Process

increase

define "Initial Population":
  /***
    Patients aged between 45 and 75 years with at least 1 qualifying stool-based screening with positive result during the measurement period.
    ***/
  
  AgeInYearsAt(date from start of "Measurement Period") in Interval[45, 75]
    and exists ( "Qualifying Colorectal Screening with Positive Result" )

define "Denominator":
  "Initial Population"

define "Denominator Exclusions":
  "Has Index Colorectal Screening Done During Hospitalization"
    or "Has Positive Colorectal Screening Within 365 Days Prior"
    or "Has Colorectal Cancer Prior to Index Colorectal Screening"
    or "Has Total Colectomy Procedure Performed Prior to Index Colorectal Screening"
    or "Has Hospice Care"
    or "Has Palliative Care"

define "Numerator":
  "Has Follow-up Diagnostic Evaluations Within 180 Days of the Index Colorectal Screening"

define "Denominator Exceptions":
  "Has Colonoscopy Procedure Performed Within 3 Years Prior to the Index Colorectal Screening"
    or "Patient Deceased Within 180 Days of the Index Colorectal Screening"

define "Qualifying Colonoscopy Procedure Performed":
  ["Procedure": "Colonoscopy"] ColonoscopyPerformed
    where ColonoscopyPerformed.status in { 'completed', 'in-progress' }

define "Colorectal Screenings":
  [Observation: "Colorectal Screening"] ColorectalScreening
    where ColorectalScreening.status in { 'final', 'amended', 'corrected' }
      and ColorectalScreening.value is not null

define "Qualifying Colorectal Screenings":
  "Colorectal Screenings" CScreening
    where CScreening.effective.toInterval ( ) during day of "Measurement Period"

define "Qualifying Colorectal Screening with Positive Result":
  "Qualifying Colorectal Screenings" ColorectalScreening
    where ColorectalScreening.value in { 'Positive', 'positive' }

define "Index Colorectal Screening":
  First("Qualifying Colorectal Screening with Positive Result" QCS
      sort by issued
  )

define "Has Follow-up Diagnostic Evaluations Within 180 Days of the Index Colorectal Screening":
  exists ( "Qualifying Colonoscopy Procedure Performed" ColonoscopyProcedure
      where ColonoscopyProcedure.performed starts 180 days or less on or after "Index Colorectal Screening".issued
  )

define "Numerator":
  "Has Follow-up Diagnostic Evaluations Within 180 Days of the Index Colorectal Screening"

define "Initial Population":
  /***
    Patients aged between 45 and 75 years with at least 1 qualifying stool-based screening with positive result during the measurement period.
    ***/
  
  AgeInYearsAt(date from start of "Measurement Period") in Interval[45, 75]
    and exists ( "Qualifying Colorectal Screening with Positive Result" )

define "Denominator":
  "Initial Population"

define "Inpatient Encounter":
  ["Encounter": "Initial Hospital Inpatient Visit"] Hospitalencounter
    where Hospitalencounter.status = 'finished'
      and Hospitalencounter.period during "Measurement Period"

define "Index Colorectal Screening Done During Hospitalization":
  "Inpatient Encounter" HospitalEncounter
    with "Index Colorectal Screening" ICS
      such that ICS.effective.toInterval ( ) starts during HospitalEncounter.period

define "Has Index Colorectal Screening Done During Hospitalization":
  exists ( "Index Colorectal Screening Done During Hospitalization" )

define "Has Positive Colorectal Screening Within 365 Days Prior":
  exists ( "Colorectal Screenings" PrevCS
      where PrevCS.value in { 'Positive', 'positive' }
        and PrevCS.effective.toInterval ( ) starts 365 days or less on or before "Index Colorectal Screening".issued
  )

define "Has Colorectal Cancer Prior to Index Colorectal Screening":
  exists ( [Condition: "Malignant Neoplasm of Colon"] ColorectalCancerCondition
      where ( ColorectalCancerCondition.clinicalStatus ~ "active"
          or ColorectalCancerCondition.clinicalStatus ~ "recurrence"
          or ColorectalCancerCondition.clinicalStatus ~ "relapse"
      )
        and ColorectalCancerCondition.verificationStatus ~ "confirmed"
        and ColorectalCancerCondition.recordedDate before "Index Colorectal Screening".issued
  )

define "Has Total Colectomy Procedure Performed Prior to Index Colorectal Screening":
  exists ( [Procedure: "Total Colectomy"] TotalColectomyProcedure
      where TotalColectomyProcedure.status = 'completed'
        and TotalColectomyProcedure.performed ends on or before "Index Colorectal Screening".issued
  )

define "Has Hospice Care":
  exists ( ["Encounter": "Inpatient Stay"] HospiceEncounter
      where HospiceEncounter.status = 'finished'
        and HospiceEncounter.hospitalization.dischargeDisposition ~ "Discharge to home for hospice care (procedure)"
        and ( HospiceEncounter.period ends 1 year or less on or before "Index Colorectal Screening".issued
            or HospiceEncounter.period starts 180 days or less on or after "Index Colorectal Screening".issued
        )
  )
    or exists ( [ServiceRequest: "Hospice Care"] HospiceServiceOrder
        where HospiceServiceOrder.intent = 'order'
          and ( HospiceServiceOrder.authoredOn 1 year or less on or before "Index Colorectal Screening".issued
              or HospiceServiceOrder.authoredOn 180 days or less on or after "Index Colorectal Screening".issued
          )
    )

define "Has Palliative Care":
  exists ( ["Procedure": "Palliative Care"] PalliativeCareProcedure
      where PalliativeCareProcedure.status = 'completed'
        and PalliativeCareProcedure.performed ends 1 year or less on or before "Index Colorectal Screening".issued
        or PalliativeCareProcedure.performed starts 180 days or less on or after "Index Colorectal Screening".issued
  )
    or exists ( [ServiceRequest: "Palliative Care"] PalliativeCareOrder
        where PalliativeCareOrder.intent = 'order'
          and ( PalliativeCareOrder.authoredOn 1 year or less on or before "Index Colorectal Screening".issued
              or PalliativeCareOrder.authoredOn 180 days or less on or after "Index Colorectal Screening".issued
          )
    )
    or exists ( ["Encounter": "Palliative Care Encounter"] PalliativeCareEncounter
        where PalliativeCareEncounter.status = 'finished'
          and ( PalliativeCareEncounter.period ends 1 year or less on or before "Index Colorectal Screening".issued
              or PalliativeCareEncounter.period starts 180 days or less on or after "Index Colorectal Screening".issued
          )
    )

define "Denominator Exclusions":
  "Has Index Colorectal Screening Done During Hospitalization"
    or "Has Positive Colorectal Screening Within 365 Days Prior"
    or "Has Colorectal Cancer Prior to Index Colorectal Screening"
    or "Has Total Colectomy Procedure Performed Prior to Index Colorectal Screening"
    or "Has Hospice Care"
    or "Has Palliative Care"

define "Has Colonoscopy Procedure Performed Within 3 Years Prior to the Index Colorectal Screening":
  exists ( "Qualifying Colonoscopy Procedure Performed" ColonoscopyProcedure
      where ColonoscopyProcedure.performed starts 3 years or less on or before "Index Colorectal Screening".issued
  )

define "Patient Deceased Within 180 Days of the Index Colorectal Screening":
  Patient.deceased.toInterval ( ) starts 180 days or less on or after "Index Colorectal Screening".issued

define "Denominator Exceptions":
  "Has Colonoscopy Procedure Performed Within 3 Years Prior to the Index Colorectal Screening"
    or "Patient Deceased Within 180 Days of the Index Colorectal Screening"

/*
@description: Normalizes a value that is a choice of timing-valued types to an equivalent interval
@comment: Normalizes a choice type of DateTime, Quanitty, Interval<DateTime>, or Interval<Quantity> 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 QICore, allowing this function to be used across any resource.
The input can be provided as a DateTime, Quantity, Interval<DateTime> or Interval<Quantity>.
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 Quantity, the quantity is expected to be a calendar-duration interpreted as an Age,
and the result is a DateTime Interval beginning on the Date the patient turned that age and ending immediately before one year later.
If the input is a DateTime Interval, the result is the input.
If the input is a Quantity Interval, the quantities are expected to be calendar-durations interpreted as an Age, and the result
is a DateTime Interval beginning on the date the patient turned the age given as the start of the quantity interval, and ending
immediately before one year later than the date the patient turned the age given as the end of the quantity interval.
If the input is a Timing, an error will be thrown indicating that Timing calculations are not implemented. Any other input will reslt in a null DateTime Interval
*/
define fluent function toInterval(choice Choice<DateTime, Quantity, Interval<DateTime>, Interval<Quantity>, Timing>):
  case
	  when choice is DateTime then
    	Interval[choice as DateTime, choice as DateTime]
		when choice is Interval<DateTime> then
  		choice as Interval<DateTime>
		when choice is Quantity then
		  Interval[Patient.birthDate + (choice as Quantity),
			  Patient.birthDate + (choice as Quantity) + 1 year)
		when choice is Interval<Quantity> then
		  Interval[Patient.birthDate + (choice.low as Quantity),
			  Patient.birthDate + (choice.high as Quantity) + 1 year)
		when choice is Timing then
      Message(null, true, 'NOT_IMPLEMENTED', 'Error', 'Calculation of an interval from a Timing value is not supported') as Interval<DateTime>
		else
			null as Interval<DateTime>
	end