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Positive Improvement Examples
Matthew Gramigna edited this page Mar 23, 2022
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A measure’s improvement notation determines whether an increase or decrease in score is the preferred result of the gaps in care calculation. For a positive improvement measure, only patients in the denominator are considered in the calculation.
The following two examples show the output from fqm-execution's gaps in care calculation for measure bundles published in the Connectathon GitHub repository. These examples are both positive improvement measures.
fqm-execution -o gaps -m /path/to/EXM130/measure/bundle.json -p /path/to/EXM130/denominator/patient/bundle.json -s 2019-01-01 -e 2019-12-31 > reports.json
For this example, the measure bundle used in the CLI command is the EXM130-7.3.000 bundle, and the patient bundle used is the EXM130-7.3.000 test denominator patient bundle.
In this example, we restrict the starting date to 01/01/2019 and the ending date to 12/31/2019.
Again, the result of this calculation is a FHIR Bundle containing four resources of type Composition, MeasureReport, Patient, and DetectedIssue.
The Composition resource is as follows:
{
"resourceType": "Composition",
"type": {
"coding": [
{
"system": "http://hl7.org/fhir/us/davinci-deqm/CodeSystem/gaps-doc-type",
"code": "gaps-doc",
"display": "Gaps in Care Report"
}
]
},
"author": [
{
"reference": "Patient/denom-EXM130"
}
],
"subject": {
"reference": "Patient/denom-EXM130"
},
"date": "2022-03-23T17:24:16.743Z",
"title": "Gaps in Care Report",
"status": "preliminary",
"section": [
{
"title": "http://hl7.org/fhir/us/cqfmeasures/Measure/EXM130",
"focus": {
"reference": "MeasureReport/f83a0b90-7f68-4293-8fdd-e0cc7640343d"
},
"entry": [
{
"reference": "DetectedIssue/ae73552e-dbff-45cf-88c8-772da7322012"
}
]
}
]
}The DetectedIssue resource is as follows:
{
"resourceType": "DetectedIssue",
"id": "ae73552e-dbff-45cf-88c8-772da7322012",
"status": "final",
"code": {
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/detectedissue-category",
"code": "care-gap",
"display": "Gap in Care Detected"
}
]
},
"evidence": [
{
"detail": [
{
"reference": "#4d0c0579-0f9e-41ff-82d1-5fe4eb985c96"
}
]
},
{
"detail": [
{
"reference": "#189b808a-09e1-4ca4-8ad1-764913e70d34"
}
]
},
{
"detail": [
{
"reference": "#e2ec2a66-c594-477f-9f32-3394f2d3fccb"
}
]
},
{
"detail": [
{
"reference": "#7d139cf4-ff5e-4581-8bac-f95266aa8c4b"
}
]
},
{
"detail": [
{
"reference": "#251ef2aa-b228-4254-8284-98d904a2e930"
}
]
}
],
"contained": [
{
"resourceType": "GuidanceResponse",
"id": "4d0c0579-0f9e-41ff-82d1-5fe4eb985c96",
"dataRequirement": [
{
"type": "Procedure",
"codeFilter": [
{
"path": "code",
"valueSet": "http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.108.12.1020"
},
{
"path": "status",
"code": [
{
"code": "completed",
"system": "http://hl7.org/fhir/event-status"
}
]
}
],
"dateFilter": [
{
"path": "performed.end",
"valuePeriod": {
"start": "2009-12-31T00:00:00.000Z",
"end": "2019-12-31T00:00:00.000Z"
}
}
]
}
],
"reasonCode": [
{
"coding": [
{
"system": "CareGapReasonCodeSystem",
"code": "DateOutOfRange",
"display": "Date is out of specified range",
"extension": [
{
"url": "ReasonDetail",
"extension": [
{
"url": "reference",
"valueReference": {
"reference": "Procedure/denom-EXM130-2"
}
},
{
"url": "path",
"valueString": "performed.end"
}
]
}
]
}
]
}
],
"status": "data-required",
"moduleUri": "http://hl7.org/fhir/us/cqfmeasures/Measure/EXM130"
},
{
"resourceType": "GuidanceResponse",
"id": "189b808a-09e1-4ca4-8ad1-764913e70d34",
"dataRequirement": [
{
"type": "Observation",
"codeFilter": [
{
"path": "code",
"valueSet": "http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.198.12.1011"
},
{
"path": "status",
"code": [
{
"code": "final",
"system": "http://hl7.org/fhir/observation-status"
},
{
"code": "amended",
"system": "http://hl7.org/fhir/observation-status"
},
{
"code": "corrected",
"system": "http://hl7.org/fhir/observation-status"
},
{
"code": "preliminary",
"system": "http://hl7.org/fhir/observation-status"
}
]
}
],
"extension": [
{
"url": "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-valueFilter",
"extension": [
{
"url": "path",
"valueString": "value"
},
{
"url": "comparator",
"valueCode": "eq"
},
{
"url": "value",
"valueString": "not null"
}
]
}
],
"dateFilter": [
{
"path": "effective",
"valuePeriod": {
"start": "2019-01-01T00:00:00.000Z",
"end": "2019-12-31T00:00:00.000Z"
}
}
]
}
],
"reasonCode": [
{
"coding": [
{
"system": "CareGapReasonCodeSystem",
"code": "NotFound",
"display": "Data Element Not Found"
}
]
}
],
"status": "data-required",
"moduleUri": "http://hl7.org/fhir/us/cqfmeasures/Measure/EXM130"
},
{
"resourceType": "GuidanceResponse",
"id": "e2ec2a66-c594-477f-9f32-3394f2d3fccb",
"dataRequirement": [
{
"type": "Procedure",
"codeFilter": [
{
"path": "code",
"valueSet": "http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.198.12.1010"
},
{
"path": "status",
"code": [
{
"code": "completed",
"system": "http://hl7.org/fhir/event-status"
}
]
}
],
"dateFilter": [
{
"path": "performed.end",
"valuePeriod": {
"start": "2014-12-31T00:00:00.000Z",
"end": "2019-12-31T00:00:00.000Z"
}
}
]
}
],
"reasonCode": [
{
"coding": [
{
"system": "CareGapReasonCodeSystem",
"code": "NotFound",
"display": "Data Element Not Found"
}
]
}
],
"status": "data-required",
"moduleUri": "http://hl7.org/fhir/us/cqfmeasures/Measure/EXM130"
},
{
"resourceType": "GuidanceResponse",
"id": "7d139cf4-ff5e-4581-8bac-f95266aa8c4b",
"dataRequirement": [
{
"type": "Observation",
"codeFilter": [
{
"path": "code",
"valueSet": "http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.108.12.1039"
},
{
"path": "status",
"code": [
{
"code": "final",
"system": "http://hl7.org/fhir/observation-status"
},
{
"code": "amended",
"system": "http://hl7.org/fhir/observation-status"
},
{
"code": "corrected",
"system": "http://hl7.org/fhir/observation-status"
},
{
"code": "preliminary",
"system": "http://hl7.org/fhir/observation-status"
}
]
}
],
"extension": [
{
"url": "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-valueFilter",
"extension": [
{
"url": "path",
"valueString": "value"
},
{
"url": "comparator",
"valueCode": "eq"
},
{
"url": "value",
"valueString": "not null"
}
]
}
],
"dateFilter": [
{
"path": "effective.end",
"valuePeriod": {
"start": "2016-12-31T00:00:00.000Z",
"end": "2019-12-31T00:00:00.000Z"
}
}
]
}
],
"reasonCode": [
{
"coding": [
{
"system": "CareGapReasonCodeSystem",
"code": "NotFound",
"display": "Data Element Not Found"
}
]
}
],
"status": "data-required",
"moduleUri": "http://hl7.org/fhir/us/cqfmeasures/Measure/EXM130"
},
{
"resourceType": "GuidanceResponse",
"id": "251ef2aa-b228-4254-8284-98d904a2e930",
"dataRequirement": [
{
"type": "Procedure",
"codeFilter": [
{
"path": "code",
"valueSet": "http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.108.12.1038"
},
{
"path": "status",
"code": [
{
"code": "completed",
"system": "http://hl7.org/fhir/event-status"
}
]
}
],
"dateFilter": [
{
"path": "performed.end",
"valuePeriod": {
"start": "2014-12-31T00:00:00.000Z",
"end": "2019-12-31T00:00:00.000Z"
}
}
]
}
],
"reasonCode": [
{
"coding": [
{
"system": "CareGapReasonCodeSystem",
"code": "NotFound",
"display": "Data Element Not Found"
}
]
}
],
"status": "data-required",
"moduleUri": "http://hl7.org/fhir/us/cqfmeasures/Measure/EXM130"
}
]
}fqm-execution -o gaps -m /path/to/EXM124/measure/bundle.json -p /path/to/EXM124/denominator/patient/bundle.json > reports.json
For this example, the measure bundle used in the CLI command is the EXM124-9.0.000 bundle, and the patient bundle used is the EXM124-9.0.000 test denominator patient bundle.
The result of this calculation is a FHIR Bundle containing four resources of type Composition, MeasureReport, Patient, and DetectedIssue.
The Composition resource is as follows:
{
"resourceType": "Composition",
"type": {
"coding": [
{
"system": "http://hl7.org/fhir/us/davinci-deqm/CodeSystem/gaps-doc-type",
"code": "gaps-doc",
"display": "Gaps in Care Report"
}
]
},
"author": [
{
"reference": "Patient/denom-EXM124"
}
],
"subject": {
"reference": "Patient/denom-EXM124"
},
"date": "2022-03-23T17:20:54.824Z",
"title": "Gaps in Care Report",
"status": "preliminary",
"section": [
{
"title": "http://hl7.org/fhir/us/cqfmeasures/Measure/EXM124",
"focus": {
"reference": "MeasureReport/25902b77-5977-4b68-b86a-c2b664ba3584"
},
"entry": [
{
"reference": "DetectedIssue/a6d83904-ecb9-4519-ab96-eed359506d88"
}
]
}
]
}The DetectedIssue resource is as follows:
{
"resourceType": "DetectedIssue",
"id": "a6d83904-ecb9-4519-ab96-eed359506d88",
"status": "final",
"code": {
"coding": [
{
"system": "http://terminology.hl7.org/CodeSystem/detectedissue-category",
"code": "care-gap",
"display": "Gap in Care Detected"
}
]
},
"evidence": [
{
"detail": [
{
"reference": "#325d8395-1b4a-4d38-8597-3dd6e338d5a9"
}
]
},
{
"detail": [
{
"reference": "#920fa1fc-71ca-4087-ad34-8e758a11a205"
}
]
}
],
"contained": [
{
"resourceType": "GuidanceResponse",
"id": "325d8395-1b4a-4d38-8597-3dd6e338d5a9",
"dataRequirement": [
{
"type": "Observation",
"codeFilter": [
{
"path": "code",
"valueSet": "http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.108.12.1017"
},
{
"path": "status",
"code": [
{
"code": "final",
"system": "http://hl7.org/fhir/observation-status"
},
{
"code": "amended",
"system": "http://hl7.org/fhir/observation-status"
},
{
"code": "corrected",
"system": "http://hl7.org/fhir/observation-status"
},
{
"code": "preliminary",
"system": "http://hl7.org/fhir/observation-status"
}
]
}
],
"extension": [
{
"url": "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-valueFilter",
"extension": [
{
"url": "path",
"valueString": "value"
},
{
"url": "comparator",
"valueCode": "eq"
},
{
"url": "value",
"valueString": "not null"
}
]
}
],
"dateFilter": [
{
"path": "effective.end",
"valuePeriod": {
"start": "2016-12-31T00:00:00.000Z",
"end": "2019-12-31T00:00:00.000Z"
}
}
]
}
],
"reasonCode": [
{
"coding": [
{
"system": "CareGapReasonCodeSystem",
"code": "NotFound",
"display": "Data Element Not Found",
"extension": [
{
"url": "ReasonDetail",
"extension": [
{
"url": "reference",
"valueReference": {
"reference": "Observation/denom-EXM124-3"
}
},
{
"url": "path",
"valueString": "value"
}
]
}
]
}
]
}
],
"status": "data-required",
"moduleUri": "http://hl7.org/fhir/us/cqfmeasures/Measure/EXM124"
},
{
"resourceType": "GuidanceResponse",
"id": "920fa1fc-71ca-4087-ad34-8e758a11a205",
"dataRequirement": [
{
"type": "Observation",
"codeFilter": [
{
"path": "code",
"valueSet": "http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.110.12.1059"
},
{
"path": "status",
"code": [
{
"code": "final",
"system": "http://hl7.org/fhir/observation-status"
},
{
"code": "amended",
"system": "http://hl7.org/fhir/observation-status"
},
{
"code": "corrected",
"system": "http://hl7.org/fhir/observation-status"
},
{
"code": "preliminary",
"system": "http://hl7.org/fhir/observation-status"
}
]
}
],
"extension": [
{
"url": "http://hl7.org/fhir/us/cqfmeasures/StructureDefinition/cqfm-valueFilter",
"extension": [
{
"url": "path",
"valueString": "value"
},
{
"url": "comparator",
"valueCode": "eq"
},
{
"url": "value",
"valueString": "not null"
}
]
}
],
"dateFilter": [
{
"path": "effective.start",
"valuePeriod": {
"start": "2025-01-01T00:00:00.000Z"
}
},
{
"path": "effective.end",
"valuePeriod": {
"start": "2014-12-31T00:00:00.000Z",
"end": "2019-12-31T00:00:00.000Z"
}
}
]
}
],
"reasonCode": [
{
"coding": [
{
"system": "CareGapReasonCodeSystem",
"code": "NotFound",
"display": "Data Element Not Found"
}
]
}
],
"status": "data-required",
"moduleUri": "http://hl7.org/fhir/us/cqfmeasures/Measure/EXM124"
}
]
}