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Package gov.healthit.ecqi.ecqms
Type Measure
Id Id
FHIR Version R4
Source http://ecqi.healthit.gov/ecqms/https://build.fhir.org/ig/cqframework/ecqm-content-qicore-2024/Measure-UrinarySymptomScoreChangeAfterBenignProstaticHyperplasiaFHIR.html
Url https://madie.cms.gov/Measure/UrinarySymptomScoreChangeAfterBenignProstaticHyperplasiaFHIR
Version 1.4.000
Status draft
Date 2024-12-16T18:17:09+00:00
Name UrinarySymptomScoreChangeAfterBenignProstaticHyperplasiaFHIR
Title Urinary Symptom Score Change 6-12 Months After Diagnosis of Benign Prostatic HyperplasiaFHIR
Experimental False
Description Percentage of patients with an office visit within the measurement period and with a new diagnosis of clinically significant Benign Prostatic Hyperplasia who have International Prostate Symptoms Score (IPSS) or American Urological Association (AUA) Symptom Index (SI) documented at time of diagnosis and again 6-12 months later with an improvement of 3 points
Purpose UNKNOWN
Copyright Limited proprietary coding is contained in the measure specifications for user convenience. Users of the proprietary code sets should obtain all necessary licenses from the owners of these code sets. Large Urology Group Practice Association (LUGPA) and Oregon Urology Institute (OUI) disclaim all liability for use or accuracy of any third party codes contained in the specifications. CPT(R) contained in the Measure specifications is copyright 2004-2023. American Medical Association. LOINC(R) copyright 2004-2023 Regenstrief Institute, Inc. This material contains SNOMED Clinical Terms(R) (SNOMED CT[R]) copyright 2004-2023 International Health Terminology Standards Development Organisation. ICD-10 copyright 2023 World Health Organization. All Rights Reserved.

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Narrative

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Title: Urinary Symptom Score Change 6-12 Months After Diagnosis of Benign Prostatic HyperplasiaFHIR
Id: UrinarySymptomScoreChangeAfterBenignProstaticHyperplasiaFHIR
Version: 1.4.000
Url: Urinary Symptom Score Change 6-12 Months After Diagnosis of Benign Prostatic HyperplasiaFHIR
short-name identifier:

CMS771FHIR

version-independent identifier:

urn:uuid:0748d873-8e20-441e-9bbf-c1eefe3ea054

version-specific identifier:

urn:uuid:43e6a3d8-3d0d-4d94-b4c2-bb0232d83fb2

publisher (CMS) identifier:

771FHIR

Effective Period: 2025-01-01..2025-12-31
Status: draft
Publisher: Large Urology Group Practice Association (LUGPA)
Author: Large Urology Group Practice Association (LUGPA)
Description:

Percentage of patients with an office visit within the measurement period and with a new diagnosis of clinically significant Benign Prostatic Hyperplasia who have International Prostate Symptoms Score (IPSS) or American Urological Association (AUA) Symptom Index (SI) documented at time of diagnosis and again 6-12 months later with an improvement of 3 points
Purpose:

UNKNOWN
Copyright:

Limited proprietary coding is contained in the measure specifications for user convenience. Users of the proprietary code sets should obtain all necessary licenses from the owners of these code sets. Large Urology Group Practice Association (LUGPA) and Oregon Urology Institute (OUI) disclaim all liability for use or accuracy of any third party codes contained in the specifications. CPT(R) contained in the Measure specifications is copyright 2004-2023. American Medical Association. LOINC(R) copyright 2004-2023 Regenstrief Institute, Inc. This material contains SNOMED Clinical Terms(R) (SNOMED CT[R]) copyright 2004-2023 International Health Terminology Standards Development Organisation. ICD-10 copyright 2023 World Health Organization. All Rights Reserved.
Disclaimer:

The performance measure is not a clinical guideline and does not establish a standard of medical care, and has not been tested for all potential applications. THE MEASURE AND SPECIFICATIONS ARE PROVIDED "AS IS" WITHOUT WARRANTY OF ANY KIND. Due to technical limitations, registered trademarks are indicated by (R) or [R], and unregistered trademarks are indicated by (TM) or [TM].
Scoring:

Proportion

Rationale:

Benign prostatic hyperplasia (BPH) is one of the most common conditions affecting older men, with a prevalence of 50% by age 60 years and 90% by the ninth decade of life (Medina et al., 1999). The enlarged gland had been proposed to contribute to the overall lower urinary tract symptoms (LUTS) complex (McVary et al., 2014). Although LUTS secondary to BPH is not often a life-threatening condition, the impact of LUTS/BPH on quality of life can be significant (Wei et al., 2005). The American Urological Association Symptom Index (AUA-SI) and the International Prostate Symptom Score (IPSS) were developed to measure outcomes in studies of different treatments for BPH (Wuerstle et al., 2011). The IPSS uses the same questions as the AUA-SI, but also adds a disease-specific quality of life question (OLeary, 2005). The IPSS was adopted in 1993 by the World Health Organization. It is a reproducible, validated index designed to determine disease severity and response to therapy (D’Silva et al., 2014). It includes 3 storage symptom questions (frequency, nocturia, urgency) and four voiding symptoms (feeling of incomplete emptying, intermittency, straining, and a weak stream) as well as a Bother question: If you were to spend the rest of your life with your urinary condition just the way it is now, how would you feel about that? A three-point improvement in the score is considered meaningful (McVary et al., 2014).
Clinical recommendation statement:

The symptoms of BPH are lower urinary tract symptoms (LUTS). There are other disorders with similar symptoms that need to be excluded. History, physical examination, and testing are required prior to a diagnosis of BPH. IPSS by itself is not a reliable diagnostic tool for LUTS suggestive of BPH but serves as a quantitative measure of LUTS after the diagnosis is established (D’Silva et al., 2014). Medical and surgical interventions for BPH recommend a follow up IPSS evaluation to determine effectiveness of treatment. IPSS should be evaluated at the time of diagnosis and after definitive treatment.
Guidance (Usage): The IPSS is inclusive of the symptom index score and the quality of life score. The AUA-SI is the symptom index score alone and must be added to the QOL score. The AUA-SI with the QOL equals the IPSS. Both of these are the urinary symptom score. The patient must have a urinary symptom score (USS) within 1 month after initial diagnosis. If more than one USS in the initial one month, then the first USS counts. The patient must have a USS again at 6-12 months after the initial diagnosis and if more than one USS in this time frame, then the last USS counts. The result of the test is a numeric value that relates to a continuous numeric scale. Reported either as an integer, a ratio, a real number, or a range. The test result value may optionally contain a relational operator from the set {<=, <, >, >=}. Valid values for a quantitative test are of the form “7”, “-7”, “7.4”, “-7.4”, “7.8912”, “0.125”, “<10”, “<10.15”, “>12000”, 1-10, 1:256. Hospitalization within 30 days of Initial BPH Diagnosis refers to a 30-day period between the end of the hospitalization and the clinical office setting BPH diagnosis. This is due to aggravating factors from hospitalization, such as bed rest, medications, surgery, and altered body functions. This eCQM is a patient-based measure. Telehealth encounters are not eligible for this measure because the measure requires a clinical action that cannot be conducted via telehealth. This FHIR-based measure has been derived from the QDM-based measure: CMS771v6. Please refer to the HL7 QI-Core Implementation Guide (https://hl7.org/fhir/us/qicore/STU4.1.1/) for more information on QI-Core and mapping recommendations from QDM to QI-Core 4.1.1 (https://hl7.org/fhir/us/qicore/STU4.1.1/qdm-to-qicore.html).
Population Criteria:
6643b8e4f4fc785d87117128
Initial Population: Male patients with an initial diagnosis of benign prostatic hyperplasia 6 months prior to the measurement period, and a urinary symptom score assessment within 1 month of initial diagnosis and a follow-up urinary symptom score assessment within 6-12 months, who had a qualifying visit during the measurement period
Denominator: Equals Initial Population
Denominator Exclusion: Patients with urinary retention that starts within 1 year of initial BPH diagnosis. Patients with an initial BPH diagnosis that starts during, or within 30 days after end of hospitalization. Patients with a diagnosis of morbid obesity, or with a BMI Exam >=40 before the follow up urinary symptom score.
Numerator: Patients with a documented improvement of at least 3 points in their urinary symptom score during the measurement period
Supplemental Data Elements:

SDE Ethnicity

SDE Payer

SDE Race

SDE Sex
Supplemental Data Guidance : For every patient evaluated by this measure also identify payer, race, ethnicity and sex
Libraries:
UrinarySymptomScoreChangeAfterBenignProstaticHyperplasiaFHIR
Terminology and Other Dependencies:
  • Library/SupplementalDataElements|3.5.000
  • Library/FHIRHelpers|4.4.000
  • Library/QICoreCommon|2.1.000
  • AdministrativeGender
  • Logical Observation Identifiers, Names and Codes (LOINC)
  • International Classification of Diseases, 10th Revision, Clinical Modification (ICD-10-CM)
  • Condition Clinical Status Codes
  • ConditionVerificationStatus
  • ActCode
  • Office Visit
  • Payer
  • Urinary retention
  • http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1151.59
  • Morbid Obesity
    		•
    Parameters:
    name use min max type
    Measurement Period In 0 1 Period
    SDE Sex Out 0 1 Coding
    Numerator Out 0 1 boolean
    Denominator Out 0 1 boolean
    SDE Payer Out 0 * Resource
    Initial Population Out 0 1 boolean
    SDE Ethnicity Out 0 1 Resource
    Denominator Exclusions Out 0 1 boolean
    SDE Race Out 0 1 Resource
    DataRequirements:
    Resource Type Resource Elements Valueset Name Valueset
    Patient(QICorePatient) ethnicity race
    Observation(QICoreObservation) code effective status status.value value
    Observation(QICoreObservation) code effective status status.value value
    Observation(QICoreObservation) code status status.value value effective
    Condition(QICoreCondition) code Urinary retention Urinary retention
    Condition(QICoreCondition) code Morbid Obesity Morbid Obesity
    Condition(QICoreCondition) code
    Encounter(QICoreEncounter) type period class status status.value Office Visit Office Visit
    Encounter(QICoreEncounter) type period status status.value Hospital Services for Urology http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1151.59
    Coverage(QICoreCoverage) type period Payer Type Payer
    Observation(Observation Body Mass Index Profile) value status status.value effective
    Direct Reference Codes:
    display code system
    Male M http://hl7.org/fhir/administrative-gender
    Female F http://hl7.org/fhir/administrative-gender
    International Prostate Symptom Score [IPSS] 80976-4 http://loinc.org
    American Urological Association Symptom Index [AUASI] 80883-2 http://loinc.org
    If you were to spend the rest of your life with your urinary condition just the way it is now, how would you feel about that [IPSS] 81090-3 http://loinc.org
    Benign prostatic hyperplasia with lower urinary tract symptoms N40.1 http://hl7.org/fhir/sid/icd-10-cm
    Active active http://terminology.hl7.org/CodeSystem/condition-clinical
    Recurrence recurrence http://terminology.hl7.org/CodeSystem/condition-clinical
    Relapse relapse http://terminology.hl7.org/CodeSystem/condition-clinical
    Confirmed confirmed http://terminology.hl7.org/CodeSystem/condition-ver-status
    virtual VR http://terminology.hl7.org/CodeSystem/v3-ActCode
    Logic Definitions:
    Group Scoring Population Criteria Expression
    6643b8e4f4fc785d87117128 Group scoring: proportion Measure scoring:

    Proportion

    Type:

    Outcome

    Rate Aggregation: None
    Improvement Notation:

    Increased score indicates improvement

    Initial Population 
    define "Initial Population":
  ( "Patient is Male" )
    and "Has Qualifying Encounter"
    and "Has Qualifying BPH Diagnosis"
    and "Urinary Symptom Score Within 1 Month after Initial BPH Diagnosis" is not null
    and "Urinary Symptom Score 6 to 12 Months After Initial BPH Diagnosis" is not null
    Denominator 
    define "Denominator":
  "Initial Population"
    Denominator Exclusion 
    define "Denominator Exclusions":
  exists ( "Urinary Retention Diagnosis Starts Within 1 Year After Initial BPH Diagnosis" )
    or ( "Has Initial BPH Diagnosis Starts During or Within 30 Days After End of Hospitalization" is not null )
    or ( "Morbid Obesity Diagnosis or BMI Exam Result Greater Than or Equal to 40 Starts On or Before Follow Up USS Assessment" )
    Numerator 
    define "Numerator":
  "Urinary Symptom Score Improvement Greater Than or Equal To 3"
    Library Name Name
    SupplementalDataElements SDE Sex 
    define "SDE Sex":
  case
    when Patient.gender = 'male' then "M"
    when Patient.gender = 'female' then "F"
    else null
  end
    Library Name Name
    UrinarySymptomScoreChangeAfterBenignProstaticHyperplasiaFHIR SDE Sex 
    define "SDE Sex":
  SDE."SDE Sex"
    Library Name Name
    UrinarySymptomScoreChangeAfterBenignProstaticHyperplasiaFHIR Documented IPSS Assessment Result 
    define "Documented IPSS Assessment Result":
  [Observation: "International Prostate Symptom Score [IPSS]"] IPSSAssessment
    where IPSSAssessment.status in { 'final', 'amended', 'corrected' }
      and IPSSAssessment.value is not null
    return {
      effectiveDatetime: IPSSAssessment.effective.earliest ( ),
      valueInteger: IPSSAssessment.value as Integer
    }
    Library Name Name
    UrinarySymptomScoreChangeAfterBenignProstaticHyperplasiaFHIR AUA Symptom Index and Quality of Life Assessment Result 
    define "AUA Symptom Index and Quality of Life Assessment Result":
  [Observation: "American Urological Association Symptom Index [AUASI]"] AUASIAssessment
    let LastQOLOnDate: Last([Observation: "If you were to spend the rest of your life with your urinary condition just the way it is now, how would you feel about that [IPSS]"] QOLAssessment
        where QOLAssessment.effective.earliest() same day as AUASIAssessment.effective.earliest()
          and QOLAssessment.status in { 'final', 'amended', 'corrected' }
          and QOLAssessment.value is not null
        sort by effective.earliest()
    )
    where AUASIAssessment.status in { 'final', 'amended', 'corrected' }
      and AUASIAssessment.value is not null
    return {
      effectiveDatetime: AUASIAssessment.effective.earliest ( ),
      valueInteger: ( AUASIAssessment.value as Integer ) + ( LastQOLOnDate.value as Integer )
    }
    Library Name Name
    UrinarySymptomScoreChangeAfterBenignProstaticHyperplasiaFHIR Urinary Symptom Score Assessment 
    define "Urinary Symptom Score Assessment":
  "Documented IPSS Assessment Result"
    union "AUA Symptom Index and Quality of Life Assessment Result"
    Library Name Name
    UrinarySymptomScoreChangeAfterBenignProstaticHyperplasiaFHIR Initial BPH Diagnosis Starts Within 6 Months Before the Measurement Period 
    define "Initial BPH Diagnosis Starts Within 6 Months Before the Measurement Period":
  First([Condition: "Benign prostatic hyperplasia with lower urinary tract symptoms"] NewBPHDiagnosis
      where NewBPHDiagnosis.prevalenceInterval() starts during Interval[start of "Measurement Period" - 6 months, start of "Measurement Period"]
        and NewBPHDiagnosis.isConfirmedActiveDiagnosis()
      sort by start of onset.toInterval()
  )
    Library Name Name
    UrinarySymptomScoreChangeAfterBenignProstaticHyperplasiaFHIR Urinary Symptom Score Within 1 Month after Initial BPH Diagnosis 
    define "Urinary Symptom Score Within 1 Month after Initial BPH Diagnosis":
  First("Urinary Symptom Score Assessment" USSAssessment
      with "Initial BPH Diagnosis Starts Within 6 Months Before the Measurement Period" InitialBPHDiagnosis
        such that USSAssessment.effectiveDatetime 1 month or less on or after day of start of InitialBPHDiagnosis.prevalenceInterval()
      sort by effectiveDatetime
  )
    Library Name Name
    UrinarySymptomScoreChangeAfterBenignProstaticHyperplasiaFHIR Urinary Symptom Score 6 to 12 Months After Initial BPH Diagnosis 
    define "Urinary Symptom Score 6 to 12 Months After Initial BPH Diagnosis":
  Last("Urinary Symptom Score Assessment" USSAssessment
      with "Initial BPH Diagnosis Starts Within 6 Months Before the Measurement Period" InitialBPHDiagnosis
        such that months between start of InitialBPHDiagnosis.prevalenceInterval() and USSAssessment.effectiveDatetime in Interval[6, 12]
      sort by effectiveDatetime
  )
    Library Name Name
    UrinarySymptomScoreChangeAfterBenignProstaticHyperplasiaFHIR Urinary Symptom Score Change 
    define "Urinary Symptom Score Change":
  from
    "Urinary Symptom Score Within 1 Month after Initial BPH Diagnosis" FirstUSSAssessment,
    "Urinary Symptom Score 6 to 12 Months After Initial BPH Diagnosis" FollowUpUSSAssessment
    let USSChange: ( FirstUSSAssessment.valueInteger ) - ( FollowUpUSSAssessment.valueInteger )
    return USSChange
    Library Name Name
    UrinarySymptomScoreChangeAfterBenignProstaticHyperplasiaFHIR Urinary Symptom Score Improvement Greater Than or Equal To 3 
    define "Urinary Symptom Score Improvement Greater Than or Equal To 3":
  ( "Urinary Symptom Score Change" USSImprovement
      where USSImprovement >= 3
  ) is not null
    Library Name Name
    UrinarySymptomScoreChangeAfterBenignProstaticHyperplasiaFHIR Numerator 
    define "Numerator":
  "Urinary Symptom Score Improvement Greater Than or Equal To 3"
    Library Name Name
    UrinarySymptomScoreChangeAfterBenignProstaticHyperplasiaFHIR Patient is Male 
    define "Patient is Male":
  Patient.gender = 'male'
    Library Name Name
    UrinarySymptomScoreChangeAfterBenignProstaticHyperplasiaFHIR Has Qualifying Encounter 
    define "Has Qualifying Encounter":
  exists ( [Encounter: "Office Visit"] ValidEncounter
      where ValidEncounter.period during day of "Measurement Period"
        and ValidEncounter.class !~ "virtual"
        and ValidEncounter.status = 'finished'
  )
    Library Name Name
    UrinarySymptomScoreChangeAfterBenignProstaticHyperplasiaFHIR Has Qualifying BPH Diagnosis 
    define "Has Qualifying BPH Diagnosis":
  "Initial BPH Diagnosis Starts Within 6 Months Before the Measurement Period" is not null
    Library Name Name
    UrinarySymptomScoreChangeAfterBenignProstaticHyperplasiaFHIR Initial Population 
    define "Initial Population":
  ( "Patient is Male" )
    and "Has Qualifying Encounter"
    and "Has Qualifying BPH Diagnosis"
    and "Urinary Symptom Score Within 1 Month after Initial BPH Diagnosis" is not null
    and "Urinary Symptom Score 6 to 12 Months After Initial BPH Diagnosis" is not null
    Library Name Name
    UrinarySymptomScoreChangeAfterBenignProstaticHyperplasiaFHIR Denominator 
    define "Denominator":
  "Initial Population"
    Library Name Name
    SupplementalDataElements SDE Payer 
    define "SDE Payer":
  [Coverage: type in "Payer Type"] Payer
    return {
      code: Payer.type,
      period: Payer.period
    }
    Library Name Name
    UrinarySymptomScoreChangeAfterBenignProstaticHyperplasiaFHIR SDE Payer 
    define "SDE Payer":
  SDE."SDE Payer"
    Library Name Name
    SupplementalDataElements SDE Ethnicity 
    define "SDE Ethnicity":
  Patient.ethnicity E
    return Tuple {
      codes: { E.ombCategory } union E.detailed,
      display: E.text
    }
    Library Name Name
    UrinarySymptomScoreChangeAfterBenignProstaticHyperplasiaFHIR SDE Ethnicity 
    define "SDE Ethnicity":
  SDE."SDE Ethnicity"
    Library Name Name
    UrinarySymptomScoreChangeAfterBenignProstaticHyperplasiaFHIR Urinary Retention Diagnosis Starts Within 1 Year After Initial BPH Diagnosis 
    define "Urinary Retention Diagnosis Starts Within 1 Year After Initial BPH Diagnosis":
  [Condition: "Urinary retention"] UrinaryRetention
    with "Initial BPH Diagnosis Starts Within 6 Months Before the Measurement Period" InitialBPHDiagnosis
      such that UrinaryRetention.prevalenceInterval ( ) starts 1 year or less on or after day of start of InitialBPHDiagnosis.prevalenceInterval ( )
    where UrinaryRetention.isConfirmedActiveDiagnosis ( )
    Library Name Name
    UrinarySymptomScoreChangeAfterBenignProstaticHyperplasiaFHIR Has Initial BPH Diagnosis Starts During or Within 30 Days After End of Hospitalization 
    define "Has Initial BPH Diagnosis Starts During or Within 30 Days After End of Hospitalization":
  "Initial BPH Diagnosis Starts Within 6 Months Before the Measurement Period" InitialBPHDiagnosis
    with [Encounter: "Hospital Services for Urology"] InHospitalServices
      such that InitialBPHDiagnosis.prevalenceInterval ( ) starts during Interval[start of InHospitalServices.period, end of InHospitalServices.period + 31 days]
        and InHospitalServices.status = 'finished'
    Library Name Name
    UrinarySymptomScoreChangeAfterBenignProstaticHyperplasiaFHIR Morbid Obesity Diagnosis On or Before Follow Up USS Assessment 
    define "Morbid Obesity Diagnosis On or Before Follow Up USS Assessment":
  [Condition: "Morbid Obesity"] MorbidObesity
    with "Urinary Symptom Score 6 to 12 Months After Initial BPH Diagnosis" FollowUpUSSAssessment
      such that MorbidObesity.prevalenceInterval ( ) overlaps "Measurement Period"
        and MorbidObesity.prevalenceInterval ( ) starts on or before FollowUpUSSAssessment.effectiveDatetime
    where MorbidObesity.isConfirmedActiveDiagnosis ( )
    Library Name Name
    UrinarySymptomScoreChangeAfterBenignProstaticHyperplasiaFHIR BMI Exam Result Greater Than or Equal To 40 During Measurement Period and On or Before Follow Up USS Assessment 
    /*
* @code: Body mass index (BMI) [Ratio] - 39156-5
* @profile: http://hl7.org/fhir/StructureDefinition/bmi
*/


define "BMI Exam Result Greater Than or Equal To 40 During Measurement Period and On or Before Follow Up USS Assessment":
  exists ( ["observation-bmi"] BMIExam
      with "Urinary Symptom Score 6 to 12 Months After Initial BPH Diagnosis" FollowUpUSSAssessment
        such that BMIExam.value >= 40 'kg/m2'
          and BMIExam.status in { 'final', 'amended', 'corrected' }
          and BMIExam.effective.earliest ( ) during day of "Measurement Period"
          and BMIExam.effective.earliest ( ) on or before FollowUpUSSAssessment.effectiveDatetime
      return BMIExam.effective.earliest ( )
  )
    Library Name Name
    UrinarySymptomScoreChangeAfterBenignProstaticHyperplasiaFHIR Morbid Obesity Diagnosis or BMI Exam Result Greater Than or Equal to 40 Starts On or Before Follow Up USS Assessment 
    define "Morbid Obesity Diagnosis or BMI Exam Result Greater Than or Equal to 40 Starts On or Before Follow Up USS Assessment":
  exists "Morbid Obesity Diagnosis On or Before Follow Up USS Assessment"
    or "BMI Exam Result Greater Than or Equal To 40 During Measurement Period and On or Before Follow Up USS Assessment"
    Library Name Name
    UrinarySymptomScoreChangeAfterBenignProstaticHyperplasiaFHIR Denominator Exclusions 
    define "Denominator Exclusions":
  exists ( "Urinary Retention Diagnosis Starts Within 1 Year After Initial BPH Diagnosis" )
    or ( "Has Initial BPH Diagnosis Starts During or Within 30 Days After End of Hospitalization" is not null )
    or ( "Morbid Obesity Diagnosis or BMI Exam Result Greater Than or Equal to 40 Starts On or Before Follow Up USS Assessment" )
    Library Name Name
    SupplementalDataElements SDE Race 
    define "SDE Race":
  Patient.race R
    return Tuple {
      codes: R.ombCategory union R.detailed,
      display: R.text
    }
    Library Name Name
    UrinarySymptomScoreChangeAfterBenignProstaticHyperplasiaFHIR SDE Race 
    define "SDE Race":
  SDE."SDE Race"
    Library Name Name
    QICoreCommon earliest 
    /*
@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
    Library Name Name
    QICoreCommon prevalenceInterval 
    /*
@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 Condition):
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]
    Library Name Name
    UrinarySymptomScoreChangeAfterBenignProstaticHyperplasiaFHIR isConfirmedActiveDiagnosis 
    define fluent function isConfirmedActiveDiagnosis(condition Condition):
  condition.isActive ( )
    and condition.verificationStatus ~ QICoreCommon."confirmed"
    Library Name Name
    QICoreCommon isActive 
    /* Candidates for FHIRCommon */

/*
@description: Returns true if the given condition has a clinical status of active, recurrence, or relapse
*/
define fluent function isActive(condition Condition):
  condition.clinicalStatus ~ "active"
    or condition.clinicalStatus ~ "recurrence"
    or condition.clinicalStatus ~ "relapse"
    Library Name Name
    FHIRHelpers ToString 
    define function ToString(value uri): value.value
    Library Name Name
    FHIRHelpers ToCode 
    /*
@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
        }

    Source

    {
      "resourceType" : "Measure",
      "id" : "UrinarySymptomScoreChangeAfterBenignProstaticHyperplasiaFHIR",
      "meta" : {
        "profile" : [
          "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"
        ]
      },
      "text" : {
        "status" : "extensions",
        "div" : "<div xmlns=\"http://www.w3.org/1999/xhtml\">\n    <table class=\"grid dict\">\n        \n            <tr>\n                <th scope=\"row\"><b>Title: </b></th>\n                <td style=\"padding-left: 4px;\">Urinary Symptom Score Change 6-12 Months After Diagnosis of Benign Prostatic HyperplasiaFHIR</td>\n            </tr>\n        \n\n        \n\n        \n            <tr>\n                <th scope=\"row\"><b>Id: </b></th>\n                <td style=\"padding-left: 4px;\">UrinarySymptomScoreChangeAfterBenignProstaticHyperplasiaFHIR</td>\n            </tr>\n        \n\n        \n            <tr>\n                <th scope=\"row\"><b>Version: </b></th>\n                <td style=\"padding-left: 4px;\">1.4.000</td>\n            </tr>\n        \n\n        \n            <tr>\n                <th scope=\"row\"><b>Url: </b></th>\n                <td style=\"padding-left: 4px;\"><a href=\"Measure-UrinarySymptomScoreChangeAfterBenignProstaticHyperplasiaFHIR.html\">Urinary Symptom Score Change 6-12 Months After Diagnosis of Benign Prostatic HyperplasiaFHIR</a></td>\n            </tr>\n        \n\n        \n            <tr>\n                <th scope=\"row\">\n                    <b>\n                        \n                            \n                                short-name identifier:\n                            \n                        \n                    </b>\n                </th>\n\n                <td style=\"padding-left: 4px;\">\n                    \n                        <p style=\"margin-bottom: 5px;\">\n                            <span>CMS771FHIR</span>\n                        </p>\n                    \n                </td>\n            </tr>\n        \n            <tr>\n                <th scope=\"row\">\n                    <b>\n                        \n                            \n                                version-independent identifier:\n                            \n                        \n                    </b>\n                </th>\n\n                <td style=\"padding-left: 4px;\">\n                    \n                        <p style=\"margin-bottom: 5px;\">\n                            <span>urn:uuid:0748d873-8e20-441e-9bbf-c1eefe3ea054</span>\n                        </p>\n                    \n                </td>\n            </tr>\n        \n            <tr>\n                <th scope=\"row\">\n                    <b>\n                        \n                            \n                                version-specific identifier:\n                            \n                        \n                    </b>\n                </th>\n\n                <td style=\"padding-left: 4px;\">\n                    \n                        <p style=\"margin-bottom: 5px;\">\n                            <span>urn:uuid:43e6a3d8-3d0d-4d94-b4c2-bb0232d83fb2</span>\n                        </p>\n                    \n                </td>\n            </tr>\n        \n            <tr>\n                <th scope=\"row\">\n                    <b>\n                        \n                            \n                                publisher (CMS) identifier:\n                            \n                        \n                    </b>\n                </th>\n\n                <td style=\"padding-left: 4px;\">\n                    \n                        <p style=\"margin-bottom: 5px;\">\n                            <span>771FHIR</span>\n                        </p>\n                    \n                </td>\n            </tr>\n        \n\n        \n            <tr>\n                <th scope=\"row\"><b>Effective Period: </b></th>\n                <td style=\"padding-left: 4px;\">2025-01-01..2025-12-31</td>\n            </tr>\n        \n\n        \n            <tr>\n                <th scope=\"row\"><b>Status: </b></th>\n                <td style=\"padding-left: 4px;\">draft</td>\n            </tr>\n        \n\n        \n\n        \n            <tr>\n                <th scope=\"row\"><b>Publisher: </b></th>\n                <td style=\"padding-left: 4px;\">Large Urology Group Practice Association (LUGPA)</td>\n            </tr>\n        \n\n        \n        <tr>\n            <th scope=\"row\"><b>Author: </b></th>\n            <td style=\"padding-left: 4px;\">Large Urology Group Practice Association (LUGPA)</td>\n        </tr>\n        \n\n        \n\n        \n            <tr>\n                <th scope=\"row\"><b>Description: </b></th>\n                <td style=\"padding-left: 4px;\"><div><p>Percentage of patients with an office visit within the measurement period and with a new diagnosis of clinically significant Benign Prostatic Hyperplasia who have International Prostate Symptoms Score (IPSS) or American Urological Association (AUA) Symptom Index (SI) documented at time of diagnosis and again 6-12 months later with an improvement of 3 points</p>\n</div></td>\n            </tr>\n        \n\n        \n\n        \n\n        \n\n        \n\n        \n\n        \n            <tr>\n                <th scope=\"row\"><b>Purpose: </b></th>\n                <td style=\"padding-left: 4px;\"><div><p>UNKNOWN</p>\n</div></td>\n            </tr>\n        \n\n        \n            <tr>\n                <th scope=\"row\"><b>Copyright: </b></th>\n                <td style=\"padding-left: 4px;\"><div><p>Limited proprietary coding is contained in the measure specifications for user convenience. Users of the proprietary code sets should obtain all necessary licenses from the owners of these code sets. Large Urology Group Practice Association (LUGPA) and Oregon Urology Institute (OUI) disclaim all liability for use or accuracy of any third party codes contained in the specifications.  CPT(R) contained in the Measure specifications is copyright 2004-2023. American Medical Association. LOINC(R) copyright 2004-2023 Regenstrief Institute, Inc. This material contains SNOMED Clinical Terms(R) (SNOMED CT[R]) copyright 2004-2023 International Health Terminology Standards Development Organisation. ICD-10 copyright 2023 World Health Organization. All Rights Reserved.</p>\n</div></td>\n            </tr>\n        \n\n        \n            <tr>\n                <th scope=\"row\"><b>Disclaimer: </b></th>\n                <td style=\"padding-left: 4px;\"><div><p>The performance measure is not a clinical guideline and does not establish a standard of medical care, and has not been tested for all potential applications.  THE MEASURE AND SPECIFICATIONS ARE PROVIDED &quot;AS IS&quot; WITHOUT WARRANTY OF ANY KIND.  Due to technical limitations, registered trademarks are indicated by (R) or [R], and unregistered trademarks are indicated by (TM) or [TM].</p>\n</div></td>\n            </tr>\n        \n\n        \n\n        \n\n        \n            <tr>\n                <th scope=\"row\"><b>Scoring: </b></th>\n                <td style=\"padding-left: 4px;\">\n                    \n                        \n                            <p style=\"margin-bottom: 5px;\">\n                                <span>Proportion </span>\n                            </p>\n                        \n                    \n                    \n                </td>\n            </tr>\n        \n\n        \n\n        \n\n        \n\n        \n\n        \n        <tr>\n            <th scope=\"row\"><b>Rationale: </b></th>\n            <td style=\"padding-left: 4px;\"><div><p>Benign prostatic hyperplasia (BPH) is one of the most common conditions affecting older men, with a prevalence of 50% by age 60 years and 90% by the ninth decade of life (Medina et al., 1999). The enlarged gland had been proposed to contribute to the overall lower urinary tract symptoms (LUTS) complex (McVary et al., 2014). Although LUTS secondary to BPH is not often a life-threatening condition, the impact of LUTS/BPH on quality of life can be significant (Wei et al., 2005). The American Urological Association Symptom Index (AUA-SI) and the International Prostate Symptom Score (IPSS) were developed to measure outcomes in studies of different treatments for BPH (Wuerstle et al., 2011). The IPSS uses the same questions as the AUA-SI, but also adds a disease-specific quality of life question (OLeary, 2005). The IPSS was adopted in 1993 by the World Health Organization. It is a reproducible, validated index designed to determine disease severity and response to therapy (D’Silva et al., 2014). It includes 3 storage symptom questions (frequency, nocturia, urgency) and four voiding symptoms (feeling of incomplete emptying, intermittency, straining, and a weak stream) as well as a Bother question: If you were to spend the rest of your life with your urinary condition just the way it is now, how would you feel about that? A three-point improvement in the score is considered meaningful (McVary et al., 2014).</p>\n</div></td>\n        </tr>\n        \n\n        \n        <tr>\n            <th scope=\"row\"><b>Clinical recommendation statement: </b></th>\n            <td style=\"padding-left: 4px;\"><div><p>The symptoms of BPH are lower urinary tract symptoms (LUTS). There are other disorders with similar symptoms that need to be excluded. History, physical examination, and testing are required prior to a diagnosis of BPH. IPSS by itself is not a reliable diagnostic tool for LUTS suggestive of BPH but serves as a quantitative measure of LUTS after the diagnosis is established (D’Silva et al., 2014). Medical and surgical interventions for BPH recommend a follow up IPSS evaluation to determine effectiveness of treatment. IPSS should be evaluated at the time of diagnosis and after definitive treatment.</p>\n</div></td>\n        </tr>\n        \n\n        \n\n        \n            <tr>\n                <th scope=\"row\"><b>Guidance (Usage): </b></th>\n                <td style=\"padding-left: 4px;\">The IPSS is inclusive of the symptom index score and the quality of life score. The AUA-SI is the symptom index score alone and must be added to the QOL score. The AUA-SI with the QOL equals the IPSS. Both of these are the urinary symptom score.  The patient must have a urinary symptom score (USS) within 1 month after initial diagnosis. If more than one USS in the initial one month, then the first USS counts. The patient must have a USS again at 6-12 months after the initial diagnosis and if more than one USS in this time frame, then the last USS counts.   The result of the test is a numeric value that relates to a continuous numeric scale. Reported either as an integer, a ratio, a real number, or a range. The test result value may optionally contain a relational operator from the set {&lt;=, &lt;, &gt;, &gt;=}. Valid values for a quantitative test are of the form “7”, “-7”, “7.4”, “-7.4”, “7.8912”, “0.125”, “&lt;10”, “&lt;10.15”, “&gt;12000”, 1-10, 1:256.   Hospitalization within 30 days of Initial BPH Diagnosis refers to a 30-day period between the end of the hospitalization and the clinical office setting BPH diagnosis. This is due to aggravating factors from hospitalization, such as bed rest, medications, surgery, and altered body functions.  This eCQM is a patient-based measure.  Telehealth encounters are not eligible for this measure because the measure requires a clinical action that cannot be conducted via telehealth.  This FHIR-based measure has been derived from the QDM-based measure: CMS771v6.   Please refer to the HL7 QI-Core Implementation Guide (https://hl7.org/fhir/us/qicore/STU4.1.1/) for more information on QI-Core and mapping recommendations from QDM to QI-Core 4.1.1 (https://hl7.org/fhir/us/qicore/STU4.1.1/qdm-to-qicore.html).</td>\n            </tr>\n        \n\n        \n            \n                <tr>\n                    <th scope=\"row\"><b>Population Criteria: </b></th>\n                    <td style=\"padding-left: 4px;\">\n                        \n                            <table class=\"grid-dict\">\n                                \n                                    <tr>\n                                        <th><b>6643b8e4f4fc785d87117128</b></th>\n                                    </tr>\n                                \n                                \n                                    <tr>\n                                        <td>Initial Population:</td>\n\n                                        \n                                            \n                                                <td>Male patients with an initial diagnosis of benign prostatic hyperplasia 6 months prior to the measurement period, and a urinary symptom score assessment within 1 month of initial diagnosis and a follow-up urinary symptom score assessment within 6-12 months, who had a qualifying visit during the measurement period</td>\n                                            \n                                        \n\n                                    </tr>\n                                \n                                    <tr>\n                                        <td>Denominator:</td>\n\n                                        \n                                            \n                                                <td>Equals Initial Population</td>\n                                            \n                                        \n\n                                    </tr>\n                                \n                                    <tr>\n                                        <td>Denominator Exclusion:</td>\n\n                                        \n                                            \n                                                <td>Patients with urinary retention that starts within 1 year of initial BPH diagnosis. Patients with an initial BPH diagnosis that starts during, or within 30 days after end of hospitalization. Patients with a diagnosis of morbid obesity, or with a BMI Exam &gt;=40 before the follow up urinary symptom score.</td>\n                                            \n                                        \n\n                                    </tr>\n                                \n                                    <tr>\n                                        <td>Numerator:</td>\n\n                                        \n                                            \n                                                <td>Patients with a documented improvement of at least 3 points in their urinary symptom score during the measurement period</td>\n                                            \n                                        \n\n                                    </tr>\n                                \n                                \n                            </table>\n                        \n                    </td>\n                </tr>\n            \n        \n\n        \n            <tr>\n                <th scope=\"row\"><b> Supplemental Data Elements: </b></th>\n                <td style=\"padding-left: 4px;\">\n                    \n                        \n                            \n                                <p>SDE Ethnicity</p>\n                            \n                        \n                    \n                        \n                            \n                                <p>SDE Payer</p>\n                            \n                        \n                    \n                        \n                            \n                                <p>SDE Race</p>\n                            \n                        \n                    \n                        \n                            \n                                <p>SDE Sex</p>\n                            \n                        \n                    \n                </td>\n            </tr>\n        \n\n        \n\n        \n            <tr>\n                <th scope=\"row\">\n                    <b> Supplemental Data Guidance\n                        : </b></th>\n                <td style=\"padding-left: 4px;\"> For every patient evaluated by this measure also identify payer, race, ethnicity and sex   </td>\n            </tr>\n        \n\n        \n            <tr>\n                <th scope=\"row\"><b>Libraries: </b></th>\n                <td style=\"padding-left: 4px;\">\n                    <table class=\"grid-dict\">\n                        \n                            <tr>\n                                <td><a href=\"Library-UrinarySymptomScoreChangeAfterBenignProstaticHyperplasiaFHIR.html\">UrinarySymptomScoreChangeAfterBenignProstaticHyperplasiaFHIR</a></td>\n                            </tr>\n                        \n                    </table>\n                </td>\n            </tr>\n        \n\n        \n\n        \n            \n                <tr>\n                    <th scope=\"row\"><b>Terminology and Other Dependencies: </b></th>\n                    <td style=\"padding-left: 4px;\">\n                        \n                            <li><code>Library/SupplementalDataElements|3.5.000</code></li>\n                        \n                            <li><code>Library/FHIRHelpers|4.4.000</code></li>\n                        \n                            <li><code>Library/QICoreCommon|2.1.000</code></li>\n                        \n                            <li><a href=\"http://hl7.org/fhir/R4/codesystem-administrative-gender.html\">AdministrativeGender</a></li>\n                        \n                            <li><a href=\"http://terminology.hl7.org/5.5.0/CodeSystem-v3-loinc.html\">Logical Observation Identifiers, Names and Codes (LOINC)</a></li>\n                        \n                            <li><a href=\"http://terminology.hl7.org/5.5.0/CodeSystem-icd10CM.html\">International Classification of Diseases, 10th Revision, Clinical Modification (ICD-10-CM)</a></li>\n                        \n                            <li><a href=\"http://terminology.hl7.org/5.5.0/CodeSystem-condition-clinical.html\">Condition Clinical Status Codes</a></li>\n                        \n                            <li><a href=\"http://terminology.hl7.org/5.5.0/CodeSystem-condition-ver-status.html\">ConditionVerificationStatus</a></li>\n                        \n                            <li><a href=\"http://terminology.hl7.org/5.5.0/CodeSystem-v3-ActCode.html\">ActCode</a></li>\n                        \n                            <li><a href=\"https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.464.1003.101.12.1001/expansion\">Office Visit</a></li>\n                        \n                            <li><a href=\"https://vsac.nlm.nih.gov/valueset/2.16.840.1.114222.4.11.3591/expansion\">Payer</a></li>\n                        \n                            <li><a href=\"https://vsac.nlm.nih.gov/valueset/2.16.840.1.113762.1.4.1164.52/expansion\">Urinary retention</a></li>\n                        \n                            <li><a href=\"https://vsac.nlm.nih.gov/valueset/2.16.840.1.113762.1.4.1151.59/expansion\">http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1151.59</a></li>\n                        \n                            <li><a href=\"https://vsac.nlm.nih.gov/valueset/2.16.840.1.113762.1.4.1164.67/expansion\">Morbid Obesity</a></li>\n                        \n                    </td>\n                </tr>\n                <tr>\n                    <th scope=\"row\"><b>Parameters:</b></th>\n                    <td style=\"padding-left: 4px;\">\n                        <table class=\"grid-dict\">\n                            <tr>\n                                <th><b>name</b></th>\n                                <th><b>use</b></th>\n                                <th><b>min</b></th>\n                                <th><b>max</b></th>\n                                <th><b>type</b></th>\n                            </tr>\n                            \n                                <tr>\n                                    <td>Measurement Period</td>\n                                    <td>In</td>\n                                    <td>0</td>\n                                    <td>1</td>\n                                    <td>Period</td>\n                                </tr>\n                            \n                                <tr>\n                                    <td>SDE Sex</td>\n                                    <td>Out</td>\n                                    <td>0</td>\n                                    <td>1</td>\n                                    <td>Coding</td>\n                                </tr>\n                            \n                                <tr>\n                                    <td>Numerator</td>\n                                    <td>Out</td>\n                                    <td>0</td>\n                                    <td>1</td>\n                                    <td>boolean</td>\n                                </tr>\n                            \n                                <tr>\n                                    <td>Denominator</td>\n                                    <td>Out</td>\n                                    <td>0</td>\n                                    <td>1</td>\n                                    <td>boolean</td>\n                                </tr>\n                            \n                                <tr>\n                                    <td>SDE Payer</td>\n                                    <td>Out</td>\n                                    <td>0</td>\n                                    <td>*</td>\n                                    <td>Resource</td>\n                                </tr>\n                            \n                                <tr>\n                                    <td>Initial Population</td>\n                                    <td>Out</td>\n                                    <td>0</td>\n                                    <td>1</td>\n                                    <td>boolean</td>\n                                </tr>\n                            \n                                <tr>\n                                    <td>SDE Ethnicity</td>\n                                    <td>Out</td>\n                                    <td>0</td>\n                                    <td>1</td>\n                                    <td>Resource</td>\n                                </tr>\n                            \n                                <tr>\n                                    <td>Denominator Exclusions</td>\n                                    <td>Out</td>\n                                    <td>0</td>\n                                    <td>1</td>\n                                    <td>boolean</td>\n                                </tr>\n                            \n                                <tr>\n                                    <td>SDE Race</td>\n                                    <td>Out</td>\n                                    <td>0</td>\n                                    <td>1</td>\n                                    <td>Resource</td>\n                                </tr>\n                            \n                        </table>\n                    </td>\n                </tr>\n\n                <tr>\n                    <th scope=\"row\"><b>DataRequirements:</b></th>\n                    <td style=\"padding-left: 4px;\">\n                        <table class=\"grid-dict\">\n                            <tr>\n                                <th><b>Resource Type</b></th>\n                                <th><b>Resource Elements</b></th>\n                                <th><b>Valueset Name</b></th>\n                                <th><b>Valueset</b></th>\n                            </tr>\n                            \n                                <tr>\n                                    <td>Patient(<a href=\"http://hl7.org/fhir/us/qicore/STU4.1.1/StructureDefinition-qicore-patient.html\">QICorePatient</a>)</td>\n                                    <td>\n                                        \n                                            ethnicity\n                                        \n                                            race\n                                        \n                                    </td>\n                                    <td>\n                                        \n                                    </td>\n                                    <td/>\n                                </tr>\n                            \n                                <tr>\n                                    <td>Observation(<a href=\"http://hl7.org/fhir/us/qicore/STU4.1.1/StructureDefinition-qicore-observation.html\">QICoreObservation</a>)</td>\n                                    <td>\n                                        \n                                            code\n                                        \n                                            effective\n                                        \n                                            status\n                                        \n                                            status.value\n                                        \n                                            value\n                                        \n                                    </td>\n                                    <td>\n                                        \n                                    </td>\n                                    <td/>\n                                </tr>\n                            \n                                <tr>\n                                    <td>Observation(<a href=\"http://hl7.org/fhir/us/qicore/STU4.1.1/StructureDefinition-qicore-observation.html\">QICoreObservation</a>)</td>\n                                    <td>\n                                        \n                                            code\n                                        \n                                            effective\n                                        \n                                            status\n                                        \n                                            status.value\n                                        \n                                            value\n                                        \n                                    </td>\n                                    <td>\n                                        \n                                    </td>\n                                    <td/>\n                                </tr>\n                            \n                                <tr>\n                                    <td>Observation(<a href=\"http://hl7.org/fhir/us/qicore/STU4.1.1/StructureDefinition-qicore-observation.html\">QICoreObservation</a>)</td>\n                                    <td>\n                                        \n                                            code\n                                        \n                                            status\n                                        \n                                            status.value\n                                        \n                                            value\n                                        \n                                            effective\n                                        \n                                    </td>\n                                    <td>\n                                        \n                                    </td>\n                                    <td/>\n                                </tr>\n                            \n                                <tr>\n                                    <td>Condition(<a href=\"http://hl7.org/fhir/us/qicore/STU4.1.1/StructureDefinition-qicore-condition.html\">QICoreCondition</a>)</td>\n                                    <td>\n                                        \n                                            code\n                                        \n                                    </td>\n                                    <td>\n                                        \n                                            \n                                                 Urinary retention\n                                            \n                                        \n                                    </td>\n                                    <td><a href=\"https://vsac.nlm.nih.gov/valueset/2.16.840.1.113762.1.4.1164.52/expansion\">Urinary retention</a></td>\n                                </tr>\n                            \n                                <tr>\n                                    <td>Condition(<a href=\"http://hl7.org/fhir/us/qicore/STU4.1.1/StructureDefinition-qicore-condition.html\">QICoreCondition</a>)</td>\n                                    <td>\n                                        \n                                            code\n                                        \n                                    </td>\n                                    <td>\n                                        \n                                            \n                                                 Morbid Obesity\n                                            \n                                        \n                                    </td>\n                                    <td><a href=\"https://vsac.nlm.nih.gov/valueset/2.16.840.1.113762.1.4.1164.67/expansion\">Morbid Obesity</a></td>\n                                </tr>\n                            \n                                <tr>\n                                    <td>Condition(<a href=\"http://hl7.org/fhir/us/qicore/STU4.1.1/StructureDefinition-qicore-condition.html\">QICoreCondition</a>)</td>\n                                    <td>\n                                        \n                                            code\n                                        \n                                    </td>\n                                    <td>\n                                        \n                                    </td>\n                                    <td/>\n                                </tr>\n                            \n                                <tr>\n                                    <td>Encounter(<a href=\"http://hl7.org/fhir/us/qicore/STU4.1.1/StructureDefinition-qicore-encounter.html\">QICoreEncounter</a>)</td>\n                                    <td>\n                                        \n                                            type\n                                        \n                                            period\n                                        \n                                            class\n                                        \n                                            status\n                                        \n                                            status.value\n                                        \n                                    </td>\n                                    <td>\n                                        \n                                            \n                                                 Office Visit\n                                            \n                                        \n                                    </td>\n                                    <td><a href=\"https://vsac.nlm.nih.gov/valueset/2.16.840.1.113883.3.464.1003.101.12.1001/expansion\">Office Visit</a></td>\n                                </tr>\n                            \n                                <tr>\n                                    <td>Encounter(<a href=\"http://hl7.org/fhir/us/qicore/STU4.1.1/StructureDefinition-qicore-encounter.html\">QICoreEncounter</a>)</td>\n                                    <td>\n                                        \n                                            type\n                                        \n                                            period\n                                        \n                                            status\n                                        \n                                            status.value\n                                        \n                                    </td>\n                                    <td>\n                                        \n                                            \n                                                 Hospital Services for Urology\n                                            \n                                        \n                                    </td>\n                                    <td><a href=\"https://vsac.nlm.nih.gov/valueset/2.16.840.1.113762.1.4.1151.59/expansion\">http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1151.59</a></td>\n                                </tr>\n                            \n                                <tr>\n                                    <td>Coverage(<a href=\"http://hl7.org/fhir/us/qicore/STU4.1.1/StructureDefinition-qicore-coverage.html\">QICoreCoverage</a>)</td>\n                                    <td>\n                                        \n                                            type\n                                        \n                                            period\n                                        \n                                    </td>\n                                    <td>\n                                        \n                                            \n                                                 Payer Type\n                                            \n                                        \n                                    </td>\n                                    <td><a href=\"https://vsac.nlm.nih.gov/valueset/2.16.840.1.114222.4.11.3591/expansion\">Payer</a></td>\n                                </tr>\n                            \n                                <tr>\n                                    <td>Observation(<a href=\"http://hl7.org/fhir/R4/bmi.html\">Observation Body Mass Index Profile</a>)</td>\n                                    <td>\n                                        \n                                            value\n                                        \n                                            status\n                                        \n                                            status.value\n                                        \n                                            effective\n                                        \n                                    </td>\n                                    <td>\n                                        \n                                    </td>\n                                    <td/>\n                                </tr>\n                            \n                        </table>\n                    </td>\n                </tr>\n\n                \n                    <tr>\n                        <th scope=\"row\"><b>Direct Reference Codes:</b></th>\n                        <td style=\"padding-left: 4px;\">\n                            <table class=\"grid-dict\">\n                                <tr>\n                                    <th><b>display</b></th>\n                                    <th><b>code</b></th>\n                                    <th><b>system</b></th>\n                                </tr>\n                                \n                                    <tr>\n                                        <td>Male</td>\n                                        <td>M</td>\n                                        <td><a href=\"http://hl7.org/fhir/R4/codesystem-administrative-gender.html\">http://hl7.org/fhir/administrative-gender</a></td>\n                                    </tr>\n                                \n                                    <tr>\n                                        <td>Female</td>\n                                        <td>F</td>\n                                        <td><a href=\"http://hl7.org/fhir/R4/codesystem-administrative-gender.html\">http://hl7.org/fhir/administrative-gender</a></td>\n                                    </tr>\n                                \n                                    <tr>\n                                        <td>International Prostate Symptom Score [IPSS]</td>\n                                        <td>80976-4</td>\n                                        <td><a href=\"https://loinc.org/\">http://loinc.org</a></td>\n                                    </tr>\n                                \n                                    <tr>\n                                        <td>American Urological Association Symptom Index [AUASI]</td>\n                                        <td>80883-2</td>\n                                        <td><a href=\"https://loinc.org/\">http://loinc.org</a></td>\n                                    </tr>\n                                \n                                    <tr>\n                                        <td>If you were to spend the rest of your life with your urinary condition just the way it is now, how would you feel about that [IPSS]</td>\n                                        <td>81090-3</td>\n                                        <td><a href=\"https://loinc.org/\">http://loinc.org</a></td>\n                                    </tr>\n                                \n                                    <tr>\n                                        <td>Benign prostatic hyperplasia with lower urinary tract symptoms</td>\n                                        <td>N40.1</td>\n                                        <td><a href=\"http://terminology.hl7.org/5.5.0/CodeSystem-icd10CM.html\">http://hl7.org/fhir/sid/icd-10-cm</a></td>\n                                    </tr>\n                                \n                                    <tr>\n                                        <td>Active</td>\n                                        <td>active</td>\n                                        <td><a href=\"http://terminology.hl7.org/5.5.0/CodeSystem-condition-clinical.html\">http://terminology.hl7.org/CodeSystem/condition-clinical</a></td>\n                                    </tr>\n                                \n                                    <tr>\n                                        <td>Recurrence</td>\n                                        <td>recurrence</td>\n                                        <td><a href=\"http://terminology.hl7.org/5.5.0/CodeSystem-condition-clinical.html\">http://terminology.hl7.org/CodeSystem/condition-clinical</a></td>\n                                    </tr>\n                                \n                                    <tr>\n                                        <td>Relapse</td>\n                                        <td>relapse</td>\n                                        <td><a href=\"http://terminology.hl7.org/5.5.0/CodeSystem-condition-clinical.html\">http://terminology.hl7.org/CodeSystem/condition-clinical</a></td>\n                                    </tr>\n                                \n                                    <tr>\n                                        <td>Confirmed</td>\n                                        <td>confirmed</td>\n                                        <td><a href=\"http://terminology.hl7.org/5.5.0/CodeSystem-condition-ver-status.html\">http://terminology.hl7.org/CodeSystem/condition-ver-status</a></td>\n                                    </tr>\n                                \n                                    <tr>\n                                        <td>virtual</td>\n                                        <td>VR</td>\n                                        <td><a href=\"http://terminology.hl7.org/5.5.0/CodeSystem-v3-ActCode.html\">http://terminology.hl7.org/CodeSystem/v3-ActCode</a></td>\n                                    </tr>\n                                \n                            </table>\n                        </td>\n                    </tr>\n                \n\n                \n                <tr>\n                    <th scope=\"row\"><b>Logic Definitions:</b></th>\n                    <td style=\"padding-left: 4px;\">\n                        \n                        <table class=\"grid-dict\">\n                            <tr>\n                                <th><b>Group</b></th>\n                                <th><b>Scoring</b></th>\n                                <th><b>Population Criteria</b></th>\n                                <th><b>Expression</b></th>\n                            </tr>\n                            <tr>\n                                \n                                <td> 6643b8e4f4fc785d87117128 </td>\n                                <td colspan=\"3\" style=\"padding-left: 4px;\">\n                                    \n                                        <b>Group scoring:</b>\n                                        \n                                            <span>  proportion </span>\n                                        \n                                    \n\n                                    \n\n                                    \n                                        <b>Measure scoring:</b>\n                                        \n                                            <p style=\"margin-bottom: 5px;\">\n                                                <span>Proportion</span>\n                                            </p>\n                                        \n                                    \n\n                                    \n\n                                    \n                                        <tr>\n                                        \n                                            <th scope=\"row\"><b>Type: </b></th>\n                                            <td style=\"padding-left: 4px;\">\n                                                \n                                                    \n                                                        <p style=\"margin-bottom: 5px;\">\n                                                            <span>Outcome </span>\n                                                        </p>\n                                                    \n                                                \n                                                \n                                            </td>\n                                        \n                                        </tr>\n                                    \n\n                                    \n\n                                    \n                                    <tr>\n                                        <th scope=\"row\"><b>Rate Aggregation: </b></th>\n                                        <td colspan=\"3\" style=\"padding-left: 4px;\">None</td>\n                                    </tr>\n                                    \n\n                                    \n                                        <tr>\n                                            <th scope=\"row\"><b>Improvement Notation: </b></th>\n                                            <td style=\"padding-left: 4px;\">\n                                            \n                                                \n                                                    \n                                                        <p style=\"margin-bottom: 5px;\">\n                                                            <span>Increased score indicates improvement </span>\n                                                        </p>\n                                                    \n                                                \n                                                \n                                            \n                                            </td>\n                                        </tr>\n                                    \n\n                                    \n\n                                </td>\n                                \n                                <tr>\n                                    <td/>\n                                    <td/>\n                                    <td>Initial Population</td>\n                                    <td>\n                                        \n                                            <pre><code class=\"language-cql\">define &quot;Initial Population&quot;:\n  ( &quot;Patient is Male&quot; )\n    and &quot;Has Qualifying Encounter&quot;\n    and &quot;Has Qualifying BPH Diagnosis&quot;\n    and &quot;Urinary Symptom Score Within 1 Month after Initial BPH Diagnosis&quot; is not null\n    and &quot;Urinary Symptom Score 6 to 12 Months After Initial BPH Diagnosis&quot; is not null</code></pre>\n                                        \n                                    </td>\n                                </tr>\n                                \n                                <tr>\n                                    <td/>\n                                    <td/>\n                                    <td>Denominator</td>\n                                    <td>\n                                        \n                                            <pre><code class=\"language-cql\">define &quot;Denominator&quot;:\n  &quot;Initial Population&quot;</code></pre>\n                                        \n                                    </td>\n                                </tr>\n                                \n                                <tr>\n                                    <td/>\n                                    <td/>\n                                    <td>Denominator Exclusion</td>\n                                    <td>\n                                        \n                                            <pre><code class=\"language-cql\">define &quot;Denominator Exclusions&quot;:\n  exists ( &quot;Urinary Retention Diagnosis Starts Within 1 Year After Initial BPH Diagnosis&quot; )\n    or ( &quot;Has Initial BPH Diagnosis Starts During or Within 30 Days After End of Hospitalization&quot; is not null )\n    or ( &quot;Morbid Obesity Diagnosis or BMI Exam Result Greater Than or Equal to 40 Starts On or Before Follow Up USS Assessment&quot; )</code></pre>\n                                        \n                                    </td>\n                                </tr>\n                                \n                                <tr>\n                                    <td/>\n                                    <td/>\n                                    <td>Numerator</td>\n                                    <td>\n                                        \n                                            <pre><code class=\"language-cql\">define &quot;Numerator&quot;:\n  &quot;Urinary Symptom Score Improvement Greater Than or Equal To 3&quot;</code></pre>\n                                        \n                                    </td>\n                                </tr>\n                                \n                                \n                            \n                            </tr>\n                        </table>\n                \n\n                <table class=\"grid-dict\">\n                    \n                        <tr>\n                            <th><b>Library Name</b></th>\n                            <th><b>Name</b></th>\n                        </tr>\n                        <tr>\n                            \n                                <td>SupplementalDataElements</td>\n                            \n                            \n                                <td>SDE Sex</td>\n                            \n                        </tr>\n                        <tr>\n                            \n                                <td/>\n                                <td>\n                                    <pre class=\"highlight language-cql\"><code class=\"language-cql\">define &quot;SDE Sex&quot;:\n  case\n    when Patient.gender = 'male' then &quot;M&quot;\n    when Patient.gender = 'female' then &quot;F&quot;\n    else null\n  end</code></pre>\n                                </td>\n                            \n                        </tr>\n                    \n                        <tr>\n                            <th><b>Library Name</b></th>\n                            <th><b>Name</b></th>\n                        </tr>\n                        <tr>\n                            \n                                <td>UrinarySymptomScoreChangeAfterBenignProstaticHyperplasiaFHIR</td>\n                            \n                            \n                                <td>SDE Sex</td>\n                            \n                        </tr>\n                        <tr>\n                            \n                                <td/>\n                                <td>\n                                    <pre class=\"highlight language-cql\"><code class=\"language-cql\">define &quot;SDE Sex&quot;:\n  SDE.&quot;SDE Sex&quot;</code></pre>\n                                </td>\n                            \n                        </tr>\n                    \n                        <tr>\n                            <th><b>Library Name</b></th>\n                            <th><b>Name</b></th>\n                        </tr>\n                        <tr>\n                            \n                                <td>UrinarySymptomScoreChangeAfterBenignProstaticHyperplasiaFHIR</td>\n                            \n                            \n                                <td>Documented IPSS Assessment Result</td>\n                            \n                        </tr>\n                        <tr>\n                            \n                                <td/>\n                                <td>\n                                    <pre class=\"highlight language-cql\"><code class=\"language-cql\">define &quot;Documented IPSS Assessment Result&quot;:\n  [Observation: &quot;International Prostate Symptom Score [IPSS]&quot;] IPSSAssessment\n    where IPSSAssessment.status in { 'final', 'amended', 'corrected' }\n      and IPSSAssessment.value is not null\n    return {\n      effectiveDatetime: IPSSAssessment.effective.earliest ( ),\n      valueInteger: IPSSAssessment.value as Integer\n    }</code></pre>\n                                </td>\n                            \n                        </tr>\n                    \n                        <tr>\n                            <th><b>Library Name</b></th>\n                            <th><b>Name</b></th>\n                        </tr>\n                        <tr>\n                            \n                                <td>UrinarySymptomScoreChangeAfterBenignProstaticHyperplasiaFHIR</td>\n                            \n                            \n                                <td>AUA Symptom Index and Quality of Life Assessment Result</td>\n                            \n                        </tr>\n                        <tr>\n                            \n                                <td/>\n                                <td>\n                                    <pre class=\"highlight language-cql\"><code class=\"language-cql\">define &quot;AUA Symptom Index and Quality of Life Assessment Result&quot;:\n  [Observation: &quot;American Urological Association Symptom Index [AUASI]&quot;] AUASIAssessment\n    let LastQOLOnDate: Last([Observation: &quot;If you were to spend the rest of your life with your urinary condition just the way it is now, how would you feel about that [IPSS]&quot;] QOLAssessment\n        where QOLAssessment.effective.earliest() same day as AUASIAssessment.effective.earliest()\n          and QOLAssessment.status in { 'final', 'amended', 'corrected' }\n          and QOLAssessment.value is not null\n        sort by effective.earliest()\n    )\n    where AUASIAssessment.status in { 'final', 'amended', 'corrected' }\n      and AUASIAssessment.value is not null\n    return {\n      effectiveDatetime: AUASIAssessment.effective.earliest ( ),\n      valueInteger: ( AUASIAssessment.value as Integer ) + ( LastQOLOnDate.value as Integer )\n    }</code></pre>\n                                </td>\n                            \n                        </tr>\n                    \n                        <tr>\n                            <th><b>Library Name</b></th>\n                            <th><b>Name</b></th>\n                        </tr>\n                        <tr>\n                            \n                                <td>UrinarySymptomScoreChangeAfterBenignProstaticHyperplasiaFHIR</td>\n                            \n                            \n                                <td>Urinary Symptom Score Assessment</td>\n                            \n                        </tr>\n                        <tr>\n                            \n                                <td/>\n                                <td>\n                                    <pre class=\"highlight language-cql\"><code class=\"language-cql\">define &quot;Urinary Symptom Score Assessment&quot;:\n  &quot;Documented IPSS Assessment Result&quot;\n    union &quot;AUA Symptom Index and Quality of Life Assessment Result&quot;</code></pre>\n                                </td>\n                            \n                        </tr>\n                    \n                        <tr>\n                            <th><b>Library Name</b></th>\n                            <th><b>Name</b></th>\n                        </tr>\n                        <tr>\n                            \n                                <td>UrinarySymptomScoreChangeAfterBenignProstaticHyperplasiaFHIR</td>\n                            \n                            \n                                <td>Initial BPH Diagnosis Starts Within 6 Months Before the Measurement Period</td>\n                            \n                        </tr>\n                        <tr>\n                            \n                                <td/>\n                                <td>\n                                    <pre class=\"highlight language-cql\"><code class=\"language-cql\">define &quot;Initial BPH Diagnosis Starts Within 6 Months Before the Measurement Period&quot;:\n  First([Condition: &quot;Benign prostatic hyperplasia with lower urinary tract symptoms&quot;] NewBPHDiagnosis\n      where NewBPHDiagnosis.prevalenceInterval() starts during Interval[start of &quot;Measurement Period&quot; - 6 months, start of &quot;Measurement Period&quot;]\n        and NewBPHDiagnosis.isConfirmedActiveDiagnosis()\n      sort by start of onset.toInterval()\n  )</code></pre>\n                                </td>\n                            \n                        </tr>\n                    \n                        <tr>\n                            <th><b>Library Name</b></th>\n                            <th><b>Name</b></th>\n                        </tr>\n                        <tr>\n                            \n                                <td>UrinarySymptomScoreChangeAfterBenignProstaticHyperplasiaFHIR</td>\n                            \n                            \n                                <td>Urinary Symptom Score Within 1 Month after Initial BPH Diagnosis</td>\n                            \n                        </tr>\n                        <tr>\n                            \n                                <td/>\n                                <td>\n                                    <pre class=\"highlight language-cql\"><code class=\"language-cql\">define &quot;Urinary Symptom Score Within 1 Month after Initial BPH Diagnosis&quot;:\n  First(&quot;Urinary Symptom Score Assessment&quot; USSAssessment\n      with &quot;Initial BPH Diagnosis Starts Within 6 Months Before the Measurement Period&quot; InitialBPHDiagnosis\n        such that USSAssessment.effectiveDatetime 1 month or less on or after day of start of InitialBPHDiagnosis.prevalenceInterval()\n      sort by effectiveDatetime\n  )</code></pre>\n                                </td>\n                            \n                        </tr>\n                    \n                        <tr>\n                            <th><b>Library Name</b></th>\n                            <th><b>Name</b></th>\n                        </tr>\n                        <tr>\n                            \n                                <td>UrinarySymptomScoreChangeAfterBenignProstaticHyperplasiaFHIR</td>\n                            \n                            \n                                <td>Urinary Symptom Score 6 to 12 Months After Initial BPH Diagnosis</td>\n                            \n                        </tr>\n                        <tr>\n                            \n                                <td/>\n                                <td>\n                                    <pre class=\"highlight language-cql\"><code class=\"language-cql\">define &quot;Urinary Symptom Score 6 to 12 Months After Initial BPH Diagnosis&quot;:\n  Last(&quot;Urinary Symptom Score Assessment&quot; USSAssessment\n      with &quot;Initial BPH Diagnosis Starts Within 6 Months Before the Measurement Period&quot; InitialBPHDiagnosis\n        such that months between start of InitialBPHDiagnosis.prevalenceInterval() and USSAssessment.effectiveDatetime in Interval[6, 12]\n      sort by effectiveDatetime\n  )</code></pre>\n                                </td>\n                            \n                        </tr>\n                    \n                        <tr>\n                            <th><b>Library Name</b></th>\n                            <th><b>Name</b></th>\n                        </tr>\n                        <tr>\n                            \n                                <td>UrinarySymptomScoreChangeAfterBenignProstaticHyperplasiaFHIR</td>\n                            \n                            \n                                <td>Urinary Symptom Score Change</td>\n                            \n                        </tr>\n                        <tr>\n                            \n                                <td/>\n                                <td>\n                                    <pre class=\"highlight language-cql\"><code class=\"language-cql\">define &quot;Urinary Symptom Score Change&quot;:\n  from\n    &quot;Urinary Symptom Score Within 1 Month after Initial BPH Diagnosis&quot; FirstUSSAssessment,\n    &quot;Urinary Symptom Score 6 to 12 Months After Initial BPH Diagnosis&quot; FollowUpUSSAssessment\n    let USSChange: ( FirstUSSAssessment.valueInteger ) - ( FollowUpUSSAssessment.valueInteger )\n    return USSChange</code></pre>\n                                </td>\n                            \n                        </tr>\n                    \n                        <tr>\n                            <th><b>Library Name</b></th>\n                            <th><b>Name</b></th>\n                        </tr>\n                        <tr>\n                            \n                                <td>UrinarySymptomScoreChangeAfterBenignProstaticHyperplasiaFHIR</td>\n                            \n                            \n                                <td>Urinary Symptom Score Improvement Greater Than or Equal To 3</td>\n                            \n                        </tr>\n                        <tr>\n                            \n                                <td/>\n                                <td>\n                                    <pre class=\"highlight language-cql\"><code class=\"language-cql\">define &quot;Urinary Symptom Score Improvement Greater Than or Equal To 3&quot;:\n  ( &quot;Urinary Symptom Score Change&quot; USSImprovement\n      where USSImprovement &gt;= 3\n  ) is not null</code></pre>\n                                </td>\n                            \n                        </tr>\n                    \n                        <tr>\n                            <th><b>Library Name</b></th>\n                            <th><b>Name</b></th>\n                        </tr>\n                        <tr>\n                            \n                                <td>UrinarySymptomScoreChangeAfterBenignProstaticHyperplasiaFHIR</td>\n                            \n                            \n                                <td>Numerator</td>\n                            \n                        </tr>\n                        <tr>\n                            \n                                <td/>\n                                <td>\n                                    <pre class=\"highlight language-cql\"><code class=\"language-cql\">define &quot;Numerator&quot;:\n  &quot;Urinary Symptom Score Improvement Greater Than or Equal To 3&quot;</code></pre>\n                                </td>\n                            \n                        </tr>\n                    \n                        <tr>\n                            <th><b>Library Name</b></th>\n                            <th><b>Name</b></th>\n                        </tr>\n                        <tr>\n                            \n                                <td>UrinarySymptomScoreChangeAfterBenignProstaticHyperplasiaFHIR</td>\n                            \n                            \n                                <td>Patient is Male</td>\n                            \n                        </tr>\n                        <tr>\n                            \n                                <td/>\n                                <td>\n                                    <pre class=\"highlight language-cql\"><code class=\"language-cql\">define &quot;Patient is Male&quot;:\n  Patient.gender = 'male'</code></pre>\n                                </td>\n                            \n                        </tr>\n                    \n                        <tr>\n                            <th><b>Library Name</b></th>\n                            <th><b>Name</b></th>\n                        </tr>\n                        <tr>\n                            \n                                <td>UrinarySymptomScoreChangeAfterBenignProstaticHyperplasiaFHIR</td>\n                            \n                            \n                                <td>Has Qualifying Encounter</td>\n                            \n                        </tr>\n                        <tr>\n                            \n                                <td/>\n                                <td>\n                                    <pre class=\"highlight language-cql\"><code class=\"language-cql\">define &quot;Has Qualifying Encounter&quot;:\n  exists ( [Encounter: &quot;Office Visit&quot;] ValidEncounter\n      where ValidEncounter.period during day of &quot;Measurement Period&quot;\n        and ValidEncounter.class !~ &quot;virtual&quot;\n        and ValidEncounter.status = 'finished'\n  )</code></pre>\n                                </td>\n                            \n                        </tr>\n                    \n                        <tr>\n                            <th><b>Library Name</b></th>\n                            <th><b>Name</b></th>\n                        </tr>\n                        <tr>\n                            \n                                <td>UrinarySymptomScoreChangeAfterBenignProstaticHyperplasiaFHIR</td>\n                            \n                            \n                                <td>Has Qualifying BPH Diagnosis</td>\n                            \n                        </tr>\n                        <tr>\n                            \n                                <td/>\n                                <td>\n                                    <pre class=\"highlight language-cql\"><code class=\"language-cql\">define &quot;Has Qualifying BPH Diagnosis&quot;:\n  &quot;Initial BPH Diagnosis Starts Within 6 Months Before the Measurement Period&quot; is not null</code></pre>\n                                </td>\n                            \n                        </tr>\n                    \n                        <tr>\n                            <th><b>Library Name</b></th>\n                            <th><b>Name</b></th>\n                        </tr>\n                        <tr>\n                            \n                                <td>UrinarySymptomScoreChangeAfterBenignProstaticHyperplasiaFHIR</td>\n                            \n                            \n                                <td>Initial Population</td>\n                            \n                        </tr>\n                        <tr>\n                            \n                                <td/>\n                                <td>\n                                    <pre class=\"highlight language-cql\"><code class=\"language-cql\">define &quot;Initial Population&quot;:\n  ( &quot;Patient is Male&quot; )\n    and &quot;Has Qualifying Encounter&quot;\n    and &quot;Has Qualifying BPH Diagnosis&quot;\n    and &quot;Urinary Symptom Score Within 1 Month after Initial BPH Diagnosis&quot; is not null\n    and &quot;Urinary Symptom Score 6 to 12 Months After Initial BPH Diagnosis&quot; is not null</code></pre>\n                                </td>\n                            \n                        </tr>\n                    \n                        <tr>\n                            <th><b>Library Name</b></th>\n                            <th><b>Name</b></th>\n                        </tr>\n                        <tr>\n                            \n                                <td>UrinarySymptomScoreChangeAfterBenignProstaticHyperplasiaFHIR</td>\n                            \n                            \n                                <td>Denominator</td>\n                            \n                        </tr>\n                        <tr>\n                            \n                                <td/>\n                                <td>\n                                    <pre class=\"highlight language-cql\"><code class=\"language-cql\">define &quot;Denominator&quot;:\n  &quot;Initial Population&quot;</code></pre>\n                                </td>\n                            \n                        </tr>\n                    \n                        <tr>\n                            <th><b>Library Name</b></th>\n                            <th><b>Name</b></th>\n                        </tr>\n                        <tr>\n                            \n                                <td>SupplementalDataElements</td>\n                            \n                            \n                                <td>SDE Payer</td>\n                            \n                        </tr>\n                        <tr>\n                            \n                                <td/>\n                                <td>\n                                    <pre class=\"highlight language-cql\"><code class=\"language-cql\">define &quot;SDE Payer&quot;:\n  [Coverage: type in &quot;Payer Type&quot;] Payer\n    return {\n      code: Payer.type,\n      period: Payer.period\n    }</code></pre>\n                                </td>\n                            \n                        </tr>\n                    \n                        <tr>\n                            <th><b>Library Name</b></th>\n                            <th><b>Name</b></th>\n                        </tr>\n                        <tr>\n                            \n                                <td>UrinarySymptomScoreChangeAfterBenignProstaticHyperplasiaFHIR</td>\n                            \n                            \n                                <td>SDE Payer</td>\n                            \n                        </tr>\n                        <tr>\n                            \n                                <td/>\n                                <td>\n                                    <pre class=\"highlight language-cql\"><code class=\"language-cql\">define &quot;SDE Payer&quot;:\n  SDE.&quot;SDE Payer&quot;</code></pre>\n                                </td>\n                            \n                        </tr>\n                    \n                        <tr>\n                            <th><b>Library Name</b></th>\n                            <th><b>Name</b></th>\n                        </tr>\n                        <tr>\n                            \n                                <td>SupplementalDataElements</td>\n                            \n                            \n                                <td>SDE Ethnicity</td>\n                            \n                        </tr>\n                        <tr>\n                            \n                                <td/>\n                                <td>\n                                    <pre class=\"highlight language-cql\"><code class=\"language-cql\">define &quot;SDE Ethnicity&quot;:\n  Patient.ethnicity E\n    return Tuple {\n      codes: { E.ombCategory } union E.detailed,\n      display: E.text\n    }</code></pre>\n                                </td>\n                            \n                        </tr>\n                    \n                        <tr>\n                            <th><b>Library Name</b></th>\n                            <th><b>Name</b></th>\n                        </tr>\n                        <tr>\n                            \n                                <td>UrinarySymptomScoreChangeAfterBenignProstaticHyperplasiaFHIR</td>\n                            \n                            \n                                <td>SDE Ethnicity</td>\n                            \n                        </tr>\n                        <tr>\n                            \n                                <td/>\n                                <td>\n                                    <pre class=\"highlight language-cql\"><code class=\"language-cql\">define &quot;SDE Ethnicity&quot;:\n  SDE.&quot;SDE Ethnicity&quot;</code></pre>\n                                </td>\n                            \n                        </tr>\n                    \n                        <tr>\n                            <th><b>Library Name</b></th>\n                            <th><b>Name</b></th>\n                        </tr>\n                        <tr>\n                            \n                                <td>UrinarySymptomScoreChangeAfterBenignProstaticHyperplasiaFHIR</td>\n                            \n                            \n                                <td>Urinary Retention Diagnosis Starts Within 1 Year After Initial BPH Diagnosis</td>\n                            \n                        </tr>\n                        <tr>\n                            \n                                <td/>\n                                <td>\n                                    <pre class=\"highlight language-cql\"><code class=\"language-cql\">define &quot;Urinary Retention Diagnosis Starts Within 1 Year After Initial BPH Diagnosis&quot;:\n  [Condition: &quot;Urinary retention&quot;] UrinaryRetention\n    with &quot;Initial BPH Diagnosis Starts Within 6 Months Before the Measurement Period&quot; InitialBPHDiagnosis\n      such that UrinaryRetention.prevalenceInterval ( ) starts 1 year or less on or after day of start of InitialBPHDiagnosis.prevalenceInterval ( )\n    where UrinaryRetention.isConfirmedActiveDiagnosis ( )</code></pre>\n                                </td>\n                            \n                        </tr>\n                    \n                        <tr>\n                            <th><b>Library Name</b></th>\n                            <th><b>Name</b></th>\n                        </tr>\n                        <tr>\n                            \n                                <td>UrinarySymptomScoreChangeAfterBenignProstaticHyperplasiaFHIR</td>\n                            \n                            \n                                <td>Has Initial BPH Diagnosis Starts During or Within 30 Days After End of Hospitalization</td>\n                            \n                        </tr>\n                        <tr>\n                            \n                                <td/>\n                                <td>\n                                    <pre class=\"highlight language-cql\"><code class=\"language-cql\">define &quot;Has Initial BPH Diagnosis Starts During or Within 30 Days After End of Hospitalization&quot;:\n  &quot;Initial BPH Diagnosis Starts Within 6 Months Before the Measurement Period&quot; InitialBPHDiagnosis\n    with [Encounter: &quot;Hospital Services for Urology&quot;] InHospitalServices\n      such that InitialBPHDiagnosis.prevalenceInterval ( ) starts during Interval[start of InHospitalServices.period, end of InHospitalServices.period + 31 days]\n        and InHospitalServices.status = 'finished'</code></pre>\n                                </td>\n                            \n                        </tr>\n                    \n                        <tr>\n                            <th><b>Library Name</b></th>\n                            <th><b>Name</b></th>\n                        </tr>\n                        <tr>\n                            \n                                <td>UrinarySymptomScoreChangeAfterBenignProstaticHyperplasiaFHIR</td>\n                            \n                            \n                                <td>Morbid Obesity Diagnosis On or Before Follow Up USS Assessment</td>\n                            \n                        </tr>\n                        <tr>\n                            \n                                <td/>\n                                <td>\n                                    <pre class=\"highlight language-cql\"><code class=\"language-cql\">define &quot;Morbid Obesity Diagnosis On or Before Follow Up USS Assessment&quot;:\n  [Condition: &quot;Morbid Obesity&quot;] MorbidObesity\n    with &quot;Urinary Symptom Score 6 to 12 Months After Initial BPH Diagnosis&quot; FollowUpUSSAssessment\n      such that MorbidObesity.prevalenceInterval ( ) overlaps &quot;Measurement Period&quot;\n        and MorbidObesity.prevalenceInterval ( ) starts on or before FollowUpUSSAssessment.effectiveDatetime\n    where MorbidObesity.isConfirmedActiveDiagnosis ( )</code></pre>\n                                </td>\n                            \n                        </tr>\n                    \n                        <tr>\n                            <th><b>Library Name</b></th>\n                            <th><b>Name</b></th>\n                        </tr>\n                        <tr>\n                            \n                                <td>UrinarySymptomScoreChangeAfterBenignProstaticHyperplasiaFHIR</td>\n                            \n                            \n                                <td>BMI Exam Result Greater Than or Equal To 40 During Measurement Period and On or Before Follow Up USS Assessment</td>\n                            \n                        </tr>\n                        <tr>\n                            \n                                <td/>\n                                <td>\n                                    <pre class=\"highlight language-cql\"><code class=\"language-cql\">/*\n* @code: Body mass index (BMI) [Ratio] - 39156-5\n* @profile: http://hl7.org/fhir/StructureDefinition/bmi\n*/\n\n\ndefine &quot;BMI Exam Result Greater Than or Equal To 40 During Measurement Period and On or Before Follow Up USS Assessment&quot;:\n  exists ( [&quot;observation-bmi&quot;] BMIExam\n      with &quot;Urinary Symptom Score 6 to 12 Months After Initial BPH Diagnosis&quot; FollowUpUSSAssessment\n        such that BMIExam.value &gt;= 40 'kg/m2'\n          and BMIExam.status in { 'final', 'amended', 'corrected' }\n          and BMIExam.effective.earliest ( ) during day of &quot;Measurement Period&quot;\n          and BMIExam.effective.earliest ( ) on or before FollowUpUSSAssessment.effectiveDatetime\n      return BMIExam.effective.earliest ( )\n  )</code></pre>\n                                </td>\n                            \n                        </tr>\n                    \n                        <tr>\n                            <th><b>Library Name</b></th>\n                            <th><b>Name</b></th>\n                        </tr>\n                        <tr>\n                            \n                                <td>UrinarySymptomScoreChangeAfterBenignProstaticHyperplasiaFHIR</td>\n                            \n                            \n                                <td>Morbid Obesity Diagnosis or BMI Exam Result Greater Than or Equal to 40 Starts On or Before Follow Up USS Assessment</td>\n                            \n                        </tr>\n                        <tr>\n                            \n                                <td/>\n                                <td>\n                                    <pre class=\"highlight language-cql\"><code class=\"language-cql\">define &quot;Morbid Obesity Diagnosis or BMI Exam Result Greater Than or Equal to 40 Starts On or Before Follow Up USS Assessment&quot;:\n  exists &quot;Morbid Obesity Diagnosis On or Before Follow Up USS Assessment&quot;\n    or &quot;BMI Exam Result Greater Than or Equal To 40 During Measurement Period and On or Before Follow Up USS Assessment&quot;</code></pre>\n                                </td>\n                            \n                        </tr>\n                    \n                        <tr>\n                            <th><b>Library Name</b></th>\n                            <th><b>Name</b></th>\n                        </tr>\n                        <tr>\n                            \n                                <td>UrinarySymptomScoreChangeAfterBenignProstaticHyperplasiaFHIR</td>\n                            \n                            \n                                <td>Denominator Exclusions</td>\n                            \n                        </tr>\n                        <tr>\n                            \n                                <td/>\n                                <td>\n                                    <pre class=\"highlight language-cql\"><code class=\"language-cql\">define &quot;Denominator Exclusions&quot;:\n  exists ( &quot;Urinary Retention Diagnosis Starts Within 1 Year After Initial BPH Diagnosis&quot; )\n    or ( &quot;Has Initial BPH Diagnosis Starts During or Within 30 Days After End of Hospitalization&quot; is not null )\n    or ( &quot;Morbid Obesity Diagnosis or BMI Exam Result Greater Than or Equal to 40 Starts On or Before Follow Up USS Assessment&quot; )</code></pre>\n                                </td>\n                            \n                        </tr>\n                    \n                        <tr>\n                            <th><b>Library Name</b></th>\n                            <th><b>Name</b></th>\n                        </tr>\n                        <tr>\n                            \n                                <td>SupplementalDataElements</td>\n                            \n                            \n                                <td>SDE Race</td>\n                            \n                        </tr>\n                        <tr>\n                            \n                                <td/>\n                                <td>\n                                    <pre class=\"highlight language-cql\"><code class=\"language-cql\">define &quot;SDE Race&quot;:\n  Patient.race R\n    return Tuple {\n      codes: R.ombCategory union R.detailed,\n      display: R.text\n    }</code></pre>\n                                </td>\n                            \n                        </tr>\n                    \n                        <tr>\n                            <th><b>Library Name</b></th>\n                            <th><b>Name</b></th>\n                        </tr>\n                        <tr>\n                            \n                                <td>UrinarySymptomScoreChangeAfterBenignProstaticHyperplasiaFHIR</td>\n                            \n                            \n                                <td>SDE Race</td>\n                            \n                        </tr>\n                        <tr>\n                            \n                                <td/>\n                                <td>\n                                    <pre class=\"highlight language-cql\"><code class=\"language-cql\">define &quot;SDE Race&quot;:\n  SDE.&quot;SDE Race&quot;</code></pre>\n                                </td>\n                            \n                        </tr>\n                    \n                        <tr>\n                            <th><b>Library Name</b></th>\n                            <th><b>Name</b></th>\n                        </tr>\n                        <tr>\n                            \n                                <td>QICoreCommon</td>\n                            \n                            \n                                <td>earliest</td>\n                            \n                        </tr>\n                        <tr>\n                            \n                                <td/>\n                                <td>\n                                    <pre class=\"highlight language-cql\"><code class=\"language-cql\">/*\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&lt;DateTime, Quantity, Interval&lt;DateTime&gt;, Interval&lt;Quantity&gt;&gt; ):\n  (choice.toInterval()) period\n    return\n      if (period.&quot;hasStart&quot;()) then start of period\n      else end of period</code></pre>\n                                </td>\n                            \n                        </tr>\n                    \n                        <tr>\n                            <th><b>Library Name</b></th>\n                            <th><b>Name</b></th>\n                        </tr>\n                        <tr>\n                            \n                                <td>QICoreCommon</td>\n                            \n                            \n                                <td>prevalenceInterval</td>\n                            \n                        </tr>\n                        <tr>\n                            \n                                <td/>\n                                <td>\n                                    <pre class=\"highlight language-cql\"><code class=\"language-cql\">/*\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 Condition):\nif condition.clinicalStatus ~ &quot;active&quot;\n  or condition.clinicalStatus ~ &quot;recurrence&quot;\n  or condition.clinicalStatus ~ &quot;relapse&quot; 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]</code></pre>\n                                </td>\n                            \n                        </tr>\n                    \n                        <tr>\n                            <th><b>Library Name</b></th>\n                            <th><b>Name</b></th>\n                        </tr>\n                        <tr>\n                            \n                                <td>UrinarySymptomScoreChangeAfterBenignProstaticHyperplasiaFHIR</td>\n                            \n                            \n                                <td>isConfirmedActiveDiagnosis</td>\n                            \n                        </tr>\n                        <tr>\n                            \n                                <td/>\n                                <td>\n                                    <pre class=\"highlight language-cql\"><code class=\"language-cql\">define fluent function isConfirmedActiveDiagnosis(condition Condition):\n  condition.isActive ( )\n    and condition.verificationStatus ~ QICoreCommon.&quot;confirmed&quot;</code></pre>\n                                </td>\n                            \n                        </tr>\n                    \n                        <tr>\n                            <th><b>Library Name</b></th>\n                            <th><b>Name</b></th>\n                        </tr>\n                        <tr>\n                            \n                                <td>QICoreCommon</td>\n                            \n                            \n                                <td>isActive</td>\n                            \n                        </tr>\n                        <tr>\n                            \n                                <td/>\n                                <td>\n                                    <pre class=\"highlight language-cql\"><code class=\"language-cql\">/* Candidates for FHIRCommon */\n\n/*\n@description: Returns true if the given condition has a clinical status of active, recurrence, or relapse\n*/\ndefine fluent function isActive(condition Condition):\n  condition.clinicalStatus ~ &quot;active&quot;\n    or condition.clinicalStatus ~ &quot;recurrence&quot;\n    or condition.clinicalStatus ~ &quot;relapse&quot;</code></pre>\n                                </td>\n                            \n                        </tr>\n                    \n                        <tr>\n                            <th><b>Library Name</b></th>\n                            <th><b>Name</b></th>\n                        </tr>\n                        <tr>\n                            \n                                <td>FHIRHelpers</td>\n                            \n                            \n                                <td>ToString</td>\n                            \n                        </tr>\n                        <tr>\n                            \n                                <td/>\n                                <td>\n                                    <pre class=\"highlight language-cql\"><code class=\"language-cql\">define function ToString(value uri): value.value</code></pre>\n                                </td>\n                            \n                        </tr>\n                    \n                        <tr>\n                            <th><b>Library Name</b></th>\n                            <th><b>Name</b></th>\n                        </tr>\n                        <tr>\n                            \n                                <td>FHIRHelpers</td>\n                            \n                            \n                                <td>ToCode</td>\n                            \n                        </tr>\n                        <tr>\n                            \n                                <td/>\n                                <td>\n                                    <pre class=\"highlight language-cql\"><code class=\"language-cql\">/*\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        }</code></pre>\n                                </td>\n                            \n                        </tr>\n                    \n                    </table>\n                </td>\n            </tr>\n            \n        \n    \n\n    </table>\n</div>"
      },
      "contained" : [
        {
          "resourceType" : "Library",
          "id" : "effective-data-requirements",
          "extension" : [
            {
              "url" : "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-directReferenceCode",
              "valueCoding" : {
                "system" : "http://hl7.org/fhir/administrative-gender",
                "code" : "M",
                "display" : "Male"
              }
            },
            {
              "url" : "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-directReferenceCode",
              "valueCoding" : {
                "system" : "http://hl7.org/fhir/administrative-gender",
                "code" : "F",
                "display" : "Female"
              }
            },
            {
              "url" : "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-directReferenceCode",
              "valueCoding" : {
                "system" : "http://loinc.org",
                "code" : "80976-4",
                "display" : "International Prostate Symptom Score [IPSS]"
              }
            },
            {
              "url" : "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-directReferenceCode",
              "valueCoding" : {
                "system" : "http://loinc.org",
                "code" : "80883-2",
                "display" : "American Urological Association Symptom Index [AUASI]"
              }
            },
            {
              "url" : "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-directReferenceCode",
              "valueCoding" : {
                "system" : "http://loinc.org",
                "code" : "81090-3",
                "display" : "If you were to spend the rest of your life with your urinary condition just the way it is now, how would you feel about that [IPSS]"
              }
            },
            {
              "url" : "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-directReferenceCode",
              "valueCoding" : {
                "system" : "http://hl7.org/fhir/sid/icd-10-cm",
                "code" : "N40.1",
                "display" : "Benign prostatic hyperplasia with lower urinary tract symptoms"
              }
            },
            {
              "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"
              }
            },
            {
              "url" : "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-directReferenceCode",
              "valueCoding" : {
                "system" : "http://terminology.hl7.org/CodeSystem/condition-ver-status",
                "code" : "confirmed",
                "display" : "Confirmed"
              }
            },
            {
              "url" : "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-directReferenceCode",
              "valueCoding" : {
                "system" : "http://terminology.hl7.org/CodeSystem/v3-ActCode",
                "code" : "VR",
                "display" : "virtual"
              }
            },
            {
              "extension" : [
                {
                  "url" : "libraryName",
                  "valueString" : "SupplementalDataElements"
                },
                {
                  "url" : "name",
                  "valueString" : "SDE Sex"
                },
                {
                  "url" : "statement",
                  "valueString" : "define \"SDE Sex\":\n  case\n    when Patient.gender = 'male' then \"M\"\n    when Patient.gender = 'female' then \"F\"\n    else null\n  end"
                },
                {
                  "url" : "displaySequence",
                  "valueInteger" : 0
                }
              ],
              "url" : "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition"
            },
            {
              "extension" : [
                {
                  "url" : "libraryName",
                  "valueString" : "UrinarySymptomScoreChangeAfterBenignProstaticHyperplasiaFHIR"
                },
                {
                  "url" : "name",
                  "valueString" : "SDE Sex"
                },
                {
                  "url" : "statement",
                  "valueString" : "define \"SDE Sex\":\n  SDE.\"SDE Sex\""
                },
                {
                  "url" : "displaySequence",
                  "valueInteger" : 1
                }
              ],
              "url" : "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition"
            },
            {
              "extension" : [
                {
                  "url" : "libraryName",
                  "valueString" : "UrinarySymptomScoreChangeAfterBenignProstaticHyperplasiaFHIR"
                },
                {
                  "url" : "name",
                  "valueString" : "Documented IPSS Assessment Result"
                },
                {
                  "url" : "statement",
                  "valueString" : "define \"Documented IPSS Assessment Result\":\n  [Observation: \"International Prostate Symptom Score [IPSS]\"] IPSSAssessment\n    where IPSSAssessment.status in { 'final', 'amended', 'corrected' }\n      and IPSSAssessment.value is not null\n    return {\n      effectiveDatetime: IPSSAssessment.effective.earliest ( ),\n      valueInteger: IPSSAssessment.value as Integer\n    }"
                },
                {
                  "url" : "displaySequence",
                  "valueInteger" : 2
                }
              ],
              "url" : "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition"
            },
            {
              "extension" : [
                {
                  "url" : "libraryName",
                  "valueString" : "UrinarySymptomScoreChangeAfterBenignProstaticHyperplasiaFHIR"
                },
                {
                  "url" : "name",
                  "valueString" : "AUA Symptom Index and Quality of Life Assessment Result"
                },
                {
                  "url" : "statement",
                  "valueString" : "define \"AUA Symptom Index and Quality of Life Assessment Result\":\n  [Observation: \"American Urological Association Symptom Index [AUASI]\"] AUASIAssessment\n    let LastQOLOnDate: Last([Observation: \"If you were to spend the rest of your life with your urinary condition just the way it is now, how would you feel about that [IPSS]\"] QOLAssessment\n        where QOLAssessment.effective.earliest() same day as AUASIAssessment.effective.earliest()\n          and QOLAssessment.status in { 'final', 'amended', 'corrected' }\n          and QOLAssessment.value is not null\n        sort by effective.earliest()\n    )\n    where AUASIAssessment.status in { 'final', 'amended', 'corrected' }\n      and AUASIAssessment.value is not null\n    return {\n      effectiveDatetime: AUASIAssessment.effective.earliest ( ),\n      valueInteger: ( AUASIAssessment.value as Integer ) + ( LastQOLOnDate.value as Integer )\n    }"
                },
                {
                  "url" : "displaySequence",
                  "valueInteger" : 3
                }
              ],
              "url" : "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition"
            },
            {
              "extension" : [
                {
                  "url" : "libraryName",
                  "valueString" : "UrinarySymptomScoreChangeAfterBenignProstaticHyperplasiaFHIR"
                },
                {
                  "url" : "name",
                  "valueString" : "Urinary Symptom Score Assessment"
                },
                {
                  "url" : "statement",
                  "valueString" : "define \"Urinary Symptom Score Assessment\":\n  \"Documented IPSS Assessment Result\"\n    union \"AUA Symptom Index and Quality of Life Assessment Result\""
                },
                {
                  "url" : "displaySequence",
                  "valueInteger" : 4
                }
              ],
              "url" : "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition"
            },
            {
              "extension" : [
                {
                  "url" : "libraryName",
                  "valueString" : "UrinarySymptomScoreChangeAfterBenignProstaticHyperplasiaFHIR"
                },
                {
                  "url" : "name",
                  "valueString" : "Initial BPH Diagnosis Starts Within 6 Months Before the Measurement Period"
                },
                {
                  "url" : "statement",
                  "valueString" : "define \"Initial BPH Diagnosis Starts Within 6 Months Before the Measurement Period\":\n  First([Condition: \"Benign prostatic hyperplasia with lower urinary tract symptoms\"] NewBPHDiagnosis\n      where NewBPHDiagnosis.prevalenceInterval() starts during Interval[start of \"Measurement Period\" - 6 months, start of \"Measurement Period\"]\n        and NewBPHDiagnosis.isConfirmedActiveDiagnosis()\n      sort by start of onset.toInterval()\n  )"
                },
                {
                  "url" : "displaySequence",
                  "valueInteger" : 5
                }
              ],
              "url" : "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition"
            },
            {
              "extension" : [
                {
                  "url" : "libraryName",
                  "valueString" : "UrinarySymptomScoreChangeAfterBenignProstaticHyperplasiaFHIR"
                },
                {
                  "url" : "name",
                  "valueString" : "Urinary Symptom Score Within 1 Month after Initial BPH Diagnosis"
                },
                {
                  "url" : "statement",
                  "valueString" : "define \"Urinary Symptom Score Within 1 Month after Initial BPH Diagnosis\":\n  First(\"Urinary Symptom Score Assessment\" USSAssessment\n      with \"Initial BPH Diagnosis Starts Within 6 Months Before the Measurement Period\" InitialBPHDiagnosis\n        such that USSAssessment.effectiveDatetime 1 month or less on or after day of start of InitialBPHDiagnosis.prevalenceInterval()\n      sort by effectiveDatetime\n  )"
                },
                {
                  "url" : "displaySequence",
                  "valueInteger" : 6
                }
              ],
              "url" : "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition"
            },
            {
              "extension" : [
                {
                  "url" : "libraryName",
                  "valueString" : "UrinarySymptomScoreChangeAfterBenignProstaticHyperplasiaFHIR"
                },
                {
                  "url" : "name",
                  "valueString" : "Urinary Symptom Score 6 to 12 Months After Initial BPH Diagnosis"
                },
                {
                  "url" : "statement",
                  "valueString" : "define \"Urinary Symptom Score 6 to 12 Months After Initial BPH Diagnosis\":\n  Last(\"Urinary Symptom Score Assessment\" USSAssessment\n      with \"Initial BPH Diagnosis Starts Within 6 Months Before the Measurement Period\" InitialBPHDiagnosis\n        such that months between start of InitialBPHDiagnosis.prevalenceInterval() and USSAssessment.effectiveDatetime in Interval[6, 12]\n      sort by effectiveDatetime\n  )"
                },
                {
                  "url" : "displaySequence",
                  "valueInteger" : 7
                }
              ],
              "url" : "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition"
            },
            {
              "extension" : [
                {
                  "url" : "libraryName",
                  "valueString" : "UrinarySymptomScoreChangeAfterBenignProstaticHyperplasiaFHIR"
                },
                {
                  "url" : "name",
                  "valueString" : "Urinary Symptom Score Change"
                },
                {
                  "url" : "statement",
                  "valueString" : "define \"Urinary Symptom Score Change\":\n  from\n    \"Urinary Symptom Score Within 1 Month after Initial BPH Diagnosis\" FirstUSSAssessment,\n    \"Urinary Symptom Score 6 to 12 Months After Initial BPH Diagnosis\" FollowUpUSSAssessment\n    let USSChange: ( FirstUSSAssessment.valueInteger ) - ( FollowUpUSSAssessment.valueInteger )\n    return USSChange"
                },
                {
                  "url" : "displaySequence",
                  "valueInteger" : 8
                }
              ],
              "url" : "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition"
            },
            {
              "extension" : [
                {
                  "url" : "libraryName",
                  "valueString" : "UrinarySymptomScoreChangeAfterBenignProstaticHyperplasiaFHIR"
                },
                {
                  "url" : "name",
                  "valueString" : "Urinary Symptom Score Improvement Greater Than or Equal To 3"
                },
                {
                  "url" : "statement",
                  "valueString" : "define \"Urinary Symptom Score Improvement Greater Than or Equal To 3\":\n  ( \"Urinary Symptom Score Change\" USSImprovement\n      where USSImprovement >= 3\n  ) is not null"
                },
                {
                  "url" : "displaySequence",
                  "valueInteger" : 9
                }
              ],
              "url" : "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition"
            },
            {
              "extension" : [
                {
                  "url" : "libraryName",
                  "valueString" : "UrinarySymptomScoreChangeAfterBenignProstaticHyperplasiaFHIR"
                },
                {
                  "url" : "name",
                  "valueString" : "Numerator"
                },
                {
                  "url" : "statement",
                  "valueString" : "define \"Numerator\":\n  \"Urinary Symptom Score Improvement Greater Than or Equal To 3\""
                },
                {
                  "url" : "displaySequence",
                  "valueInteger" : 10
                }
              ],
              "url" : "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition"
            },
            {
              "extension" : [
                {
                  "url" : "libraryName",
                  "valueString" : "UrinarySymptomScoreChangeAfterBenignProstaticHyperplasiaFHIR"
                },
                {
                  "url" : "name",
                  "valueString" : "Patient is Male"
                },
                {
                  "url" : "statement",
                  "valueString" : "define \"Patient is Male\":\n  Patient.gender = 'male'"
                },
                {
                  "url" : "displaySequence",
                  "valueInteger" : 11
                }
              ],
              "url" : "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition"
            },
            {
              "extension" : [
                {
                  "url" : "libraryName",
                  "valueString" : "UrinarySymptomScoreChangeAfterBenignProstaticHyperplasiaFHIR"
                },
                {
                  "url" : "name",
                  "valueString" : "Has Qualifying Encounter"
                },
                {
                  "url" : "statement",
                  "valueString" : "define \"Has Qualifying Encounter\":\n  exists ( [Encounter: \"Office Visit\"] ValidEncounter\n      where ValidEncounter.period during day of \"Measurement Period\"\n        and ValidEncounter.class !~ \"virtual\"\n        and ValidEncounter.status = 'finished'\n  )"
                },
                {
                  "url" : "displaySequence",
                  "valueInteger" : 12
                }
              ],
              "url" : "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition"
            },
            {
              "extension" : [
                {
                  "url" : "libraryName",
                  "valueString" : "UrinarySymptomScoreChangeAfterBenignProstaticHyperplasiaFHIR"
                },
                {
                  "url" : "name",
                  "valueString" : "Has Qualifying BPH Diagnosis"
                },
                {
                  "url" : "statement",
                  "valueString" : "define \"Has Qualifying BPH Diagnosis\":\n  \"Initial BPH Diagnosis Starts Within 6 Months Before the Measurement Period\" is not null"
                },
                {
                  "url" : "displaySequence",
                  "valueInteger" : 13
                }
              ],
              "url" : "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition"
            },
            {
              "extension" : [
                {
                  "url" : "libraryName",
                  "valueString" : "UrinarySymptomScoreChangeAfterBenignProstaticHyperplasiaFHIR"
                },
                {
                  "url" : "name",
                  "valueString" : "Initial Population"
                },
                {
                  "url" : "statement",
                  "valueString" : "define \"Initial Population\":\n  ( \"Patient is Male\" )\n    and \"Has Qualifying Encounter\"\n    and \"Has Qualifying BPH Diagnosis\"\n    and \"Urinary Symptom Score Within 1 Month after Initial BPH Diagnosis\" is not null\n    and \"Urinary Symptom Score 6 to 12 Months After Initial BPH Diagnosis\" is not null"
                },
                {
                  "url" : "displaySequence",
                  "valueInteger" : 14
                }
              ],
              "url" : "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition"
            },
            {
              "extension" : [
                {
                  "url" : "libraryName",
                  "valueString" : "UrinarySymptomScoreChangeAfterBenignProstaticHyperplasiaFHIR"
                },
                {
                  "url" : "name",
                  "valueString" : "Denominator"
                },
                {
                  "url" : "statement",
                  "valueString" : "define \"Denominator\":\n  \"Initial Population\""
                },
                {
                  "url" : "displaySequence",
                  "valueInteger" : 15
                }
              ],
              "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" : 16
                }
              ],
              "url" : "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition"
            },
            {
              "extension" : [
                {
                  "url" : "libraryName",
                  "valueString" : "UrinarySymptomScoreChangeAfterBenignProstaticHyperplasiaFHIR"
                },
                {
                  "url" : "name",
                  "valueString" : "SDE Payer"
                },
                {
                  "url" : "statement",
                  "valueString" : "define \"SDE Payer\":\n  SDE.\"SDE Payer\""
                },
                {
                  "url" : "displaySequence",
                  "valueInteger" : 17
                }
              ],
              "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" : 18
                }
              ],
              "url" : "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition"
            },
            {
              "extension" : [
                {
                  "url" : "libraryName",
                  "valueString" : "UrinarySymptomScoreChangeAfterBenignProstaticHyperplasiaFHIR"
                },
                {
                  "url" : "name",
                  "valueString" : "SDE Ethnicity"
                },
                {
                  "url" : "statement",
                  "valueString" : "define \"SDE Ethnicity\":\n  SDE.\"SDE Ethnicity\""
                },
                {
                  "url" : "displaySequence",
                  "valueInteger" : 19
                }
              ],
              "url" : "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition"
            },
            {
              "extension" : [
                {
                  "url" : "libraryName",
                  "valueString" : "UrinarySymptomScoreChangeAfterBenignProstaticHyperplasiaFHIR"
                },
                {
                  "url" : "name",
                  "valueString" : "Urinary Retention Diagnosis Starts Within 1 Year After Initial BPH Diagnosis"
                },
                {
                  "url" : "statement",
                  "valueString" : "define \"Urinary Retention Diagnosis Starts Within 1 Year After Initial BPH Diagnosis\":\n  [Condition: \"Urinary retention\"] UrinaryRetention\n    with \"Initial BPH Diagnosis Starts Within 6 Months Before the Measurement Period\" InitialBPHDiagnosis\n      such that UrinaryRetention.prevalenceInterval ( ) starts 1 year or less on or after day of start of InitialBPHDiagnosis.prevalenceInterval ( )\n    where UrinaryRetention.isConfirmedActiveDiagnosis ( )"
                },
                {
                  "url" : "displaySequence",
                  "valueInteger" : 20
                }
              ],
              "url" : "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition"
            },
            {
              "extension" : [
                {
                  "url" : "libraryName",
                  "valueString" : "UrinarySymptomScoreChangeAfterBenignProstaticHyperplasiaFHIR"
                },
                {
                  "url" : "name",
                  "valueString" : "Has Initial BPH Diagnosis Starts During or Within 30 Days After End of Hospitalization"
                },
                {
                  "url" : "statement",
                  "valueString" : "define \"Has Initial BPH Diagnosis Starts During or Within 30 Days After End of Hospitalization\":\n  \"Initial BPH Diagnosis Starts Within 6 Months Before the Measurement Period\" InitialBPHDiagnosis\n    with [Encounter: \"Hospital Services for Urology\"] InHospitalServices\n      such that InitialBPHDiagnosis.prevalenceInterval ( ) starts during Interval[start of InHospitalServices.period, end of InHospitalServices.period + 31 days]\n        and InHospitalServices.status = 'finished'"
                },
                {
                  "url" : "displaySequence",
                  "valueInteger" : 21
                }
              ],
              "url" : "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition"
            },
            {
              "extension" : [
                {
                  "url" : "libraryName",
                  "valueString" : "UrinarySymptomScoreChangeAfterBenignProstaticHyperplasiaFHIR"
                },
                {
                  "url" : "name",
                  "valueString" : "Morbid Obesity Diagnosis On or Before Follow Up USS Assessment"
                },
                {
                  "url" : "statement",
                  "valueString" : "define \"Morbid Obesity Diagnosis On or Before Follow Up USS Assessment\":\n  [Condition: \"Morbid Obesity\"] MorbidObesity\n    with \"Urinary Symptom Score 6 to 12 Months After Initial BPH Diagnosis\" FollowUpUSSAssessment\n      such that MorbidObesity.prevalenceInterval ( ) overlaps \"Measurement Period\"\n        and MorbidObesity.prevalenceInterval ( ) starts on or before FollowUpUSSAssessment.effectiveDatetime\n    where MorbidObesity.isConfirmedActiveDiagnosis ( )"
                },
                {
                  "url" : "displaySequence",
                  "valueInteger" : 22
                }
              ],
              "url" : "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition"
            },
            {
              "extension" : [
                {
                  "url" : "libraryName",
                  "valueString" : "UrinarySymptomScoreChangeAfterBenignProstaticHyperplasiaFHIR"
                },
                {
                  "url" : "name",
                  "valueString" : "BMI Exam Result Greater Than or Equal To 40 During Measurement Period and On or Before Follow Up USS Assessment"
                },
                {
                  "url" : "statement",
                  "valueString" : "/*\n* @code: Body mass index (BMI) [Ratio] - 39156-5\n* @profile: http://hl7.org/fhir/StructureDefinition/bmi\n*/\n\n\ndefine \"BMI Exam Result Greater Than or Equal To 40 During Measurement Period and On or Before Follow Up USS Assessment\":\n  exists ( [\"observation-bmi\"] BMIExam\n      with \"Urinary Symptom Score 6 to 12 Months After Initial BPH Diagnosis\" FollowUpUSSAssessment\n        such that BMIExam.value >= 40 'kg/m2'\n          and BMIExam.status in { 'final', 'amended', 'corrected' }\n          and BMIExam.effective.earliest ( ) during day of \"Measurement Period\"\n          and BMIExam.effective.earliest ( ) on or before FollowUpUSSAssessment.effectiveDatetime\n      return BMIExam.effective.earliest ( )\n  )"
                },
                {
                  "url" : "displaySequence",
                  "valueInteger" : 23
                }
              ],
              "url" : "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition"
            },
            {
              "extension" : [
                {
                  "url" : "libraryName",
                  "valueString" : "UrinarySymptomScoreChangeAfterBenignProstaticHyperplasiaFHIR"
                },
                {
                  "url" : "name",
                  "valueString" : "Morbid Obesity Diagnosis or BMI Exam Result Greater Than or Equal to 40 Starts On or Before Follow Up USS Assessment"
                },
                {
                  "url" : "statement",
                  "valueString" : "define \"Morbid Obesity Diagnosis or BMI Exam Result Greater Than or Equal to 40 Starts On or Before Follow Up USS Assessment\":\n  exists \"Morbid Obesity Diagnosis On or Before Follow Up USS Assessment\"\n    or \"BMI Exam Result Greater Than or Equal To 40 During Measurement Period and On or Before Follow Up USS Assessment\""
                },
                {
                  "url" : "displaySequence",
                  "valueInteger" : 24
                }
              ],
              "url" : "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition"
            },
            {
              "extension" : [
                {
                  "url" : "libraryName",
                  "valueString" : "UrinarySymptomScoreChangeAfterBenignProstaticHyperplasiaFHIR"
                },
                {
                  "url" : "name",
                  "valueString" : "Denominator Exclusions"
                },
                {
                  "url" : "statement",
                  "valueString" : "define \"Denominator Exclusions\":\n  exists ( \"Urinary Retention Diagnosis Starts Within 1 Year After Initial BPH Diagnosis\" )\n    or ( \"Has Initial BPH Diagnosis Starts During or Within 30 Days After End of Hospitalization\" is not null )\n    or ( \"Morbid Obesity Diagnosis or BMI Exam Result Greater Than or Equal to 40 Starts On or Before Follow Up USS Assessment\" )"
                },
                {
                  "url" : "displaySequence",
                  "valueInteger" : 25
                }
              ],
              "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" : 26
                }
              ],
              "url" : "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition"
            },
            {
              "extension" : [
                {
                  "url" : "libraryName",
                  "valueString" : "UrinarySymptomScoreChangeAfterBenignProstaticHyperplasiaFHIR"
                },
                {
                  "url" : "name",
                  "valueString" : "SDE Race"
                },
                {
                  "url" : "statement",
                  "valueString" : "define \"SDE Race\":\n  SDE.\"SDE Race\""
                },
                {
                  "url" : "displaySequence",
                  "valueInteger" : 27
                }
              ],
              "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" : 28
                }
              ],
              "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 Condition):\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" : 29
                }
              ],
              "url" : "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition"
            },
            {
              "extension" : [
                {
                  "url" : "libraryName",
                  "valueString" : "UrinarySymptomScoreChangeAfterBenignProstaticHyperplasiaFHIR"
                },
                {
                  "url" : "name",
                  "valueString" : "isConfirmedActiveDiagnosis"
                },
                {
                  "url" : "statement",
                  "valueString" : "define fluent function isConfirmedActiveDiagnosis(condition Condition):\n  condition.isActive ( )\n    and condition.verificationStatus ~ QICoreCommon.\"confirmed\""
                },
                {
                  "url" : "displaySequence",
                  "valueInteger" : 30
                }
              ],
              "url" : "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition"
            },
            {
              "extension" : [
                {
                  "url" : "libraryName",
                  "valueString" : "QICoreCommon"
                },
                {
                  "url" : "name",
                  "valueString" : "isActive"
                },
                {
                  "url" : "statement",
                  "valueString" : "/* Candidates for FHIRCommon */\n\n/*\n@description: Returns true if the given condition has a clinical status of active, recurrence, or relapse\n*/\ndefine fluent function isActive(condition Condition):\n  condition.clinicalStatus ~ \"active\"\n    or condition.clinicalStatus ~ \"recurrence\"\n    or condition.clinicalStatus ~ \"relapse\""
                },
                {
                  "url" : "displaySequence",
                  "valueInteger" : 31
                }
              ],
              "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" : 32
                }
              ],
              "url" : "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-logicDefinition"
            },
            {
              "extension" : [
                {
                  "url" : "libraryName",
                  "valueString" : "FHIRHelpers"
                },
                {
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              "url" : "guidance",
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            },
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      ],
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                "code" : "publisher"
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          "system" : "https://madie.cms.gov/measure/cmsId",
          "value" : "771FHIR",
          "assigner" : {
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        }
      ],
      "version" : "1.4.000",
      "name" : "UrinarySymptomScoreChangeAfterBenignProstaticHyperplasiaFHIR",
      "title" : "Urinary Symptom Score Change 6-12 Months After Diagnosis of Benign Prostatic HyperplasiaFHIR",
      "status" : "draft",
      "experimental" : false,
      "date" : "2024-12-16T18:17:09+00:00",
      "publisher" : "Large Urology Group Practice Association (LUGPA)",
      "contact" : [
        {
          "telecom" : [
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              "system" : "url",
              "value" : "https://www.lugpa.org/"
            }
          ]
        }
      ],
      "description" : "Percentage of patients with an office visit within the measurement period and with a new diagnosis of clinically significant Benign Prostatic Hyperplasia who have International Prostate Symptoms Score (IPSS) or American Urological Association (AUA) Symptom Index (SI) documented at time of diagnosis and again 6-12 months later with an improvement of 3 points",
      "purpose" : "UNKNOWN",
      "usage" : "The IPSS is inclusive of the symptom index score and the quality of life score. The AUA-SI is the symptom index score alone and must be added to the QOL score. The AUA-SI with the QOL equals the IPSS. Both of these are the urinary symptom score.  The patient must have a urinary symptom score (USS) within 1 month after initial diagnosis. If more than one USS in the initial one month, then the first USS counts. The patient must have a USS again at 6-12 months after the initial diagnosis and if more than one USS in this time frame, then the last USS counts.   The result of the test is a numeric value that relates to a continuous numeric scale. Reported either as an integer, a ratio, a real number, or a range. The test result value may optionally contain a relational operator from the set {<=, <, >, >=}. Valid values for a quantitative test are of the form “7”, “-7”, “7.4”, “-7.4”, “7.8912”, “0.125”, “<10”, “<10.15”, “>12000”, 1-10, 1:256.   Hospitalization within 30 days of Initial BPH Diagnosis refers to a 30-day period between the end of the hospitalization and the clinical office setting BPH diagnosis. This is due to aggravating factors from hospitalization, such as bed rest, medications, surgery, and altered body functions.  This eCQM is a patient-based measure.  Telehealth encounters are not eligible for this measure because the measure requires a clinical action that cannot be conducted via telehealth.  This FHIR-based measure has been derived from the QDM-based measure: CMS771v6.   Please refer to the HL7 QI-Core Implementation Guide (https://hl7.org/fhir/us/qicore/STU4.1.1/) for more information on QI-Core and mapping recommendations from QDM to QI-Core 4.1.1 (https://hl7.org/fhir/us/qicore/STU4.1.1/qdm-to-qicore.html).",
      "copyright" : "Limited proprietary coding is contained in the measure specifications for user convenience. Users of the proprietary code sets should obtain all necessary licenses from the owners of these code sets. Large Urology Group Practice Association (LUGPA) and Oregon Urology Institute (OUI) disclaim all liability for use or accuracy of any third party codes contained in the specifications.  CPT(R) contained in the Measure specifications is copyright 2004-2023. American Medical Association. LOINC(R) copyright 2004-2023 Regenstrief Institute, Inc. This material contains SNOMED Clinical Terms(R) (SNOMED CT[R]) copyright 2004-2023 International Health Terminology Standards Development Organisation. ICD-10 copyright 2023 World Health Organization. All Rights Reserved.",
      "effectivePeriod" : {
        "start" : "2025-01-01",
        "end" : "2025-12-31"
      },
      "author" : [
        {
          "name" : "Large Urology Group Practice Association (LUGPA)",
          "telecom" : [
            {
              "system" : "url",
              "value" : "https://www.lugpa.org/"
            }
          ]
        }
      ],
      "library" : [
        "https://madie.cms.gov/Library/UrinarySymptomScoreChangeAfterBenignProstaticHyperplasiaFHIR"
      ],
      "disclaimer" : "The performance measure is not a clinical guideline and does not establish a standard of medical care, and has not been tested for all potential applications.  THE MEASURE AND SPECIFICATIONS ARE PROVIDED \"AS IS\" WITHOUT WARRANTY OF ANY KIND.  Due to technical limitations, registered trademarks are indicated by (R) or [R], and unregistered trademarks are indicated by (TM) or [TM].",
      "scoring" : {
        "coding" : [
          {
            "system" : "http://terminology.hl7.org/CodeSystem/measure-scoring",
            "code" : "proportion",
            "display" : "Proportion"
          }
        ]
      },
      "rationale" : "Benign prostatic hyperplasia (BPH) is one of the most common conditions affecting older men, with a prevalence of 50% by age 60 years and 90% by the ninth decade of life (Medina et al., 1999). The enlarged gland had been proposed to contribute to the overall lower urinary tract symptoms (LUTS) complex (McVary et al., 2014). Although LUTS secondary to BPH is not often a life-threatening condition, the impact of LUTS/BPH on quality of life can be significant (Wei et al., 2005). The American Urological Association Symptom Index (AUA-SI) and the International Prostate Symptom Score (IPSS) were developed to measure outcomes in studies of different treatments for BPH (Wuerstle et al., 2011). The IPSS uses the same questions as the AUA-SI, but also adds a disease-specific quality of life question (OLeary, 2005). The IPSS was adopted in 1993 by the World Health Organization. It is a reproducible, validated index designed to determine disease severity and response to therapy (D’Silva et al., 2014). It includes 3 storage symptom questions (frequency, nocturia, urgency) and four voiding symptoms (feeling of incomplete emptying, intermittency, straining, and a weak stream) as well as a Bother question: If you were to spend the rest of your life with your urinary condition just the way it is now, how would you feel about that? A three-point improvement in the score is considered meaningful (McVary et al., 2014).",
      "clinicalRecommendationStatement" : "The symptoms of BPH are lower urinary tract symptoms (LUTS). There are other disorders with similar symptoms that need to be excluded. History, physical examination, and testing are required prior to a diagnosis of BPH. IPSS by itself is not a reliable diagnostic tool for LUTS suggestive of BPH but serves as a quantitative measure of LUTS after the diagnosis is established (D’Silva et al., 2014). Medical and surgical interventions for BPH recommend a follow up IPSS evaluation to determine effectiveness of treatment. IPSS should be evaluated at the time of diagnosis and after definitive treatment.",
      "group" : [
        {
          "id" : "6643b8e4f4fc785d87117128",
          "extension" : [
            {
              "url" : "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-scoring",
              "valueCodeableConcept" : {
                "coding" : [
                  {
                    "system" : "http://terminology.hl7.org/CodeSystem/measure-scoring",
                    "code" : "proportion",
                    "display" : "Proportion"
                  }
                ]
              }
            },
            {
              "url" : "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-populationBasis",
              "valueCode" : "boolean"
            },
            {
              "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-rateAggregation",
              "valueCode" : "None"
            },
            {
              "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"
                  }
                ]
              }
            }
          ],
          "population" : [
            {
              "id" : "DF446A75-F4AB-4A5D-B121-066198848C5A",
              "code" : {
                "coding" : [
                  {
                    "system" : "http://terminology.hl7.org/CodeSystem/measure-population",
                    "code" : "initial-population",
                    "display" : "Initial Population"
                  }
                ]
              },
              "description" : "Male patients with an initial diagnosis of benign prostatic hyperplasia 6 months prior to the measurement period, and a urinary symptom score assessment within 1 month of initial diagnosis and a follow-up urinary symptom score assessment within 6-12 months, who had a qualifying visit during the measurement period",
              "criteria" : {
                "language" : "text/cql-identifier",
                "expression" : "Initial Population"
              }
            },
            {
              "id" : "180F8058-1D0B-4367-81C2-FA5736868C5F",
              "code" : {
                "coding" : [
                  {
                    "system" : "http://terminology.hl7.org/CodeSystem/measure-population",
                    "code" : "denominator",
                    "display" : "Denominator"
                  }
                ]
              },
              "description" : "Equals Initial Population",
              "criteria" : {
                "language" : "text/cql-identifier",
                "expression" : "Denominator"
              }
            },
            {
              "id" : "71261DED-82AC-4F2E-AE2B-3E74CA3F8A42",
              "code" : {
                "coding" : [
                  {
                    "system" : "http://terminology.hl7.org/CodeSystem/measure-population",
                    "code" : "denominator-exclusion",
                    "display" : "Denominator Exclusion"
                  }
                ]
              },
              "description" : "Patients with urinary retention that starts within 1 year of initial BPH diagnosis. Patients with an initial BPH diagnosis that starts during, or within 30 days after end of hospitalization. Patients with a diagnosis of morbid obesity, or with a BMI Exam >=40 before the follow up urinary symptom score.",
              "criteria" : {
                "language" : "text/cql-identifier",
                "expression" : "Denominator Exclusions"
              }
            },
            {
              "id" : "5CA575BA-5A1E-431E-903C-FAC40AA0CBE7",
              "code" : {
                "coding" : [
                  {
                    "system" : "http://terminology.hl7.org/CodeSystem/measure-population",
                    "code" : "numerator",
                    "display" : "Numerator"
                  }
                ]
              },
              "description" : "Patients with a documented improvement of at least 3 points in their urinary symptom score during the measurement period",
              "criteria" : {
                "language" : "text/cql-identifier",
                "expression" : "Numerator"
              }
            }
          ]
        }
      ],
      "supplementalData" : [
        {
          "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-payer",
          "usage" : [
            {
              "coding" : [
                {
                  "system" : "http://terminology.hl7.org/CodeSystem/measure-data-usage",
                  "code" : "supplemental-data"
                }
              ]
            }
          ],
          "description" : "SDE Payer",
          "criteria" : {
            "language" : "text/cql-identifier",
            "expression" : "SDE Payer"
          }
        },
        {
          "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-sex",
          "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"
          }
        }
      ]
    }

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