FHIRsmith: Measure/Measure-CAUTIRateExample.json

FHIR IG analytics

Package	hl7.fhir.uv.cqm
Resource Type	Measure
Id	Measure-CAUTIRateExample.json
FHIR Version	R4
Source	https://build.fhir.org/ig/HL7/fhir-cqm/Measure-CAUTIRateExample.html
URL	http://hl7.org/fhir/uv/cqm/Measure/CAUTIRateExample
Version	2.0.0-ballot
Status	draft
Date	2025-08-13
Name	CAUTIRateExample
Title	Example Catheter-Associated Urinary Tract Infection Rate
Realm	uv
Authority	hl7
Description	Example measure illustrating an approach to representing the Catheter-Associated Urinary Tract Infection (CAUTI) Rate per 1000 indwelling urinary catheter (IUC) days. See https://github.com/cqframework/CQL-Formatting-and-Usage-Wiki/blob/master/Source/Cooking%20With%20CQL/93/CAUTI.md for more detailed discussion of the example.

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Narrative

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Metadata

Title Example Catheter-Associated Urinary Tract Infection Rate

Version 2.0.0-ballot

Identifier urn:oid:2.16.840.1.113883.4.642.40.61.29.26

Status Draft

Experimental true

Jurisdiction 001 from http://unstats.un.org/unsd/methods/m49/m49.htm

Topic Health Quality Measure Document

Steward (Publisher) HL7 International / Clinical Quality Information

Description

Example measure illustrating an approach to representing the Catheter-Associated Urinary Tract Infection (CAUTI) Rate per 1000 indwelling urinary catheter (IUC) days. See https://github.com/cqframework/CQL-Formatting-and-Usage-Wiki/blob/master/Source/Cooking%20With%20CQL/93/CAUTI.md for more detailed discussion of the example.

Measure Group (Rate) (ID: group-1)

Basis Location

Scoring Ratio

Scoring Unit per 1000 catheter days

Initial Population ID: denominator-initial-population
Description: No description provided Criteria: Denominator Initial Population

Initial Population ID: numerator-initial-population
Description: No description provided Criteria: Numerator Initial Population

Denominator ID: denominator
Description: No description provided Criteria: Denominator
Input Population: denominator-initial-population

Numerator ID: numerator
Description: No description provided Criteria: Numerator
Input Population: numerator-initial-population

Measure Observation ID: denominator-observation
Description: No description provided Criteria: Denominator Observation
Input Population: denominator AggregateMethod: sum

Measure Observation ID: numerator-observation
Description: No description provided Criteria: Numerator Observation
Input Population: numerator AggregateMethod: sum

Measure Logic

Primary Library CAUTI Rate

Contents Population Criteria
Logic Definitions
Terminology
Dependencies
Data Requirements
Parameters

Population Criteria

Measure Group (Rate) (ID: group-1)

Initial Population

define "Denominator Initial Population":
  [Location] L
    with Elements."Encounter During Measurement Period" E
     such that E.location.location.references(L)

Definition

Initial Population

define "Numerator Initial Population":
  exists (Elements."Encounter During Measurement Period")

Definition

Denominator

define "Denominator":
  "Denominator Initial Population"

Definition

Numerator

define "Numerator":
  "Numerator Initial Population"

Definition

Measure Observation

define function "Denominator Observation"():
  Sum(
    Elements."Catheter Usage During Measurement Period" Usage
      return all duration in days of Usage
  )

Definition

Measure Observation

define function "Numerator Observation"():
  Count(Elements."Catheter-Associated UTI")

Definition

Logic Definitions

Logic Definition Library Name: CAUTIElements

define "Encounter During Measurement Period":
  [Encounter] E
    where E.period during "Measurement Period"

Logic Definition Library Name: CAUTIElements

define "Catheter Inserted Procedure":
  [Procedure: "Catheter Inserted"] P
    where P.status = 'completed'

Logic Definition Library Name: CAUTIElements

define "Catheter Removed Procedure":
  [Procedure: "Catheter Removed"] P
    where P.status = 'completed'

Logic Definition Library Name: CAUTIElements

define "Catheter Usage":
  "Catheter Inserted Procedure" I
    let catheterRemoved: 
      First(
        "Catheter Removed Procedure" R
          where R.performed.toInterval() starts after I.performed.toInterval()
          sort by start of performed.toInterval()
      )
    return Interval[
      date from start of I.performed.toInterval(), 
      date from start of catheterRemoved.performed.toInterval()
    ]

Logic Definition Library Name: CAUTIElements

define "Catheter Usage During Measurement Period":
  collapse (
    "Catheter Usage" Usage
        where Usage overlaps "Measurement Period"
        return Interval[
            Max({start of Usage, start of "Measurement Period"}),
            Min({end of Usage, end of "Measurement Period"})
        ]
  )

Logic Definition Library Name: CAUTIElements

define "Urine Culture With Bacterium":
  [Observation: "Urine Culture"] O
    where O.status = 'final'
      and exists (
        O.component C
          where C.code in "Bacterium Presence"
            and C.value >= 10000 '[CFU]/mL'
      )

Logic Definition Library Name: CAUTIElements

define "UTI":
  "Urine Culture With Bacterium" U
    let 
      DOE: date from start of U.effective.toInterval(),
      IWP: Interval[DOE - 3 days, DOE + 3 days]
    where start of U.effective.toInterval() during "Measurement Period"
    return {
      urineCultureResult: U,
      dateOfEvent: DOE,
      infectionWindowPeriod: IWP
    }

Logic Definition Library Name: CAUTIElements

define "Catheter-Associated UTI":
  "UTI" U
    where exists (
        "Catheter Usage" Usage
          where start of Usage before U.dateOfEvent
            and end of Usage on or after U.dateOfEvent - 1 day
            and duration in days of Usage > 2
    )

Logic Definition Library Name: FHIRCommon

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

Logic Definition Library Name: FHIRCommon

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

Logic Definition Library Name: FHIRCommon

/*
@description: Normalizes a value that is a choice of timing-valued types to an equivalent interval
@comment: Normalizes a choice type of FHIR.dateTime, FHIR.Period, FHIR.Timing, FHIR.instance, FHIR.string, FHIR.Age, or FHIR.Range types
to an equivalent interval. This selection of choice types is a superset of the majority of choice types that are used as possible
representations for timing-valued elements in FHIR, allowing this function to be used across any resource.

The input can be provided as a dateTime, Period, Timing, instant, string, Age, or Range.
The intent of this function is to provide a clear and concise mechanism to treat single
elements that have multiple possible representations as intervals so that logic doesn't have to account
for the variability. More complex calculations (such as medication request period or dispense period
calculation) need specific guidance and consideration. That guidance may make use of this function, but
the focus of this function is on single element calculations where the semantics are unambiguous.
If the input is a dateTime, the result a DateTime Interval beginning and ending on that dateTime.
If the input is a Period, the result is a DateTime Interval.
If the input is a Timing, an error is raised indicating a single interval cannot be computed from a Timing.
If the input is an instant, the result is a DateTime Interval beginning and ending on that instant.
If the input is a string, an error is raised indicating a single interval cannot be computed from a string.
If the input is an Age, the result is a DateTime Interval beginning when the patient was the given Age,
and ending immediately prior to when the patient was the given Age plus one year.
If the input is a Range, the result is a DateTime Interval beginning when the patient was the Age given
by the low end of the Range, and ending immediately prior to when the patient was the Age given by the
high end of the Range plus one year.

NOTE: Due to the
complexity of determining a single interval from a Timing or String type, this function will throw a run-time exception if it is used
with a Timing or String.
*/
define fluent function toInterval(choice Choice<FHIR.dateTime, FHIR.Period, FHIR.Timing, FHIR.instant, FHIR.string, FHIR.Age, FHIR.Range>):
  case
    when choice is FHIR.dateTime then
      Interval[FHIRHelpers.ToDateTime(choice as FHIR.dateTime), FHIRHelpers.ToDateTime(choice as FHIR.dateTime)]
    when choice is FHIR.Period then
      FHIRHelpers.ToInterval(choice as FHIR.Period)
    when choice is FHIR.instant then
      Interval[FHIRHelpers.ToDateTime(choice as FHIR.instant), FHIRHelpers.ToDateTime(choice as FHIR.instant)]
    when choice is FHIR.Age then
      Interval[FHIRHelpers.ToDate(Patient.birthDate) + FHIRHelpers.ToQuantity(choice as FHIR.Age),
        FHIRHelpers.ToDate(Patient.birthDate) + FHIRHelpers.ToQuantity(choice as FHIR.Age) + 1 year)
    when choice is FHIR.Range then
      Interval[FHIRHelpers.ToDate(Patient.birthDate) + FHIRHelpers.ToQuantity((choice as FHIR.Range).low),
        FHIRHelpers.ToDate(Patient.birthDate) + FHIRHelpers.ToQuantity((choice as FHIR.Range).high) + 1 year)
    when choice is FHIR.Timing then
      Message(null as Interval<DateTime>, true, 'NOT_IMPLEMENTED', 'Error', 'Calculation of an interval from a Timing value is not supported')
    when choice is FHIR.string then
      Message(null as Interval<DateTime>, true, 'NOT_IMPLEMENTED', 'Error', 'Calculation of an interval from a String value is not supported')
    else
      null as Interval<DateTime>
  end

Logic Definition Library Name: CAUTIRate

define "Denominator Initial Population":
  [Location] L
    with Elements."Encounter During Measurement Period" E
     such that E.location.location.references(L)

Logic Definition Library Name: CAUTIRate

define "Numerator Initial Population":
  exists (Elements."Encounter During Measurement Period")

Logic Definition Library Name: CAUTIRate

define "Numerator":
  "Numerator Initial Population"

Logic Definition Library Name: CAUTIRate

define "Denominator":
  "Denominator Initial Population"

Logic Definition Library Name: CAUTIRate

define function "Denominator Observation"():
  Sum(
    Elements."Catheter Usage During Measurement Period" Usage
      return all duration in days of Usage
  )

Logic Definition Library Name: CAUTIRate

define function "Numerator Observation"():
  Count(Elements."Catheter-Associated UTI")