care-gaps 'prospective-gap' calculation

[Capt-Mac]

Description

As a user of Care-Gaps operation, I want the ability to process care-gap status of 'prospective-gap' per requested change to specification.

Proposed Enhancement

This will make use of a MeasureReport.GroupComponent.extension that defines a "Date of Compliance" datetime interval of when the requested quality Measure scenario is meant to be addressed.

the "Date of Compliance" extension makes reference to a CQL criteria expression that calculates the Interval for "Date of Compliance", if this value is defined on the Measure resource, then prospective-gap is not able to be calculated, and would default to behavior for existing care-gap status.

This extension will only calculate when measure evaluation parameter reportType = 'subject'

required Measure configuration

• 'Date of Compliance' CQL Expression defined in Measure CQL
• 'Date of Compliance' CQL Expression is referenced as an extension within Measure.Group.extension with appropriate extension url to uniquely identify it.
• Measure must be of scoringType 'Ratio' or 'Proportion'

care-gap inputs required

• 'statuses' parameter is populated with prospective-gap
• measure parameters contain reference to Measure with defined 'date of compliance' expression
• 'subject' defined for evaluating Measure

prospective-gap required data inputs

• 'subject' meets criteria for measure to result in 'numerator' or 'denominator' count >0, if subject is not applicable to scenario, then there is nothing to calculate.
• 'Date of Compliance' Interval is calculated and available on Measure Report. Without an interval to measure against, prospective-gap is not able to be derived.
• 'date of report' - the date of the request for a care-gap report indicates if opportunity to address care fell in the recommended window, or if that window has passed. If within or before the 'Date of Compliance' Interval, then it is 'prospective-gap', there is opportunity to still provide recommended care. If greater than the end of the 'Date of Compliance' Interval, then

Example Measure Scenario and Status Calculation

A provider is meant to perform a 'blood pressure test' with their patient once during the year 2024.

Example 'Date Of Compliance' calculated and displayed on MeasureReport.GroupComponent.extension

Interval[2024-01-01T00:00:00, 2024-12-31T23:59:59]

Example 'Care Gap' status query on day 2024-06-01, where Patient has not received a 'blood pressure test'

• prospective-gap: if 2024-06-01 within Interval[2024-01-01T00:00:00, 2024-12-31T23:59:59] and patient did not receive 'blood pressure test' (care can still be applied within best-practice range).
• open-gap: if 2024-06-01 greater than end of Interval[2024-01-01T00:00:00, 2024-12-31T23:59:59] and patient did not receive 'blood pressure test' (care cannot be applied within best-practice range).
• closed-gap: if 2024-06-01 within Interval[2024-01-01T00:00:00, 2024-12-31T23:59:59] and patient received 'blood pressure test'
• not-applicable: patient was not meant to receive 'blood pressure test'

Example Result

• patient would be care-gap status of prospective-gap