eCQM Title

Excess Antibiotic Duration for Adult Hospitalized Patients with Uncomplicated Community-Acquired Pneumonia

CMS ID

1301

eCQM Version Number

Draft based on 0.0.000

CBE Number

Not Applicable

GUID

6f496b5b-ed49-4daf-b932-036bc668d982

Measurement Period

January 1, 2024 through December 31, 2024

Measure Steward

University of Utah

Measure Developer

University of Utah

Endorsed By

None

Description

The Excess Antibiotic Duration for Hospitalized Patients with Uncomplicated Community-Acquired Pneumonia measure is a process measure representing the annual percentage of hospitalized adults with uncomplicated community-acquired pneumonia who receive an excess antibiotic duration. The measure will be calculated using electronic health record (EHR) data and is intended for use at the facility level for both quality improvement and pay-for-performance.

None

Disclaimer

None

Measure Scoring

Proportion

Measure Type

Process

Stratification

None

Risk Adjustment

None

Rate Aggregation

Rationale

The overall objective of this electronic clinical quality measure is to quantify excess antibiotic duration in hospitalized adults with uncomplicated community-acquired pneumonia (CAP).

Antibiotic overuse is a national and international public health emergency with antibiotic resistant infections estimated to directly cause 1.27 million deaths globally and indirectly contribute to 4.95 million deaths. [1]  National studies by the Centers for Disease Control and Prevention (CDC) estimate that up to 50% of hospitalized patients receive antibiotic therapy, most commonly for pneumonia, and that up to 40% of antibiotic prescribing could be improved. [2] Because of these harms, the CDC developed recommendations for Antibiotic Stewardship which it published in its “Core Elements of Hospital Antibiotic Stewardship Programs.” These recommendations include “Assessing how often patients are discharged on the correct antibiotics for the recommended duration”. Specifically, the CDC recommends, “most cases of uncomplicated pneumonia can be treated for 5 days when a patient has a timely clinical response". [3] The 5-day treatment duration is based on national 5-day guideline recommendations for uncomplicated CAP, multiple randomized clinical trials showing the safety of short vs. long durations, [4-13] and retrospective observational studies showing higher antibiotic-associated adverse events in patients who receive excess (i.e., >5 day) antibiotic durations.

Pneumonia is not only the most common reason for inpatient antibiotic use but also the most common infectious cause of mortality in the US resulting in approximately 1.4 million emergency department visits, 740 000 hospitalizations, 41 000 deaths, and $7.7 billion in inpatient costs each year in the US. Given studies suggesting that up to ⅔ of patients hospitalized and treated for CAP have excess duration, there is substantial potential benefit to patients and the US by reducing excess treatment durations. For patients, shorter durations are associated with fewer antibiotic-associated adverse events and less risk of developing antibiotic resistant infections. When used as a pay-for-performance measure across 41 Michigan hospitals, the chart review measure from which our eCQM was adapted increased appropriate use of short duration therapy for CAP by 22% and decreased adverse events (driven by antibiotic-associated harm; aOR per quarter, 0.98 [95% confidence interval: .96-.99]). Taken together, our guideline-based measure has the demonstrated ability to improve patient care for a large number of patients hospitalized with CAP across the US.

How measure will improve quality of care?: By establishing a standardized process for to assess treatment duration for CAP, a larger proportion of patients will receive appropriate care that is consistent with the 2019 ATS/IDSA CAP national guidelines. [1] Appropriateness of antibiotic therapy for pneumonia is a priority for numerous federal organizations–including the CDC, The Joint Commission, and Centers for Medicare and Medicaid Services–and is not currently captured in typical quality improvement measures. For example, NHSN antimicrobial use (AU) measures focus on quantifying antibiotic use and comparing to expected values, with no assessment of appropriateness or duration of therapy. Notably, the NHSN AU initiative could be augmented with an eCQM to assess appropriateness of antibiotic duration for CAP.

What are the benefits or improvements in quality envisioned by this measure?: Duration of antibiotic therapy for CAP often exceeds national guidelines. HMS and CDC data analyses report excessive duration of antibiotics for >70% of CAP cases in the US. [2,3] The consequences of excess duration of therapy include adverse events in 20% of patients who receive unnecessary antibiotics, with increasing risk for each excess day of therapy for pneumonia. [2] Conversely, a quality initiative (based on a chart review version of this measure) to adhere to 5-day antibiotic duration in qualified uncomplicated CAP patients implemented across 41 hospitals was associated with a higher percentage of appropriate duration and fewer adverse events. [4]

Clinical Recommendation Statement

Joint ATS/IDSA clinical guidelines recommend a 5-day antibiotic duration for adult medical patients hospitalized with uncomplicated community-acquired pneumonia. [1]

Improvement Notation

Decreased score indicates improvement

Reference

Reference Type: Citation

Reference Text: '1. Antimicrobial Resistance Collaborators. Global burden of bacterial antimicrobial resistance in 2019: a systematic analysis. Lancet. Feb 12 2022;399(10325):629-655. doi:10.1016/s0140-6736(21)02724-0.'

Reference

Reference Type: Citation

Reference Text: '10. Dinh A, Davido B, Bouchand F, Duran C, Ropers J, Crémieux AC. Honey, I Shrunk the Antibiotic Therapy. Clin Infect Dis. Jun 1 2018;66(12):1981-1982. doi:10.1093/cid/ciy047.'

Reference

Reference Type: Citation

Reference Text: '11. Harris JA, Kolokathis A, Campbell M, Cassell GH, Hammerschlag MR. Safety and efficacy of azithromycin in the treatment of community-acquired pneumonia in children. Pediatr Infect Dis J. Oct 1998;17(10):865-71. doi:10.1097/00006454-199810000-00004.'

Reference

Reference Type: Citation

Reference Text: '12. Ginsburg AS, Mvalo T, Nkwopara E, et al. Amoxicillin for 3 or 5 Days for Chest-Indrawing Pneumonia in Malawian Children. N Engl J Med. Jul 2 2020;383(1):13-23. doi:10.1056/NEJMoa1912400.'

Reference

Reference Type: Citation

Reference Text: '13. Pernica JM, Harman S, Kam AJ, et al. Short-Course Antimicrobial Therapy for Pediatric Community-Acquired Pneumonia: The SAFER Randomized Clinical Trial. JAMA Pediatr. May 1 2021;175(5):475-482. doi:10.1001/jamapediatrics.2020.6735.'

Reference

Reference Type: Citation

Reference Text: '2. Fridkin S, Baggs J, Fagan R, et al. Vital signs: improving antibiotic use among hospitalized patients. MMWR Morbidity and mortality weekly report. Mar 7 2014;63(9):194-200.'

Reference

Reference Type: Citation

Reference Text: '3. CDC. Core Elements of Hospital Antibiotic Stewardship Programs. (US Department of Health and Human Services, CDC) (2019. Available at https://www.cdc.gov/antibiotic-use/core-elements/hospital.html.).'

Reference

Reference Type: Citation

Reference Text: '4. Dunbar LM, Khashab MM, Kahn JB, Zadeikis N, Xiang JX, Tennenberg AM. Efficacy of 750-mg, 5-day levofloxacin in the treatment of community-acquired pneumonia caused by atypical pathogens. Curr Med Res Opin. Apr 2004;20(4):555-63. doi:10.1185/030079904125003304.'

Reference

Reference Type: Citation

Reference Text: '5. Zhao X, Wu JF, Xiu QY, et al. A randomized controlled clinical trial of levofloxacin 750 mg versus 500 mg intravenous infusion in the treatment of community-acquired pneumonia. Diagn Microbiol Infect Dis. Oct 2014;80(2):141-7. doi:10.1016/j.diagmicrobio.2013.11.008.'

Reference

Reference Type: Citation

Reference Text: '6. Pakistan Multicentre Amoxycillin Short Course Therapy (MASCOT) pneumonia study group. Clinical efficacy of 3 days versus 5 days of oral amoxicillin for treatment of childhood pneumonia: a multicentre double-blind trial. Lancet. Sep 14 2002;360(9336):835-41. doi:10.1016/s0140-6736(02)09994-4.'

Reference

Reference Type: Citation

Reference Text: '7. Greenberg D, Givon-Lavi N, Sadaka Y, Ben-Shimol S, Bar-Ziv J, Dagan R. Short-course antibiotic treatment for community-acquired alveolar pneumonia in ambulatory children: a double-blind, randomized, placebo-controlled trial. Pediatr Infect Dis J. Feb 2014;33(2):136-42. doi:10.1097/inf.0000000000000023.'

Reference

Reference Type: Citation

Reference Text: '8. el Moussaoui R, de Borgie CA, van den Broek P, et al. Effectiveness of discontinuing antibiotic treatment after three days versus eight days in mild to moderate-severe community acquired pneumonia: randomised, double blind study. BMJ (Clinical research ed). Jun 10 2006;332(7554):1355. doi:10.1136/bmj.332.7554.1355.'

Reference

Reference Type: Citation

Reference Text: '9. Uranga A, Espana PP, Bilbao A, et al. Duration of Antibiotic Treatment in Community-Acquired Pneumonia: A Multicenter Randomized Clinical Trial. JAMA Intern Med. Sep 1 2016;176(9):1257-65. doi:10.1001/jamainternmed.2016.3633.'

Definition

None

Guidance

This is a facility-level process eCQM to quantify the percentage of adult, medical patients hospitalized with uncomplicated community-acquired pneumonia who qualify for a 5-day antibiotic duration according to national guidelines (as specified in denominator) who received excess antibiotic duration (defined as ≥ 7 days of total antibiotic therapy including inpatient and discharge antibiotics). Better performance is indicated by a lower score.

Transmission Format

TBD

Initial Population

Adult patients diagnosed with Community Acquired Pneumonia receiving standard care.

Denominator

Adult patients with an inpatient non-ICU hospitalization in which the discharge diagnosis includes pneumonia or sepsis AND respiratory failure (RF) who received a respiratory antibiotic within 48 hours of hospitalization, received chest imaging within +/- 3 days of the hospital encounter, were not transferred from another hospital, and do not have a concurrent infection. Restrict to patients with uncomplicated pneumonia that qualify for a 5-day duration according to national guidelines

Denominator Exclusions

Exclude complex CAP patients with: mechanical ventilation in first 48 hours of hospitalization, ANC<500 cells/uL, cystic fibrosis, bronchiectasis, HIV, tracheostomy, transplant in prior year, hematologic malignancy, or pulmonary complication (empyema, lung abscess, necrotizing pneumona). 
Exclude cases in which the antibiotic duration is unknown due to the following factors: patient died during hospitalization, patient was discharged to another hospital, patient was discharged to inpatient or home hospice, or an antibiotic was prescribed at discharge but the duration is missing.
Exclude cases in which the patient's condition requires longer antibiotic duration than is typical for uncomplicated CAP. This includes cases where the patient was transferred to ICU during hospitalization, was bacteremic during hospitalization, Staphylococcus aureus was identified in respiratory culture, Pseudomonas aeruginosa was identified in respiratory culture, Legionella pneumonia was identified by urine antigen or DNA presence, or the patient did not achieve clinical stability by day 5 of hospitalization.
Exclude conditions where treatment is likely not for uncomplicated CAP, suggesting an alternate diagnosis. This includes cases where the patient had a total antibiotic duration of <3 or greater than 14 days.

Numerator

From the denominator population, identify patients who received excess antibiotic duration, defined as >/= 7 days of total antibiotic therapy including inpatient and discharge antibiotics

Numerator Exclusions

None

Denominator Exceptions

None

Supplemental Data Elements

For every patient evaluated by this measure also identify payer, race, ethnicity and sex.

Population Criteria
Definitions
Functions
Terminology
Data Criteria (QDM Data Elements)
Supplemental Data Elements
Risk Adjustment Variables

Population Criteria

Initial Population

    "Qualifying CAP Encounter for Patient with Appropriate Age"

- Denominator
  - "Initial Population"

Denominator Exclusions

    "Complex CAP Encounter"
        union "Cases in Which Antibiotic Duration is Unknown"
        union "Encounter with non-CAP Diagnosis"
        union "Encounter with Longer Antibiotic Duration"

- Numerator
  - "Excess Antibiotic Duration"

- Numerator Exclusions
  - None

- Denominator Exceptions
  - None

- Stratification
  - None

Definitions

Cases in Which Antibiotic Duration is Unknown

   "Qualifying CAP Encounter" QCAPEncounter
       where QCAPEncounter.dischargeDisposition.code in "Discharge To Acute Care Facility"
            or QCAPEncounter.dischargeDisposition.code in "Discharged to Health Care Facility for Hospice Care"
            or QCAPEncounter.dischargeDisposition.code in "Discharged to Home for Hospice Care"
            or QCAPEncounter.dischargeDisposition.code in "Patient Expired"

Clinical Stability by Day 5

  exists ("Qualifying CAP Encounter" QCAPEncounter
      where (
        exists (["Physical Exam, Performed": "Body Temperature"] BodyTemp
            where BodyTemp.result as Quantity <= 37.8 'Cel'
                or BodyTemp.result as Quantity <= 100.04 '[degF]'
            and BodyTemp.relevantDatetime during Interval[start of QCAPEncounter.relevantPeriod, start of QCAPEncounter.relevantPeriod + 5 days])
        and exists (["Physical Exam, Performed": "Systolic Blood Pressure"] SystolicBP
            where SystolicBP.result >= 90 'mm[Hg]'
                and SystolicBP.relevantDatetime during Interval[start of QCAPEncounter.relevantPeriod, start of QCAPEncounter.relevantPeriod + 5 days])))

Complex CAP Encounter

    "Relevant Comorbidities"
        union "Neutropenia"
        union "History of Transplant"

Concurrent Infection

    ["Encounter, Performed": "Encounter Inpatient"] Encounter
        with Encounter.diagnoses ConcurrentDx
            such that ConcurrentDx.code in "CAP Concurrent Infections"

Contaminated Bacteria Culture

    ["Encounter, Performed": "Encounter Inpatient"] Encounter        
        with ["Laboratory Test, Performed": "Bacteria identified in Blood by Culture"] BloodCulture
            such that BloodCulture.result.code in "Bacterial Skin Commensals"

Deceased in 48 Hours

    ["Encounter, Performed": "Encounter Inpatient"] Encounter
        with ["Patient Characteristic Expired": "Dead (finding)"] Deceased
            such that Deceased.expiredDatetime during Interval[start of Encounter.relevantPeriod, start of Encounter.relevantPeriod + 48 hours]

Denominator
- - "Initial Population"

Denominator Exclusions

    "Complex CAP Encounter"
        union "Cases in Which Antibiotic Duration is Unknown"
        union "Encounter with non-CAP Diagnosis"
        union "Encounter with Longer Antibiotic Duration"

Disqualifying Encounter Elements

    "Deceased in 48 Hours"
        union "ICU Admission"
        union "Transfer In"
        union "Concurrent Infection"

Encounter with Chest Imaging during Hospitalization

    ["Encounter, Performed": "Encounter Inpatient"] InpatientEncounter
        with ["Diagnostic Study, Performed": "Chest Imaging for Pneumonia Grouping Definition"] ChestImaging
            such that ChestImaging.authorDatetime during Interval [start of InpatientEncounter.relevantPeriod -72 hours, end of InpatientEncounter.relevantPeriod + 72 hours]
                and ChestImaging.authorDatetime during day of "Measurement Period"

Encounter with Longer Antibiotic Duration

    "Qualifying CAP Encounter" QCAPEncounter
        where "ICU Care" is true
            or "Secondary Infection" is true
            or "Clinical Stability by Day 5" is false

Encounter with non-CAP Diagnosis

    "Qualifying CAP Encounter" QCAPEncounter
        where ("Total Antibiotic Duration" < 3 or "Total Antibiotic Duration" > 14)

Excess Antibiotic Duration

    "Qualifying CAP Encounter" QCAPEncounter
        where "Total Antibiotic Duration" >= 7

History of Transplant

    "Qualifying CAP Encounter" QCAPEncounter
        with ["Procedure, Performed": "Major Transplant"] Transplant
            such that Transplant.relevantPeriod ends during day of Interval[start of QCAPEncounter.relevantPeriod - 365 days, start of QCAPEncounter.relevantPeriod]

ICU Admission

    ["Encounter, Performed": "Encounter Inpatient"] Encounter   
        where exists Encounter.facilityLocations Location
            where Location.code in "Intensive Care Unit"
                and Location.locationPeriod starts during Interval[start of Encounter.relevantPeriod, start of Encounter.relevantPeriod + 48 hours]

ICU Care

    exists "Qualifying CAP Encounter" QCAPEncounter
        where exists QCAPEncounter.facilityLocations Location  
                where Location.code in "Intensive Care Unit"
                    and Location.locationPeriod overlaps QCAPEncounter.relevantPeriod

Initial Population

    "Qualifying CAP Encounter for Patient with Appropriate Age"

Neutropenia

   "Qualifying CAP Encounter" QCAPEncounter
        where exists (["Laboratory Test, Performed": "Complete Blood Count (with Diff)"] BloodTest
            where exists BloodTest.components Component
                where Component.code = "Neutrophils [#/volume] in Blood"
                    and Component.result is not null
                    and Component.result as Quantity < 500 '{Cells}/uL')

Numerator
- - "Excess Antibiotic Duration"

Qualifying CAP Encounter

    "Qualifying Encounter" QEncounter
        where exists (QEncounter.diagnoses Diagnosis
            where Diagnosis.code in "CAP, Sepsis, Respiratory Failure Diagnostic")

Qualifying CAP Encounter for Patient with Appropriate Age

    "Qualifying CAP Encounter" QCAPEncounter
        where QCAPEncounter.relevantPeriod ends during day of "Measurement Period"
            and AgeInYearsAt(date from start of QCAPEncounter.relevantPeriod) >= 18

Qualifying Encounter

    ["Encounter, Performed": "Encounter Inpatient"] QCAPEncounter
        where exists (["Medication, Administered": "Antibiotic Usage for CAP Diagnosis"] Antibiotic
            where Antibiotic.authorDatetime during Interval[start of QCAPEncounter.relevantPeriod, start of QCAPEncounter.relevantPeriod + 48 hours])
        and exists "Encounter with Chest Imaging during Hospitalization" ChestImagingEnc
            where ChestImagingEnc.id = QCAPEncounter.id
        and not exists "Disqualifying Encounter Elements" dqEncounter
            where dqEncounter.id = QCAPEncounter.id

Relevant Comorbidities

    "Qualifying CAP Encounter" QCAPEncounter        
        with QCAPEncounter.diagnoses EncounterDiagnoses
            such that EncounterDiagnoses.code in "Comorbidities Indicated with CAP"
                or EncounterDiagnoses.code = "Human immunodeficiency virus [HIV] disease"
                or EncounterDiagnoses.code = "Patient immunocompromised (finding)"

SDE Ethnicity

    ["Patient Characteristic Ethnicity": "Ethnicity"]

SDE Payer

    ["Patient Characteristic Payer": "Payer Type"]

SDE Race

    ["Patient Characteristic Race": "Race"]

SDE Sex

    ["Patient Characteristic Sex": "ONC Administrative Sex"]

Secondary Infection

    exists "Qualifying CAP Encounter" QCAPEncounter
        where exists (["Laboratory Test, Performed": "Bacteria identified in Blood by Culture"] BloodCulture
            where BloodCulture.result.code in "Bacteria (Tests in Blood by Culture and Identification Method)"
                and not exists "Contaminated Bacteria Culture" Contamination
                    where Contamination.id = QCAPEncounter.id)
        or exists (["Laboratory Test, Performed": "Bacteria identified in Specimen by Respiratory culture"] RespCulture
            where RespCulture.result.code in "Staphylococcus aureus (Organism or Substance in Lab Results)"
                or RespCulture.result.code in "Pseudomonas aeruginosa (Organism or Substance in Lab Results)")
        or exists (["Laboratory Test, Performed": "Legionella Presence by Urine Antigen or DNA"] LegionellaTest
            where LegionellaTest.result.code in "Legionella Presence by Urine Antigen or DNA")

Total AdminMed

    Sum(
        ["Medication, Administered": "Antibiotic Usage for CAP Diagnosis"] AdminMed
            where exists ("Qualifying CAP Encounter" QCAPEncounter
                where AdminMed.relevantPeriod overlaps Interval[start of QCAPEncounter.relevantPeriod, end of QCAPEncounter.relevantPeriod])
        return Global.LengthInDays(AdminMed.relevantPeriod)
    )

Total Antibiotic Duration

    "Total AdminMed" + "Total DischargeMed"

Total DischargeMed

    Coalesce(
        Sum(
            ["Medication, Discharge": "Antibiotic Usage for CAP Diagnosis"] DischargeMed
                where exists ("Qualifying CAP Encounter" QCAPEncounter
                    where DischargeMed.authorDatetime during Interval[start of QCAPEncounter.relevantPeriod, end of QCAPEncounter.relevantPeriod])
            return DischargeMed.daysSupplied), 0)

Transfer In

    ["Encounter, Performed": "Encounter Inpatient"] Encounter
        where exists ["Procedure, Performed": "Hospital admission, transfer from other hospital or health care facility (procedure)"] TransferIn

Functions

Global.LengthInDays(Value Interval<DateTime>)

  difference in days between start of Value and end of Value

Terminology

code "Bacteria identified in Blood by Culture" ("LOINC Code (600-7)")
code "Bacteria identified in Specimen by Respiratory culture" ("LOINC Code (32355-0)")
code "Dead (finding)" ("SNOMEDCT Code (419099009)")
code "Hospital admission, transfer from other hospital or health care facility (procedure)" ("SNOMEDCT Code (4563007)")
code "Human immunodeficiency virus [HIV] disease" ("ICD10CM Code (B20)")
code "Neutrophils [#/volume] in Blood" ("LOINC Code (26499-4)")
code "Patient immunocompromised (finding)" ("SNOMEDCT Code (370388006)")
valueset "Antibiotic Usage for CAP Diagnosis" (2.16.840.1.113762.1.4.1264.25)
valueset "Bacteria (Tests in Blood by Culture and Identification Method)" (2.16.840.1.113762.1.4.1146.1460)
valueset "Bacterial Skin Commensals" (2.16.840.1.114222.24.7.281)
valueset "Body Temperature" (2.16.840.1.113762.1.4.1045.152)
valueset "CAP Concurrent Infections" (2.16.840.1.113762.1.4.1264.23)
valueset "CAP, Sepsis, Respiratory Failure Diagnostic" (2.16.840.1.113762.1.4.1264.24)
valueset "Chest Imaging for Pneumonia Grouping Definition" (2.16.840.1.113762.1.4.1264.12)
valueset "Comorbidities Indicated with CAP" (2.16.840.1.113762.1.4.1264.26)
valueset "Complete Blood Count (with Diff)" (1.3.6.1.4.1.6997.4.1.2.271.13.38167.1.1.999.594)
valueset "Discharge To Acute Care Facility" (2.16.840.1.113883.3.117.1.7.1.87)
valueset "Discharged to Health Care Facility for Hospice Care" (2.16.840.1.113883.3.117.1.7.1.207)
valueset "Discharged to Home for Hospice Care" (2.16.840.1.113883.3.117.1.7.1.209)
valueset "Encounter Inpatient" (2.16.840.1.113883.3.666.5.307)
valueset "Ethnicity" (2.16.840.1.114222.4.11.837)
valueset "Intensive Care Unit" (2.16.840.1.113762.1.4.1029.204)
valueset "Legionella Presence by Urine Antigen or DNA" (2.16.840.1.113762.1.4.1264.27)
valueset "Major Transplant" (2.16.840.1.113883.3.464.1003.198.12.1075)
valueset "ONC Administrative Sex" (2.16.840.1.113762.1.4.1)
valueset "Patient Expired" (2.16.840.1.113883.3.117.1.7.1.309)
valueset "Payer Type" (2.16.840.1.114222.4.11.3591)
valueset "Pseudomonas aeruginosa (Organism or Substance in Lab Results)" (2.16.840.1.113762.1.4.1146.1679)
valueset "Race" (2.16.840.1.114222.4.11.836)
valueset "Staphylococcus aureus (Organism or Substance in Lab Results)" (2.16.840.1.113762.1.4.1146.1156)
valueset "Systolic Blood Pressure" (2.16.840.1.113762.1.4.1045.163)

Data Criteria (QDM Data Elements)

"Diagnostic Study, Performed: Chest Imaging for Pneumonia Grouping Definition" using "Chest Imaging for Pneumonia Grouping Definition (2.16.840.1.113762.1.4.1264.12)"
"Encounter, Performed: Encounter Inpatient" using "Encounter Inpatient (2.16.840.1.113883.3.666.5.307)"
"Laboratory Test, Performed: Bacteria identified in Blood by Culture" using "Bacteria identified in Blood by Culture (LOINC Code 600-7)"
"Laboratory Test, Performed: Bacteria identified in Specimen by Respiratory culture" using "Bacteria identified in Specimen by Respiratory culture (LOINC Code 32355-0)"
"Laboratory Test, Performed: Complete Blood Count (with Diff)" using "Complete Blood Count (with Diff) (1.3.6.1.4.1.6997.4.1.2.271.13.38167.1.1.999.594)"
"Laboratory Test, Performed: Legionella Presence by Urine Antigen or DNA" using "Legionella Presence by Urine Antigen or DNA (2.16.840.1.113762.1.4.1264.27)"
"Medication, Administered: Antibiotic Usage for CAP Diagnosis" using "Antibiotic Usage for CAP Diagnosis (2.16.840.1.113762.1.4.1264.25)"
"Medication, Discharge: Antibiotic Usage for CAP Diagnosis" using "Antibiotic Usage for CAP Diagnosis (2.16.840.1.113762.1.4.1264.25)"
"Patient Characteristic Ethnicity: Ethnicity" using "Ethnicity (2.16.840.1.114222.4.11.837)"
"Patient Characteristic Expired: Dead (finding)" using "Dead (finding) (SNOMEDCT Code 419099009)"
"Patient Characteristic Payer: Payer Type" using "Payer Type (2.16.840.1.114222.4.11.3591)"
"Patient Characteristic Race: Race" using "Race (2.16.840.1.114222.4.11.836)"
"Patient Characteristic Sex: ONC Administrative Sex" using "ONC Administrative Sex (2.16.840.1.113762.1.4.1)"
"Physical Exam, Performed: Body Temperature" using "Body Temperature (2.16.840.1.113762.1.4.1045.152)"
"Physical Exam, Performed: Systolic Blood Pressure" using "Systolic Blood Pressure (2.16.840.1.113762.1.4.1045.163)"
"Procedure, Performed: Hospital admission, transfer from other hospital or health care facility (procedure)" using "Hospital admission, transfer from other hospital or health care facility (procedure) (SNOMEDCT Code 4563007)"
"Procedure, Performed: Major Transplant" using "Major Transplant (2.16.840.1.113883.3.464.1003.198.12.1075)"

Supplemental Data Elements

SDE Ethnicity

    ["Patient Characteristic Ethnicity": "Ethnicity"]

SDE Payer

    ["Patient Characteristic Payer": "Payer Type"]

SDE Race

    ["Patient Characteristic Race": "Race"]

SDE Sex

    ["Patient Characteristic Sex": "ONC Administrative Sex"]

Risk Adjustment Variables

None

Measure Set

None