncalculation) need specific guidance and consideration. That guidance may make use of this function, but\nthe focus of this function is on single element calculations where the semantics are unambiguous.\nIf the input is a DateTime, the result a DateTime Interval beginning and ending on that DateTime.\nIf the input is a Quantity, the quantity is expected to be a calendar-duration interpreted as an Age,\nand the result is a DateTime Interval beginning on the Date the patient turned that age and ending immediately before one year later.\nIf the input is a DateTime Interval, the result is the input.\nIf the input is a Quantity Interval, the quantities are expected to be calendar-durations interpreted as an Age, and the result\nis a DateTime Interval beginning on the date the patient turned the age given as the start of the quantity interval, and ending\nimmediately before one year later than the date the patient turned the age given as the end of the quantity interval.\nIf the input is a Timing, an error will be thrown indicating that Timing calculations are not implemented. Any other input will reslt in a null DateTime Interval\n*/\ndefine fluent function toInterval(choice Choice<DateTime, Quantity, Interval<DateTime>, Interval<Quantity>, Timing>):\n  case\n\t  when choice is DateTime then\n    \tInterval[choice as DateTime, choice as DateTime]\n\t\twhen choice is Interval<DateTime> then\n  \t\tchoice as Interval<DateTime>\n\t\twhen choice is Quantity then\n\t\t  Interval[Patient.birthDate + (choice as Quantity),\n\t\t\t  Patient.birthDate + (choice as Quantity) + 1 year)\n\t\twhen choice is Interval<Quantity> then\n\t\t  Interval[Patient.birthDate + (choice.low as Quantity),\n\t\t\t  Patient.birthDate + (choice.high as Quantity) + 1 year)\n\t\twhen choice is Timing then\n      Message(null, true, 'NOT_IMPLEMENTED', 'Error', 'Calculation of an interval from a Timing value is not supported') as Interval<DateTime>\n\t\telse\n\t\t\tnull as Interval<DateTime>\n\tend"
            },
            {
              "url": "displaySequence",
              "valueInteger": 33
            }
          ],
          "url": "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition"
        },
        {
          "extension": [
            {
              "url": "libraryName",
              "valueString": "CQMCommon"
            },
            {
              "url": "name",
              "valueString": "hospitalizationWithObservation"
            },
            {
              "url": "statement",
              "valueString": "/*\n@description: Hospitalization with Observation returns the total interval from the start of any immediately prior emergency department visit through the observation visit to the discharge of the given encounter\n*/\ndefine fluent function hospitalizationWithObservation(TheEncounter Encounter ):\n  TheEncounter Visit\n  \t\tlet ObsVisit: Last([Encounter: \"Observation Services\"] LastObs\n  \t\t\t\twhere LastObs.status = 'finished'\n            and LastObs.period ends 1 hour or less on or before start of Visit.period\n  \t\t\t\tsort by end of period\n  \t\t\t),\n  \t\t\tVisitStart: Coalesce(start of ObsVisit.period, start of Visit.period),\n  \t\t\tEDVisit: Last([Encounter: \"Emergency Department Visit\"] LastED\n  \t\t\t\twhere LastED.status = 'finished'\n            and LastED.period ends 1 hour or less on or before VisitStart\n  \t\t\t\tsort by end of period\n  \t\t\t)\n  \t\treturn Interval[Coalesce(start of EDVisit.period, VisitStart), end of Visit.period]"
            },
            {
              "url": "displaySequence",
              "valueInteger": 34
            }
          ],
          "url": "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition"
        },
        {
          "extension": [
            {
              "url": "libraryName",
              "valueString": "FHIRHelpers"
            },
            {
              "url": "name",
              "valueString": "ToString"
            },
            {
              "url": "statement",
              "valueString": "define function ToString(value uri): value.value"
            },
            {
              "url": "displaySequence",
              "valueInteger": 35
            }
          ],
          "url": "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition"
        },
        {
          "extension": [
            {
              "url": "libraryName",
              "valueString": "FHIRHelpers"
            },
            {
              "url": "name",
              "valueString": "ToCode"
            },
            {
              "url": "statement",
              "valueString": "/*\n@description: Converts the given FHIR [Coding](https://hl7.org/fhir/datatypes.html#Coding) value to a CQL Code.\n*/\ndefine function ToCode(coding FHIR.Coding):\n    if coding is null then\n        null\n    else\n        System.Code {\n          code: coding.code.value,\n          system: coding.system.value,\n          version: coding.version.value,\n          display: coding.display.value\n        }"
            },
            {
              "url": "displaySequence",
              "valueInteger": 36
            }
          ],
          "url": "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition"
        },
        {
          "extension": [
            {
              "url": "libraryName",
              "valueString": "CMS986FHIRMalnutritionScore"
            },
            {
              "url": "name",
              "valueString": "Measure Observation 1"
            },
            {
              "url": "statement",
              "valueString": "define function \"Measure Observation 1\"(MalnutritionRiskScreening Encounter):\n  if \"Encounter with Malnutrition Risk Screening or with Dietitian Referral\" contains MalnutritionRiskScreening then 1 \n    else 0"
            },
            {
              "url": "displaySequence",
              "valueInteger": 37
            }
          ],
          "url": "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition"
        },
        {
          "extension": [
            {
              "url": "libraryName",
              "valueString": "CMS986FHIRMalnutritionScore"
            },
            {
              "url": "name",
              "valueString": "Measure Observation Total Malnutrition Components Score"
            },
            {
              "url": "statement",
              "valueString": "define function \"Measure Observation Total Malnutrition Components Score\"(QualifyingEncounter Encounter):\n  Sum({ \"Measure Observation 1\"(QualifyingEncounter), \"Measure Observation 2\"(QualifyingEncounter), \"Measure Observation 3\"(QualifyingEncounter), \"Measure Observation 4\"(QualifyingEncounter) })"
            },
            {
              "url": "displaySequence",
              "valueInteger": 38
            }
          ],
          "url": "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition"
        },
        {
          "extension": [
            {
              "url": "libraryName",
              "valueString": "CMS986FHIRMalnutritionScore"
            },
            {
              "url": "name",
              "valueString": "Measure Observation 1"
            },
            {
              "url": "statement",
              "valueString": "define function \"Measure Observation 1\"(MalnutritionRiskScreening Encounter):\n  if \"Encounter with Malnutrition Risk Screening or with Dietitian Referral\" contains MalnutritionRiskScreening then 1 \n    else 0"
            },
            {
              "url": "displaySequence",
              "valueInteger": 39
            }
          ],
          "url": "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition"
        },
        {
          "extension": [
            {
              "url": "libraryName",
              "valueString": "CMS986FHIRMalnutritionScore"
            },
            {
              "url": "name",
              "valueString": "Measure Observation 2"
            },
            {
              "url": "statement",
              "valueString": "define function \"Measure Observation 2\"(NutritionAssessment Encounter):\n  if \"Encounter with Malnutrition Not At Risk Screening and without Dietitian Referral\" contains NutritionAssessment then 0 \n    else if \"Encounter with Malnutrition Risk Screening At Risk or with Dietitian Referral\" contains NutritionAssessment then if \"Encounter With Most Recent Nutrition Assessment And Identified Status\" contains NutritionAssessment then 1 \n    else 0 \n    else 0"
            },
            {
              "url": "displaySequence",
              "valueInteger": 40
            }
          ],
          "url": "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition"
        },
        {
          "extension": [
            {
              "url": "libraryName",
              "valueString": "QICoreCommon"
            },
            {
              "url": "name",
              "valueString": "latest"
            },
            {
              "url": "statement",
              "valueString": "/*\n@description: Given an interval, returns the ending point if the interval has an ending boundary specified,\notherwise, returns the starting point\n*/\ndefine fluent function latest(choice Choice<DateTime, Quantity, Interval<DateTime>, Interval<Quantity>> ):\n  (choice.toInterval()) period\n    return\n      if (period.\"hasEnd\"()) then end of period\n      else start of period"
            },
            {
              "url": "displaySequence",
              "valueInteger": 41
            }
          ],
          "url": "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition"
        },
        {
          "extension": [
            {
              "url": "libraryName",
              "valueString": "QICoreCommon"
            },
            {
              "url": "name",
              "valueString": "hasEnd"
            },
            {
              "url": "statement",
              "valueString": "/*\n@description: Given an interval, returns true if the interval has an ending boundary specified\n(i.e. the end of the interval is not null and not the maximum DateTime value)\n*/\ndefine fluent function hasEnd(period Interval<DateTime> ):\n  not (\n    end of period is null\n      or end of period = maximum DateTime\n  )"
            },
            {
              "url": "displaySequence",
              "valueInteger": 42
            }
          ],
          "url": "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition"
        },
        {
          "extension": [
            {
              "url": "libraryName",
              "valueString": "CMS986FHIRMalnutritionScore"
            },
            {
              "url": "name",
              "valueString": "Last Nutrition Assessment Day During Encounter"
            },
            {
              "url": "statement",
              "valueString": "define function \"Last Nutrition Assessment Day During Encounter\"(QualifyingEncounter Encounter):\n  Last(\"Nutrition Assessment Performed\" NutritionAssessmentTuple\n      where NutritionAssessmentTuple.HospEncId = QualifyingEncounter.id\n      return NutritionAssessmentTuple.NutrAssessTimingLatest\n      sort asc\n  )"
            },
            {
              "url": "displaySequence",
              "valueInteger": 43
            }
          ],
          "url": "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition"
        },
        {
          "extension": [
            {
              "url": "libraryName",
              "valueString": "CMS986FHIRMalnutritionScore"
            },
            {
              "url": "name",
              "valueString": "Measure Observation 3"
            },
            {
              "url": "statement",
              "valueString": "define function \"Measure Observation 3\"(MalnutritionDiagnosis Encounter):\n  if \"Encounter with Malnutrition Not At Risk Screening and without Dietitian Referral\" contains MalnutritionDiagnosis then 0 \n    else if \"Encounter with Malnutrition Risk Screening At Risk or with Dietitian Referral\" contains MalnutritionDiagnosis then if \"Encounter with Malnutrition Diagnosis\" contains MalnutritionDiagnosis then if \"Encounter With Most Recent Nutrition Assessment Status of Not or Mildly Malnourished\" contains MalnutritionDiagnosis then 0 \n    else if \"Encounter With Most Recent Nutrition Assessment Status of Moderately Or Severely Malnourished\" contains MalnutritionDiagnosis then 1 \n    else 0 \n    else 0 \n    else 0"
            },
            {
              "url": "displaySequence",
              "valueInteger": 44
            }
          ],
          "url": "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition"
        },
        {
          "extension": [
            {
              "url": "libraryName",
              "valueString": "QICoreCommon"
            },
            {
              "url": "name",
              "valueString": "prevalenceInterval"
            },
            {
              "url": "statement",
              "valueString": "/*\n@description: Returns an interval representing the normalized prevalence period of a given Condition.\n@comment: Uses the ToInterval and ToAbatementInterval functions to determine the widest potential interval from\nonset to abatement as specified in the given Condition. If the condition is active, or has an abatement date the resulting \ninterval will have a closed ending boundary. Otherwise, the resulting interval will have an open ending boundary.\n*/\ndefine fluent function prevalenceInterval(condition Choice<\"ConditionEncounterDiagnosis\", \"ConditionProblemsHealthConcerns\">):\nif condition.clinicalStatus ~ \"active\"\n  or condition.clinicalStatus ~ \"recurrence\"\n  or condition.clinicalStatus ~ \"relapse\" then\n  Interval[start of condition.onset.toInterval(), end of condition.abatementInterval()]\nelse\n    (end of condition.abatementInterval()) abatementDate\n    return if abatementDate is null then\n      Interval[start of condition.onset.toInterval(), abatementDate)\n    else\n      Interval[start of condition.onset.toInterval(), abatementDate]"
            },
            {
              "url": "displaySequence",
              "valueInteger": 45
            }
          ],
          "url": "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition"
        },
        {
          "extension": [
            {
              "url": "libraryName",
              "valueString": "QICoreCommon"
            },
            {
              "url": "name",
              "valueString": "abatementInterval"
            },
            {
              "url": "statement",
              "valueString": "/*\n@description: Returns an interval representing the normalized abatement of a given Condition.\n@comment: If the abatement element of the Condition is represented as a DateTime, the result\nis an interval beginning and ending on that DateTime.\nIf the abatement is represented as a Quantity, the quantity is expected to be a calendar-duration and is interpreted as the age of the patient. The\nresult is an interval from the date the patient turned that age to immediately before one year later.\nIf the abatement is represented as a Quantity Interval, the quantities are expected to be calendar-durations and are interpreted as an age range during\nwhich the abatement occurred. The result is an interval from the date the patient turned the starting age of the quantity interval, and ending immediately\nbefore one year later than the date the patient turned the ending age of the quantity interval.\n*/\ndefine fluent function abatementInterval(condition Choice<\"ConditionEncounterDiagnosis\", \"ConditionProblemsHealthConcerns\">):\n\tif condition.abatement is DateTime then\n\t  Interval[condition.abatement as DateTime, condition.abatement as DateTime]\n\telse if condition.abatement is Quantity then\n\t\tInterval[Patient.birthDate + (condition.abatement as Quantity),\n\t\t\tPatient.birthDate + (condition.abatement as Quantity) + 1 year)\n\telse if condition.abatement is Interval<Quantity> then\n\t  Interval[Patient.birthDate + (condition.abatement.low as Quantity),\n\t\t  Patient.birthDate + (condition.abatement.high as Quantity) + 1 year)\n\telse if condition.abatement is Interval<DateTime> then\n\t  Interval[condition.abatement.low, condition.abatement.high)\n\telse null as Interval<DateTime>"
            },
            {
              "url": "displaySequence",
              "valueInteger": 46
            }
          ],
          "url": "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition"
        },
        {
          "extension": [
            {
              "url": "libraryName",
              "valueString": "FHIRHelpers"
            },
            {
              "url": "name",
              "valueString": "ToConcept"
            },
            {
              "url": "statement",
              "valueString": "/*\n@description: Converts the given FHIR [CodeableConcept](https://hl7.org/fhir/datatypes.html#CodeableConcept) value to a CQL Concept.\n*/\ndefine function ToConcept(concept FHIR.CodeableConcept):\n    if concept is null then\n        null\n    else\n        System.Concept {\n            codes: concept.coding C return ToCode(C),\n            display: concept.text.value\n        }"
            },
            {
              "url": "displaySequence",
              "valueInteger": 47
            }
          ],
          "url": "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition"
        },
        {
          "extension": [
            {
              "url": "libraryName",
              "valueString": "QICoreCommon"
            },
            {
              "url": "name",
              "valueString": "references"
            },
            {
              "url": "statement",
              "valueString": "/*\n@description: Returns true if any of the given references are to the given resource\n@comment: Returns true if the `id` element of the given resource exactly equals the tail of any of the given references.\nNOTE: This function assumes resources from the same source server.\n*/\ndefine fluent function references(references List<Reference>, resource Resource):\n  exists (references R where R.references(resource))"
            },
            {
              "url": "displaySequence",
              "valueInteger": 48
            }
          ],
          "url": "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition"
        },
        {
          "extension": [
            {
              "url": "libraryName",
              "valueString": "QICoreCommon"
            },
            {
              "url": "name",
              "valueString": "references"
            },
            {
              "url": "statement",
              "valueString": "/*\n@description: Returns true if the given reference is to the given resource\n@comment: Returns true if the `id` element of the given resource exactly equals the tail of the given reference.\nNOTE: This function assumes resources from the same source server.\n*/\ndefine fluent function references(reference Reference, resource Resource):\n  resource.id = Last(Split(reference.reference, '/'))"
            },
            {
              "url": "displaySequence",
              "valueInteger": 49
            }
          ],
          "url": "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition"
        },
        {
          "extension": [
            {
              "url": "libraryName",
              "valueString": "CMS986FHIRMalnutritionScore"
            },
            {
              "url": "name",
              "valueString": "Measure Observation 4"
            },
            {
              "url": "statement",
              "valueString": "define function \"Measure Observation 4\"(NutritionCarePlan Encounter):\n  if \"Encounter with Malnutrition Not At Risk Screening and without Dietitian Referral\" contains NutritionCarePlan then 0 \n    else if \"Encounter with Malnutrition Risk Screening At Risk or with Dietitian Referral\" contains NutritionCarePlan then if \"Encounter with Nutrition Care Plan\" contains NutritionCarePlan then if \"Encounter With Most Recent Nutrition Assessment Status of Not or Mildly Malnourished\" contains NutritionCarePlan then 0 \n    else if \"Encounter With Most Recent Nutrition Assessment Status of Moderately Or Severely Malnourished\" contains NutritionCarePlan then 1 \n    else 0 \n    else 0 \n    else 0"
            },
            {
              "url": "displaySequence",
              "valueInteger": 50
            }
          ],
          "url": "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition"
        },
        {
          "extension": [
            {
              "url": "libraryName",
              "valueString": "QICoreCommon"
            },
            {
              "url": "name",
              "valueString": "earliest"
            },
            {
              "url": "statement",
              "valueString": "/*\n@description: Given an interval, return the starting point if the interval has a starting boundary specified,\notherwise, return the ending point\n*/\ndefine fluent function earliest(choice Choice<DateTime, Quantity, Interval<DateTime>, Interval<Quantity>> ):\n  (choice.toInterval()) period\n    return\n      if (period.\"hasStart\"()) then start of period\n      else end of period"
            },
            {
              "url": "displaySequence",
              "valueInteger": 51
            }
          ],
          "url": "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition"
        },
        {
          "extension": [
            {
              "url": "libraryName",
              "valueString": "QICoreCommon"
            },
            {
              "url": "name",
              "valueString": "hasStart"
            },
            {
              "url": "statement",
              "valueString": "/*\n@description: Given an interval, return true if the interval has a starting boundary specified\n(i.e. the start of the interval is not null and not the minimum DateTime value)\n*/\ndefine fluent function hasStart(period Interval<DateTime> ):\n  not ( start of period is null\n      or start of period = minimum DateTime\n  )"
            },
            {
              "url": "displaySequence",
              "valueInteger": 52
            }
          ],
          "url": "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition"
        },
        {
          "extension": [
            {
              "url": "libraryName",
              "valueString": "CMS986FHIRMalnutritionScore"
            },
            {
              "url": "name",
              "valueString": "Measure Observation 3"
            },
            {
              "url": "statement",
              "valueString": "define function \"Measure Observation 3\"(MalnutritionDiagnosis Encounter):\n  if \"Encounter with Malnutrition Not At Risk Screening and without Dietitian Referral\" contains MalnutritionDiagnosis then 0 \n    else if \"Encounter with Malnutrition Risk Screening At Risk or with Dietitian Referral\" contains MalnutritionDiagnosis then if \"Encounter with Malnutrition Diagnosis\" contains MalnutritionDiagnosis then if \"Encounter With Most Recent Nutrition Assessment Status of Not or Mildly Malnourished\" contains MalnutritionDiagnosis then 0 \n    else if \"Encounter With Most Recent Nutrition Assessment Status of Moderately Or Severely Malnourished\" contains MalnutritionDiagnosis then 1 \n    else 0 \n    else 0 \n    else 0"
            },
            {
              "url": "displaySequence",
              "valueInteger": 53
            }
          ],
          "url": "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition"
        },
        {
          "extension": [
            {
              "url": "libraryName",
              "valueString": "CMS986FHIRMalnutritionScore"
            },
            {
              "url": "name",
              "valueString": "Measure Observation 2"
            },
            {
              "url": "statement",
              "valueString": "define function \"Measure Observation 2\"(NutritionAssessment Encounter):\n  if \"Encounter with Malnutrition Not At Risk Screening and without Dietitian Referral\" contains NutritionAssessment then 0 \n    else if \"Encounter with Malnutrition Risk Screening At Risk or with Dietitian Referral\" contains NutritionAssessment then if \"Encounter With Most Recent Nutrition Assessment And Identified Status\" contains NutritionAssessment then 1 \n    else 0 \n    else 0"
            },
            {
              "url": "displaySequence",
              "valueInteger": 54
            }
          ],
          "url": "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition"
        },
        {
          "extension": [
            {
              "url": "libraryName",
              "valueString": "CMS986FHIRMalnutritionScore"
            },
            {
              "url": "name",
              "valueString": "Measure Observation 4"
            },
            {
              "url": "statement",
              "valueString": "define function \"Measure Observation 4\"(NutritionCarePlan Encounter):\n  if \"Encounter with Malnutrition Not At Risk Screening and without Dietitian Referral\" contains NutritionCarePlan then 0 \n    else if \"Encounter with Malnutrition Risk Screening At Risk or with Dietitian Referral\" contains NutritionCarePlan then if \"Encounter with Nutrition Care Plan\" contains NutritionCarePlan then if \"Encounter With Most Recent Nutrition Assessment Status of Not or Mildly Malnourished\" contains NutritionCarePlan then 0 \n    else if \"Encounter With Most Recent Nutrition Assessment Status of Moderately Or Severely Malnourished\" contains NutritionCarePlan then 1 \n    else 0 \n    else 0 \n    else 0"
            },
            {
              "url": "displaySequence",
              "valueInteger": 55
            }
          ],
          "url": "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition"
        },
        {
          "extension": [
            {
              "url": "libraryName",
              "valueString": "CMS986FHIRMalnutritionScore"
            },
            {
              "url": "name",
              "valueString": "Measure Observation Total Malnutrition Care Score as Percentage"
            },
            {
              "url": "statement",
              "valueString": "define function \"Measure Observation Total Malnutrition Care Score as Percentage\"(QualifyingEncounter Encounter):\n  100 * ( \"Measure Observation Total Malnutrition Components Score\"(QualifyingEncounter) / \"Total Malnutrition Care Score Eligible Occurrences\"(QualifyingEncounter) )"
            },
            {
              "url": "displaySequence",
              "valueInteger": 56
            }
          ],
          "url": "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition"
        },
        {
          "extension": [
            {
              "url": "libraryName",
              "valueString": "CMS986FHIRMalnutritionScore"
            },
            {
              "url": "name",
              "valueString": "Measure Observation Total Malnutrition Components Score"
            },
            {
              "url": "statement",
              "valueString": "define function \"Measure Observation Total Malnutrition Components Score\"(QualifyingEncounter Encounter):\n  Sum({ \"Measure Observation 1\"(QualifyingEncounter), \"Measure Observation 2\"(QualifyingEncounter), \"Measure Observation 3\"(QualifyingEncounter), \"Measure Observation 4\"(QualifyingEncounter) })"
            },
            {
              "url": "displaySequence",
              "valueInteger": 57
            }
          ],
          "url": "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition"
        },
        {
          "extension": [
            {
              "url": "libraryName",
              "valueString": "CMS986FHIRMalnutritionScore"
            },
            {
              "url": "name",
              "valueString": "Total Malnutrition Care Score Eligible Occurrences"
            },
            {
              "url": "statement",
              "valueString": "define function \"Total Malnutrition Care Score Eligible Occurrences\"(QualifyingEncounter Encounter):\n  if ( ( \"Encounter with Malnutrition Risk Screening or with Dietitian Referral\" contains QualifyingEncounter )\n      and ( \"Encounter with Malnutrition Risk Screening Not At Risk\" contains QualifyingEncounter )\n  )\n    and not ( \"Encounter with Dietitian Referral\" contains QualifyingEncounter ) then 1 \n    else if ( ( ( \"Encounter with Malnutrition Risk Screening or with Dietitian Referral\" contains QualifyingEncounter )\n        and ( \"Encounter with Malnutrition Risk Screening At Risk\" contains QualifyingEncounter )\n    )\n      or ( \"Encounter with Dietitian Referral\" contains QualifyingEncounter )\n  )\n    and ( \"Encounter With Most Recent Nutrition Assessment Status of Not or Mildly Malnourished\" contains QualifyingEncounter )\n    or not ( \"Encounter With Most Recent Nutrition Assessment And Identified Status\" contains QualifyingEncounter ) then 2 \n    else 4"
            },
            {
              "url": "displaySequence",
              "valueInteger": 58
            }
          ],
          "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": "Library QICoreCommon",
          "resource": "Library/QICoreCommon|4.0.000"
        },
        {
          "type": "depends-on",
          "display": "Library CQMCommon",
          "resource": "Library/CQMCommon|4.1.000"
        },
        {
          "type": "depends-on",
          "display": "Library FHIRHelpers",
          "resource": "Library/FHIRHelpers|4.4.000"
        },
        {
          "type": "depends-on",
          "display": "Library SDE",
          "resource": "Library/SupplementalDataElements|5.1.000"
        },
        {
          "type": "depends-on",
          "display": "Library FHIRHelpers",
          "resource": "Library/FHIRHelpers|4.4.000"
        },
        {
          "type": "depends-on",
          "display": "Library FHIRHelpers",
          "resource": "Library/FHIRHelpers|4.4.000"
        },
        {
          "type": "depends-on",
          "display": "Code system SNOMEDCT",
          "resource": "http://snomed.info/sct"
        },
        {
          "type": "depends-on",
          "display": "Code system ConditionClinicalStatusCodes",
          "resource": "http://terminology.hl7.org/CodeSystem/condition-clinical"
        },
        {
          "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"
        },
        {
          "type": "depends-on",
          "display": "Value set Hospice Care Referral or Admission",
          "resource": "http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1116.365"
        },
        {
          "type": "depends-on",
          "display": "Value set Hospice Status",
          "resource": "http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1095.101"
        },
        {
          "type": "depends-on",
          "display": "Value set Observation Services",
          "resource": "http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1111.143"
        },
        {
          "type": "depends-on",
          "display": "Value set Emergency Department Visit",
          "resource": "http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.117.1.7.1.292"
        },
        {
          "type": "depends-on",
          "display": "Value set Malnutrition Risk Screening",
          "resource": "http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1095.92"
        },
        {
          "type": "depends-on",
          "display": "Value set Malnutrition Screening Finding of Not At Risk Result",
          "resource": "http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1095.34"
        },
        {
          "type": "depends-on",
          "display": "Value set Malnutrition Screening Finding of At Risk Result",
          "resource": "http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1095.89"
        },
        {
          "type": "depends-on",
          "display": "Value set Dietitian Referral",
          "resource": "http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1095.91"
        },
        {
          "type": "depends-on",
          "display": "Value set Nutrition Assessment",
          "resource": "http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1095.21"
        },
        {
          "type": "depends-on",
          "display": "Value set Nutrition Assessment Status Finding of Well Nourished or Not Malnourished or Mildly Malnourished",
          "resource": "http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1095.96"
        },
        {
          "type": "depends-on",
          "display": "Value set Nutrition Assessment Status Finding of Moderately Malnourished",
          "resource": "http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1095.47"
        },
        {
          "type": "depends-on",
          "display": "Value set Nutrition Assessment Status Finding of Severely Malnourished",
          "resource": "http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1095.43"
        },
        {
          "type": "depends-on",
          "display": "Value set Malnutrition Diagnosis",
          "resource": "http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1095.55"
        },
        {
          "type": "depends-on",
          "display": "Value set Nutrition Care Plan",
          "resource": "http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1095.93"
        },
        {
          "type": "depends-on",
          "display": "Value set Payer Type",
          "resource": "http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.114222.4.11.3591"
        }
      ],
      "parameter": [
        {
          "name": "Measurement Period",
          "use": "in",
          "min": 0,
          "max": "1",
          "type": "Period"
        },
        {
          "name": "Measure Population Exclusion",
          "use": "out",
          "min": 0,
          "max": "*",
          "type": "Resource"
        },
        {
          "name": "SDE Race",
          "use": "out",
          "min": 0,
          "max": "1",
          "type": "Resource"
        },
        {
          "name": "SDE Sex",
          "use": "out",
          "min": 0,
          "max": "1",
          "type": "Coding"
        },
        {
          "name": "SDE Payer Type",
          "use": "out",
          "min": 0,
          "max": "*",
          "type": "Resource"
        },
        {
          "name": "Initial Population",
          "use": "out",
          "min": 0,
          "max": "*",
          "type": "Resource"
        },
        {
          "name": "SDE Ethnicity",
          "use": "out",
          "min": 0,
          "max": "1",
          "type": "Resource"
        },
        {
          "name": "Measure Population",
          "use": "out",
          "min": 0,
          "max": "*",
          "type": "Resource"
        }
      ],
      "dataRequirement": [
        {
          "type": "Patient",
          "profile": [
            "http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-patient"
          ]
        },
        {
          "type": "Encounter",
          "profile": [
            "http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-encounter"
          ],
          "mustSupport": [
            "type",
            "period",
            "status",
            "status.value"
          ],
          "codeFilter": [
            {
              "path": "type",
              "valueSet": "http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.666.5.307"
            }
          ]
        },
        {
          "type": "Encounter",
          "profile": [
            "http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-encounter"
          ],
          "mustSupport": [
            "type",
            "period",
            "status",
            "status.value",
            "hospitalization",
            "hospitalization.dischargeDisposition"
          ],
          "codeFilter": [
            {
              "path": "type",
              "valueSet": "http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.666.5.307"
            }
          ]
        },
        {
          "type": "ServiceRequest",
          "profile": [
            "http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-servicerequest"
          ],
          "mustSupport": [
            "code",
            "status",
            "status.value",
            "intent",
            "intent.value",
            "doNotPerform",
            "doNotPerform.value"
          ],
          "codeFilter": [
            {
              "path": "code",
              "valueSet": "http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1095.101"
            }
          ]
        },
        {
          "type": "Procedure",
          "profile": [
            "http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-procedure"
          ],
          "mustSupport": [
            "code",
            "status",
            "status.value"
          ],
          "codeFilter": [
            {
              "path": "code",
              "valueSet": "http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1095.101"
            }
          ]
        },
        {
          "type": "Patient",
          "profile": [
            "http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-patient"
          ]
        },
        {
          "type": "Encounter",
          "profile": [
            "http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-encounter"
          ],
          "mustSupport": [
            "type",
            "status",
            "status.value",
            "period"
          ],
          "codeFilter": [
            {
              "path": "type",
              "valueSet": "http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1111.143"
            }
          ]
        },
        {
          "type": "Encounter",
          "profile": [
            "http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-encounter"
          ],
          "mustSupport": [
            "type",
            "status",
            "status.value",
            "period"
          ],
          "codeFilter": [
            {
              "path": "type",
              "valueSet": "http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.117.1.7.1.292"
            }
          ]
        },
        {
          "type": "Encounter",
          "profile": [
            "http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-encounter"
          ],
          "mustSupport": [
            "type",
            "status",
            "status.value",
            "period"
          ],
          "codeFilter": [
            {
              "path": "type",
              "valueSet": "http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1111.143"
            }
          ]
        },
        {
          "type": "Encounter",
          "profile": [
            "http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-encounter"
          ],
          "mustSupport": [
            "type",
            "status",
            "status.value",
            "period"
          ],
          "codeFilter": [
            {
              "path": "type",
              "valueSet": "http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.117.1.7.1.292"
            }
          ]
        },
        {
          "type": "Encounter",
          "profile": [
            "http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-encounter"
          ],
          "mustSupport": [
            "type",
            "period",
            "status",
            "status.value"
          ],
          "codeFilter": [
            {
              "path": "type",
              "valueSet": "http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.666.5.307"
            }
          ]
        },
        {
          "type": "Patient",
          "profile": [
            "http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-patient"
          ]
        },
        {
          "type": "Patient",
          "profile": [
            "http://hl7.org/fhir/us/qicore/StructureDefinition/qicore-patient"
          ],
          "mustSupport": [
            "url"
          ]
        },
        {
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    }
  ],
  "description": "This measure assesses the percentage of eligible encounters of adults aged 18 years and older at the start of the eligible 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 eligible encounter, adult inpatients are (1) screened for malnutrition risk or for a 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 nutrition assessment, (3) receive a \"moderate\" or \"severe\" malnutrition diagnosis by a physician or eligible clinician 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": "Percentage of hospitalizations where a patient 18 years of age or older, admitted for 24-hours or more, received optimal malnutrition care",
  "usage": "This measure is constructed of four clinically eligible components that are aggregated as an arithmetic average of eligible encounters 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 dCQM is an episode-based measure. An episode is defined as each eligible encounter with a length of stay of greater than or equal to 24 hours among individuals 18 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: CMS986v5.\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 2025 \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 2004-2024 Regenstrief Institute, Inc.  \n\nICD-10 copyright 2024 World Health Organization. \n\nThis material contains SNOMED Clinical Terms (R) (SNOMED CT [R]) copyright 2004-2024. International Health Terminology Standards Development Organisation.\nAll 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"
        }
      ]
    }
  ],
  "relatedArtifact": [
    {
      "type": "citation",
      "citation": "Citation - Academy of Nutrition and Dietetics. (2017). The Nutrition Care Process Model. Retrieved June 12, 2023 from https://www.ncpro.org/pubs/2020-encpt-en/ncp-model\n"
    },
    {
      "type": "citation",
      "citation": "Citation - Hiller, L.D., Shaw, R.F., & Fabri, P.J. (2017) Difference in composite end point of readmission and death between malnourished and nonmalnourished veterans assessed using Academy of Nutrition and Dietetics/American Society for Parenteral and Enteral Nutrition clinical characteristics. Journal of  Parenteral and Enteral Nutrition, 41(8), 1316-1324. https://doi.org/10.1177/0148607116668523\n"
    },
    {
      "type": "citation",
      "citation": "Citation - Hudson, L., Chittams, J., Griffith, C., & Compher, C. (2018) Malnutrition identified by Academy of Nutrition and Dietetics/American Society for Parenteral and Enteral Nutrition is associated with more 30-day readmissions, greater hospital mortality, and longer hospital stays: a retrospective analysis of nutrition assessment data in a major medical center. Journal of Parenteral and Enteral Nutrition, 42(5), 892-897. https://doi.org/10.1002/jpen.1021\n"
    },
    {
      "type": "citation",
      "citation": "Citation - Mogensen, K.M., Malone, A., Becker, P., Cutrell, S., Frank, L., Gonzales, K., Hudson, L., Miller, S., Guenter, P.  (2019) Academy of Nutrition and Dietetics/American Society for Parenteral and Enteral Nutrition Consensus Malnutrition Characteristics: Usability and Association With Outcomes. Nutrition in Clinical Practice, 34 (5), 657–665. https://doi.org/10.1002/ncp.10310\n"
    },
    {
      "type": "citation",
      "citation": "Citation - Mosquera, C., Koutlas, N.J., Edwards, K.C., Strickland, A., Vohra, N. A., Zervos, E.E., & Fitzgerald, T.L. (2016). Impact of malnutrition on gastrointestinal surgical patients. Journal of Surgical Research. 205(1), 95-101. https://doi.org/10.1016/j.jss.2016.05.030\n"
    },
    {
      "type": "citation",
      "citation": "Citation - Mueller, C., Compher, C., Druyan, M.E., & the ASPEN Board of Directors. (2011). ASPEN clinical guidelines on nutrition screening, assessment, and intervention in adults: Journal of Parenteral and Enteral Nutrition, 35(1), 16-24. https://doi.org/10.1177/0148607110389335\n"
    },
    {
      "type": "citation",
      "citation": "Citation - Sriram, K., Sulo, S., VanDerBosc,h .G, Partridge, J., Feldstein, J., Hegazi, R.A., Summerfelt, W.T. (2016) A comprehensive nutrition-focused quality improvement program reduces 30-day readmissions and length of stay in hospitalized patients. Journal of Parenteral and Enteral Nutrition, 41(3), 384-391. https://doi.org/10.1177/0148607116681468\n"
    }
  ],
  "library": [
    "https://madie.cms.gov/Library/CMS986FHIRMalnutritionScore"
  ],
  "disclaimer": "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. \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].",
  "rationale": "Malnutrition has been documented in approximately one-third of patients in developed countries upon admission to the hospital, and, if left untreated, can significantly impact important clinical outcomes (Mogensen et al., 2019). Adult patients with malnutrition have a significantly longer hospital length of stay (LOS) (Hudson, Chittams, Griffith, & Compher, 2018 and Mosquera et al., 2016) and significantly more patients with malnutrition have a LOS of greater than 7 days when compared to their well-nourished counterparts. Additionally, both higher rates of 30-day readmission and a significantly higher likelihood of 30-day readmission are observed in these patients (Mogensen et al., 2019; Hiller, Shaw, & Fabri, 2016; Mosquera et al., 2016). Lastly, hospitalized adults with malnutrition have an increased likelihood of death within 90 days of discharge (Hiller, Shaw, & Fabri, 2016). These consequences demonstrate the importance of addressing malnutrition in hospitalized patients to improve outcomes. \n\nThe components of this measure are supported by clinical guidance that recommends (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 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 nutrition problems 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 clinician as defined by CMS. The four measure observations individually provide a portion of the necessary information on the quality of care for patients at risk for or with malnutrition. Therefore, the four components are summed and averaged according to a patient’s degree of malnutrition and/or malnutrition risk to determine an encounter-level Malnutrition Care Score. \n\nHigh performance on this measure requires malnutrition risk screening and/or referral to RDNs for appropriate nutrition assessment for identified patients during the current hospitalization. For patients identified with 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 patients with malnutrition and subsequent improvements in rates of associated nutrition interventions. Outcomes modeling demonstrates 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 et al., 2016).",
  "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, Compher, Druyan, & ASPEN Board of Directors, 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 plans 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.",
  "group": [
    {
      "id": "Group_1",
      "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"
              }
            ]
          }
        },
        {
          "url": "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-improvementNotation",
          "valueCodeableConcept": {
            "coding": [
              {
                "system": "http://terminology.hl7.org/CodeSystem/measure-improvement-notation",
                "code": "increase",
                "display": "Increased score indicates improvement"
              }
            ]
          }
        }
      ],
      "description": "Population Criteria 1 ",
      "population": [
        {
          "id": "InitialPopulation_1",
          "code": {
            "coding": [
              {
                "system": "http://terminology.hl7.org/CodeSystem/measure-population",
                "code": "initial-population",
                "display": "Initial Population"
              }
            ]
          },
          "description": "Eligible encounters during the measurement period with length of stay of 24 hours or more among individuals 18 years of age and older at the start of the inpatient encounter",
          "criteria": {
            "language": "text/cql-identifier",
            "expression": "Initial Population"
          }
        },
        {
          "id": "MeasurePopulation_1",
          "code": {
            "coding": [
              {
                "system": "http://terminology.hl7.org/CodeSystem/measure-population",
                "code": "measure-population",
                "display": "Measure Population"
              }
            ]
          },
          "description": "Equals Initial Population",
          "criteria": {
            "language": "text/cql-identifier",
            "expression": "Measure Population"
          }
        },
        {
          "id": "MeasurePopulationExclusion_1",
          "code": {
            "coding": [
              {
                "system": "http://terminology.hl7.org/CodeSystem/measure-population",
                "code": "measure-population-exclusion",
                "display": "Measure Population Exclusion"
              }
            ]
          },
          "description": "Encounters with hospice care ordered during the inpatient qualifying encounter and encounters with a discharge disposition of hospice",
          "criteria": {
            "language": "text/cql-identifier",
            "expression": "Measure Population Exclusion"
          }
        },
        {
          "id": "MeasureObservation_1",
          "extension": [
            {
              "url": "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-aggregateMethod",
              "valueString": "Sum"
            },
            {
              "url": "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-criteriaReference",
              "valueString": "MeasurePopulation_1"
            }
          ],
          "code": {
            "coding": [
              {
                "system": "http://terminology.hl7.org/CodeSystem/measure-population",
                "code": "measure-observation",
                "display": "Measure Observation"
              }
            ]
          },
          "description": "Component Measure 1: Eligible encounters for patients with a current \"Malnutrition Risk Screening\" performed by an eligible healthcare clinician or a Dietitian Referral. \n\n\"Measure Observation 1\" is \"Encounters with Malnutrition Risk Screening and Identified Result or a Dietitian Referral\" \n\n\"Measure Observation 1\" identifies eligible encounters where a \"Malnutrition Risk Screening\" was performed or authored during the encounter (including preceding observation or emergency department encounters) with an identified \"Malnutrition Screening Finding of Not At Risk Result\" or \"Malnutrition Screening Finding of At Risk Result\". It also identifies an eligible encounter where there is a Dietitian Referral, whether there is a \"Malnutrition Risk Screening\" performed or not.\n",
          "criteria": {
            "language": "text/cql-identifier",
            "expression": "Measure Observation 1"
          }
        }
      ]
    },
    {
      "id": "Group_2",
      "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"
              }
            ]
          }
        },
        {
          "url": "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-improvementNotation",
          "valueCodeableConcept": {
            "coding": [
              {
                "system": "http://terminology.hl7.org/CodeSystem/measure-improvement-notation",
                "code": "increase",
                "display": "Increased score indicates improvement"
              }
            ]
          }
        }
      ],
      "description": "Nutrition Assessment",
      "population": [
        {
          "id": "InitialPopulation_2",
          "code": {
            "coding": [
              {
                "system": "http://terminology.hl7.org/CodeSystem/measure-population",
                "code": "initial-population",
                "display": "Initial Population"
              }
            ]
          },
          "description": "Eligible encounters during the measurement period with length of stay of 24 hours or more among individuals 18 years of age and older at the start of the inpatient encounter",
          "criteria": {
            "language": "text/cql-identifier",
            "expression": "Initial Population"
          }
        },
        {
          "id": "MeasurePopulation_2",
          "code": {
            "coding": [
              {
                "system": "http://terminology.hl7.org/CodeSystem/measure-population",
                "code": "measure-population",
                "display": "Measure Population"
              }
            ]
          },
          "description": "Equals Initial Population",
          "criteria": {
            "language": "text/cql-identifier",
            "expression": "Measure Population"
          }
        },
        {
          "id": "MeasurePopulationExclusion_2",
          "code": {
            "coding": [
              {
                "system": "http://terminology.hl7.org/CodeSystem/measure-population",
                "code": "measure-population-exclusion",
                "display": "Measure Population Exclusion"
              }
            ]
          },
          "description": "Encounters with hospice care ordered during the inpatient qualifying encounter and encounters with a discharge disposition of hospice",
          "criteria": {
            "language": "text/cql-identifier",
            "expression": "Measure Population Exclusion"
          }
        },
        {
          "id": "MeasureObservation_2",
          "extension": [
            {
              "url": "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-aggregateMethod",
              "valueString": "Sum"
            },
            {
              "url": "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-criteriaReference",
              "valueString": "MeasurePopulation_2"
            }
          ],
          "code": {
            "coding": [
              {
                "system": "http://terminology.hl7.org/CodeSystem/measure-population",
                "code": "measure-observation",
                "display": "Measure Observation"
              }
            ]
          },
          "description": "Component Measure 2: Eligible encounters for patients with a documented \"Nutrition Assessment\" performed by an RD/RDN, after a \"Malnutrition Screening Finding of At Risk Result\" or a \"Dietitian Referral\" order from a physician or eligible clinician during the current encounter. \n\n\"Measure Observation 2\" is \"Encounter With Most Recent Nutrition Assessment And Identified Status\" \n\n\"Measure Observation 2\" identifies eligible encounters where a \"Nutrition Assessment\" was performed or authored during the encounter (including preceding observation or emergency department encounters) with an identified \"Nutrition Assessment Status Finding of Well Nourished or Not Malnourished or Mildly Malnourished\", \"Nutrition Assessment Status Finding of Moderately Malnourished\", or \"Nutrition Assessment Status Finding of Severely Malnourished\".\n",
          "criteria": {
            "language": "text/cql-identifier",
            "expression": "Measure Observation 2"
          }
        }
      ]
    },
    {
      "id": "Group_3",
      "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"
              }
            ]
          }
        },
        {
          "url": "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-improvementNotation",
          "valueCodeableConcept": {
            "coding": [
              {
                "system": "http://terminology.hl7.org/CodeSystem/measure-improvement-notation",
                "code": "increase",
                "display": "Increased score indicates improvement"
              }
            ]
          }
        }
      ],
      "description": "Malnutrition Diagnosis",
      "population": [
        {
          "id": "InitialPopulation_3",
          "code": {
            "coding": [
              {
                "system": "http://terminology.hl7.org/CodeSystem/measure-population",
                "code": "initial-population",
                "display": "Initial Population"
              }
            ]
          },
          "description": "Eligible encounters during the measurement period with length of stay of 24 hours or more among individuals 18 years of age and older at the start of the inpatient encounter",
          "criteria": {
            "language": "text/cql-identifier",
            "expression": "Initial Population"
          }
        },
        {
          "id": "MeasurePopulation_3",
          "code": {
            "coding": [
              {
                "system": "http://terminology.hl7.org/CodeSystem/measure-population",
                "code": "measure-population",
                "display": "Measure Population"
              }
            ]
          },
          "description": "Equals Initial Population",
          "criteria": {
            "language": "text/cql-identifier",
            "expression": "Measure Population"
          }
        },
        {
          "id": "MeasurePopulationExclusion_3",
          "code": {
            "coding": [
              {
                "system": "http://terminology.hl7.org/CodeSystem/measure-population",
                "code": "measure-population-exclusion",
                "display": "Measure Population Exclusion"
              }
            ]
          },
          "description": "Encounters with hospice care ordered during the inpatient qualifying encounter and encounters with a discharge disposition of hospice",
          "criteria": {
            "language": "text/cql-identifier",
            "expression": "Measure Population Exclusion"
          }
        },
        {
          "id": "MeasureObservation_3",
          "extension": [
            {
              "url": "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-aggregateMethod",
              "valueString": "Sum"
            },
            {
              "url": "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-criteriaReference",
              "valueString": "MeasurePopulation_3"
            }
          ],
          "code": {
            "coding": [
              {
                "system": "http://terminology.hl7.org/CodeSystem/measure-population",
                "code": "measure-observation",
                "display": "Measure Observation"
              }
            ]
          },
          "description": "Component Measure 3: Eligible encounters for patients with a documented \"Malnutrition Diagnosis\" based on the most recent finding of \"Nutrition Assessment Status Finding of Moderately Malnourished\" or \"Nutrition Assessment Status Finding of Severely Malnourished\".\n\n\"Measure Observation 3\" is \"Encounters with Malnutrition Diagnosis\"\n\n\"Measure Observation 3\" identifies eligible encounters where a \"Malnutrition Diagnosis\" was active during the encounter (including preceding observation or emergency department encounters).\n",
          "criteria": {
            "language": "text/cql-identifier",
            "expression": "Measure Observation 3"
          }
        }
      ]
    },
    {
      "id": "Group_4",
      "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"
              }
            ]
          }
        },
        {
          "url": "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-improvementNotation",
          "valueCodeableConcept": {
            "coding": [
              {
                "system": "http://terminology.hl7.org/CodeSystem/measure-improvement-notation",
                "code": "increase",
                "display": "Increased score indicates improvement"
              }
            ]
          }
        }
      ],
      "description": "Nutrition Care Plan",
      "population": [
        {
          "id": "InitialPopulation_4",
          "code": {
            "coding": [
              {
                "system": "http://terminology.hl7.org/CodeSystem/measure-population",
                "code": "initial-population",
                "display": "Initial Population"
              }
            ]
          },
          "description": "Eligible encounters during the measurement period with length of stay of 24 hours or more among individuals 18 years of age and older at the start of the inpatient encounter",
          "criteria": {
            "language": "text/cql-identifier",
            "expression": "Initial Population"
          }
        },
        {
          "id": "MeasurePopulation_4",
          "code": {
            "coding": [
              {
                "system": "http://terminology.hl7.org/CodeSystem/measure-population",
                "code": "measure-population",
                "display": "Measure Population"
              }
            ]
          },
          "description": "Equals Initial Population",
          "criteria": {
            "language": "text/cql-identifier",
            "expression": "Measure Population"
          }
        },
        {
          "id": "MeasurePopulationExclusion_4",
          "code": {
            "coding": [
              {
                "system": "http://terminology.hl7.org/CodeSystem/measure-population",
                "code": "measure-population-exclusion",
                "display": "Measure Population Exclusion"
              }
            ]
          },
          "description": "Encounters with hospice care ordered during the inpatient qualifying encounter and encounters with a discharge disposition of hospice",
          "criteria": {
            "language": "text/cql-identifier",
            "expression": "Measure Population Exclusion"
          }
        },
        {
          "id": "MeasureObservation_4",
          "extension": [
            {
              "url": "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-aggregateMethod",
              "valueString": "Sum"
            },
            {
              "url": "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-criteriaReference",
              "valueString": "MeasurePopulation_4"
            }
          ],
          "code": {
            "coding": [
              {
                "system": "http://terminology.hl7.org/CodeSystem/measure-population",
                "code": "measure-observation",
                "display": "Measure Observation"
              }
            ]
          },
          "description": "Component Measure 4: Eligible encounters for patients with a documented \"Nutrition Care Plan\" based on the most recent finding of \"Nutrition Assessment Status Finding of Moderately Malnourished\" or “Nutrition Assessment Status Finding of Severely Malnourished”. \n\n“Measure Observation 4” is “Encounters with Nutrition Care Plan”\n\n\"Measure Observation 4\" identifies eligible encounters where a \"Nutrition Care Plan\" was performed or authored during the encounter (including preceding observation or emergency department encounters).\n",
          "criteria": {
            "language": "text/cql-identifier",
            "expression": "Measure Observation 4"
          }
        }
      ]
    },
    {
      "id": "Group_5",
      "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"
              }
            ]
          }
        },
        {
          "url": "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-improvementNotation",
          "valueCodeableConcept": {
            "coding": [
              {
                "system": "http://terminology.hl7.org/CodeSystem/measure-improvement-notation",
                "code": "increase",
                "display": "Increased score indicates improvement"
              }
            ]
          }
        }
      ],
      "description": "Total Malnutrition Care Components",
      "population": [
        {
          "id": "InitialPopulation_5",
          "code": {
            "coding": [
              {
                "system": "http://terminology.hl7.org/CodeSystem/measure-population",
                "code": "initial-population",
                "display": "Initial Population"
              }
            ]
          },
          "description": "Eligible encounters during the measurement period with length of stay of 24 hours or more among individuals 18 years of age and older at the start of the inpatient encounter",
          "criteria": {
            "language": "text/cql-identifier",
            "expression": "Initial Population"
          }
        },
        {
          "id": "MeasurePopulation_5",
          "code": {
            "coding": [
              {
                "system": "http://terminology.hl7.org/CodeSystem/measure-population",
                "code": "measure-population",
                "display": "Measure Population"
              }
            ]
          },
          "description": "Equals Initial Population",
          "criteria": {
            "language": "text/cql-identifier",
            "expression": "Measure Population"
          }
        },
        {
          "id": "MeasurePopulationExclusion_5",
          "code": {
            "coding": [
              {
                "system": "http://terminology.hl7.org/CodeSystem/measure-population",
                "code": "measure-population-exclusion",
                "display": "Measure Population Exclusion"
              }
            ]
          },
          "description": "Encounters with hospice care ordered during the inpatient qualifying encounter and encounters with a discharge disposition of hospice",
          "criteria": {
            "language": "text/cql-identifier",
            "expression": "Measure Population Exclusion"
          }
        },
        {
          "id": "MeasureObservation_5",
          "extension": [
            {
              "url": "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-aggregateMethod",
              "valueString": "Count"
            },
            {
              "url": "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-criteriaReference",
              "valueString": "MeasurePopulation_5"
            }
          ],
          "code": {
            "coding": [
              {
                "system": "http://terminology.hl7.org/CodeSystem/measure-population",
                "code": "measure-observation",
                "display": "Measure Observation"
              }
            ]
          },
          "description": "Population 5 \"Measure Observation Total Malnutrition Components Score\" Calculations-For each eligible encounter, Population Criteria 5 represents the subtotal of Measure Observations performed for Population Criteria 1, 2, 3, and 4. Possible values may be 0, 1, 2, 3, or 4.\n \nPopulation 5 \"Measure Observation Total Malnutrition Components Score\" is (\"Measure Observation 1\" plus \"Measure Observation 2\" plus \"Measure Observation 3\" plus \"Measure Observation 4\")",
          "criteria": {
            "language": "text/cql-identifier",
            "expression": "Measure Observation Total Malnutrition Components Score"
          }
        }
      ]
    },
    {
      "id": "Group_6",
      "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"
              }
            ]
          }
        },
        {
          "url": "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-improvementNotation",
          "valueCodeableConcept": {
            "coding": [
              {
                "system": "http://terminology.hl7.org/CodeSystem/measure-improvement-notation",
                "code": "increase",
                "display": "Increased score indicates improvement"
              }
            ]
          }
        }
      ],
      "description": "Encounter Malnutrition Care Score",
      "population": [
        {
          "id": "InitialPopulation_6",
          "code": {
            "coding": [
              {
                "system": "http://terminology.hl7.org/CodeSystem/measure-population",
                "code": "initial-population",
                "display": "Initial Population"
              }
            ]
          },
          "description": "Eligible encounters during the measurement period with length of stay of 24 hours or more among individuals 18 years of age and older at the start of the inpatient encounter",
          "criteria": {
            "language": "text/cql-identifier",
            "expression": "Initial Population"
          }
        },
        {
          "id": "MeasurePopulation_6",
          "code": {
            "coding": [
              {
                "system": "http://terminology.hl7.org/CodeSystem/measure-population",
                "code": "measure-population",
                "display": "Measure Population"
              }
            ]
          },
          "description": "Equals Initial Population",
          "criteria": {
            "language": "text/cql-identifier",
            "expression": "Measure Population"
          }
        },
        {
          "id": "MeasurePopulationExclusion_6",
          "code": {
            "coding": [
              {
                "system": "http://terminology.hl7.org/CodeSystem/measure-population",
                "code": "measure-population-exclusion",
                "display": "Measure Population Exclusion"
              }
            ]
          },
          "description": "Encounters with hospice care ordered during the inpatient qualifying encounter and encounters with a discharge disposition of hospice",
          "criteria": {
            "language": "text/cql-identifier",
            "expression": "Measure Population Exclusion"
          }
        },
        {
          "id": "MeasureObservation_6",
          "extension": [
            {
              "url": "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-aggregateMethod",
              "valueString": "Average"
            },
            {
              "url": "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-criteriaReference",
              "valueString": "MeasurePopulation_6"
            }
          ],
          "code": {
            "coding": [
              {
                "system": "http://terminology.hl7.org/CodeSystem/measure-population",
                "code": "measure-observation",
                "display": "Measure Observation"
              }
            ]
          },
          "description": "Population 6 \"Measure Observation Total Malnutrition Care Score as Percentage\" Calculations:-For each eligible encounter, Population Criteria 6 represents the sum of performed Measure Observations 1, 2, 3, and 4 divided by the number of clinically eligible occurrences.\n\nPopulation 6 \"Measure Observation Total Malnutrition Care Score as Percentage\" is 100 multiplied by (\"Measure Observation Total Malnutrition Components Score\" divided by \"Total Malnutrition Care Score Eligible Occurrences\"). Possible values may be 0, 50, 75, or 100 percent.\n\n\"Total Malnutrition Care Score Eligible Occurrences\" is always 4 except in the following instances:\n-The \"Total Malnutrition Care Score Eligible Occurrences\" is 1 if\n---A \"Malnutrition Risk Screening\" was performed and a \"Malnutrition Screening Finding of Not At Risk Result\" was identified and \"Dietitian Referral\" was not ordered.- The \"Total Malnutrition Care Score Eligible Occurrences\" is 2\n---If the most recent \"Nutrition Assessment\" performed has a result of \"Nutrition Status Finding of Well Nourished or Not Malnourished or Mildly Malnourished\".\n--- A \"Malnutrition Risk Screening\" was performed and a \"Malnutrition Screening Finding of Not At Risk Result\" was identified and \"Dietitian Referral\" was ordered or a \"Malnutrition Risk Screening\" was performed and a \"Malnutrition Screening Finding of At Risk Result\" was identified but the “Nutrition Assessment” was not performed.",
          "criteria": {
            "language": "text/cql-identifier",
            "expression": "Measure Observation Total Malnutrition Care Score as Percentage"
          }
        }
      ]
    }
  ],
  "supplementalData": [
    {
      "id": "sde-payer-type",
      "usage": [
        {
          "coding": [
            {
              "system": "http://terminology.hl7.org/CodeSystem/measure-data-usage",
              "code": "supplemental-data"
            }
          ]
        }
      ],
      "description": "SDE Payer Type",
      "criteria": {
        "language": "text/cql-identifier",
        "expression": "SDE Payer Type"
      }
    },
    {
      "id": "sde-race",
      "usage": [
        {
          "coding": [
            {
              "system": "http://terminology.hl7.org/CodeSystem/measure-data-usage",
              "code": "supplemental-data"
            }
          ]
        }
      ],
      "description": "SDE Race",
      "criteria": {
        "language": "text/cql-identifier",
        "expression": "SDE Race"
      }
    },
    {
      "id": "sde-ethnicity",
      "usage": [
        {
          "coding": [
            {
              "system": "http://terminology.hl7.org/CodeSystem/measure-data-usage",
              "code": "supplemental-data"
            }
          ]
        }
      ],
      "description": "SDE Ethnicity",
      "criteria": {
        "language": "text/cql-identifier",
        "expression": "SDE Ethnicity"
      }
    },
    {
      "id": "sde-sex",
      "extension": [
        {
          "url": "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-includeInReportType",
          "valueCode": "individual"
        },
        {
          "url": "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-includeInReportType",
          "valueCode": "subject-list"
        },
        {
          "url": "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-includeInReportType",
          "valueCode": "summary"
        },
        {
          "url": "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-includeInReportType",
          "valueCode": "data-collection"
        }
      ],
      "usage": [
        {
          "coding": [
            {
              "system": "http://terminology.hl7.org/CodeSystem/measure-data-usage",
              "code": "supplemental-data"
            }
          ]
        }
      ],
      "description": "SDE Sex",
      "criteria": {
        "language": "text/cql-identifier",
        "expression": "SDE Sex"
      }
    }
  ]
}