CU-SINC, Non-Postpartum: The annual percentage of most or moderately effective contraceptive method users, among patients assigned female at birth ages 15-44, excluding those who are postpartum or did not want to discuss their contraceptive needs. (Contraceptive Use, Self-Identified Need for Contraception, Non-Postpartum) Draft based on 0.0.000

Primary Measure - Most and Moderately Effective Contraceptive Provision or Use: Percentage of patients ages 15-44 and assigned female at birth who were provided or were documented to use a most or moderately effective contraceptive method in the measurement period. The primary measure captures new provision as well as current use of most and moderately effective contraceptive methods to accurately capture contraceptive utilization even if provided in a different calendar year or a different health care site. 

Submeasure - Access to LARC (LARC-SINC): Percentage of patients ages 15-44 and assigned female at birth who were provided LARC in the measurement period. The submeasure captures LARC provision to ensure access to these methods by identifying low provision rates (i.e., below 2%).  

For both measures: to focus on the population of non-postpartum patients interested in contraceptive services, the denominator excludes those individuals who were not provided nor were documented to be using of a most or moderately effective contraceptive method if they did not want to discuss their contraceptive needs, as well as those who are eligible for postpartum contraceptive services during the measurement period.

The performance measure is not a clinical guideline and does not establish a standard of medical care, and has not been tested for all potential applications. THE MEASURE AND SPECIFICATIONS ARE PROVIDED "AS IS" WITHOUT WARRANTY OF ANY KIND.

Many people – and especially women of color and women of low socioeconomic status – experience barriers accessing contraceptive care. Disparities in reproductive health outcomes could be mitigated by innovative approaches that expand options for receiving contraceptive care. The eCQMs assess the degree to which patients have their contraceptive needs met and provides an opportunity to have public reporting and Quality Improvement around meeting people’s contraceptive needs. This measure is specified for calculation at two levels of analysis: facility and clinician group/practice.

The Women's Preventive Services Initiative recommends that adolescent and adult women have access to the full range of female-controlled contraceptives to prevent undesired pregnancy and improve birth outcomes.  Contraceptive care should include contraceptive counseling, initiation of contraceptive use, and follow-up care (e.g., management, and evaluation as well as changes to and removal or discontinuation of the contraceptive method). The Women’s Preventive Services Initiative recommends that the full range of female-controlled U.S. Food and Drug Administration-approved contraceptive methods, effective family planning practices, and sterilization procedures be available as part of contraceptive care.

Increased score indicates improvement - While increased score indicates improvement for #3699e, the submeasure for LARC (LARC-SINC) is a floor measure. Specifically, the goal of the submeasure is to ensure access to LARC methods in the non-postpartum population by monitoring very low rates of provision (e.g., below 2%). This measure therefore will not have a benchmark encouraging high rates of use. In addition, utilization in pay-for-performance or similar programs or setting a high benchmark will be explicitly defined as inappropriate, as doing so may incentivize coercive practices. Contraceptive services must be offered in a client-centered manner, as recommended by CDC and OPA.

Reference Type: Citation

Reference Text: 'Health Resources and Services Administration (2019). Women’s Preventive Services Guidelines. U.S. Department of Health and Human Services. https://www.hrsa.gov/womens-guidelines-2019'

The denominator exclusion using SINC applies only to those who were not provided nor were documented to be using contraception during the measurement period, as being provided or using contraception is an indication of interest in these services. Any patient who responds to SINC that she does wish to discuss contraceptive needs is included in the denominator, even if she answered no at any other point. 

Patients who are included in the Contraceptive Use eCQM (CU-SINC), Postpartum, are not included in this measure in order to allow for measurement of distinct care pathways between those receiving prenatal care and those not receiving prenatal care. This requires excluding those who receive prenatal care at the specified facility, do not experience a pregnancy loss, and have a live birth date or EDD that would make them eligible for postpartum contraception during the measurement period. 

For further guidance on using the Contraceptive Use eCQMs, please visit our website at https://pcrhp.ucsf.edu/contraceptive-use-ecqms 

This eCQM is a patient-based measure. This version of the eCQM uses QDM version 5.6.  Please refer to the eCQI resource center (https://ecqi.healthit.gov/qdm) for more information on the QDM.

Primary Measure, Submeasure:
Patients assigned female at birth aged 15-44 who had a qualifying encounter during the measurement period

Primary Measure, Submeasure: Initial Population

Primary Measure, Submeasure:
1) Had a live birth making them eligible for postpartum contraception in the measurement period: Those who had a prenatal care visit in the year prior to the measurement period through the first 9 months of the measurement period (i.e., 1/1/XX-1 through 9/30/XX) with a documented live birth delivery date, or a documented estimated delivery date (EDD) between 3 months prior to the measurement period and 9 months into the measurement period (i.e., 10/1/XX-1 through 9/30/XX), provided that those with EDD only did not have a documented ectopic pregnancy, intrauterine fetal demise, early pregnancy loss, or abortion (i.e., non-live birth event)
2) Are anatomically infecund: those with documentation of anatomical infecundity due to removal of uterus and/or bilateral ovaries during year prior to the measurement period and through the measurement period (i.e., 1/1/XX-1 through 12/31/XX) 
3) Answered "No" to all instances of the Self-Identified Need for Contraception (SINC) question: those who did not want to discuss their contraceptive needs every time they were asked the SINC question from among those who were not provided nor were documented to use a most or moderately effective method throughout the measurement period 
Primary Measure, Submeasure:
1) Had a live birth making them eligible for postpartum contraception in the measurement period: Those who had a prenatal care visit in the year prior to the measurement period through the first 9 months of the measurement period (i.e., 1/1/XX-1 through 9/30/XX) with a documented live birth delivery date, or a documented estimated delivery date (EDD) between 3 months prior to the measurement period and 9 months into the measurement period (i.e., 10/1/XX-1 through 9/30/XX)
2) Are anatomically infecund: those with documentation of anatomical infecundity due to removal of uterus and/or bilateral ovaries during year prior to the measurement period and through the measurement period (i.e., 1/1/XX-1 through 12/31/XX) 
3) Answered "No" to all instances of the Self-Identified Need for Contraception (SINC) question: those who did not want to discuss their contraceptive needs every time they were asked the SINC question from among those who were not provided nor were documented to use a most or moderately effective method throughout the measurement period

Primary Measure: 
Of patients in the denominator, those who were provided or were documented to be using a most (i.e., sterilization, implants, intrauterine devices or systems (IUD/IUS) or moderately effective (i.e., injectables, oral pills, patch, or ring) contraceptive method during the measurement period. 

Submeasure:
Of patients in the denominator, those who were provided a long-acting reversible method of contraception (LARC, i.e., IUD or implant) during the measurement period.

For every patient evaluated by this measure, supplemental data elements (SDE) are also included: payer, race, ethnicity. These SDEs are available, but not required for eCQM calculation.

Population Criteria 1

Initial Population

  ( AgeInYearsAt(date from start of "Measurement Period") in Interval[15, 44]
      and exists ( ["Patient Characteristic Sex": "Female"] )
      and exists ( "Qualifying Encounters" )
  )

Denominator

  ( "Contraceptive Use Non-Postpartum Initial Population" )

Denominator Exclusions

( ( exists ( "Had Live Birth Delivery" )
      or ( exists ( "Had Estimated Delivery Date" )
        and not exists ( "Had Live Birth Delivery" )
        and not exists ( "Had Non Live Birth Event" ) )
    and ( "Prenatal Care Visits Group" ) )
    or exists ( "Is Anatomically Infecund" ) 
    or ( exists ( "Answered No SINC") 
    and not exists ( "Most and Moderately Effective Contraceptive Use and Provision") ) )

Numerator

  exists ( "Most and Moderately Effective Contraceptive Use and Provision" )

- Numerator Exclusions
  - None
- Denominator Exceptions
  - None
- Stratification
  - None

Population Criteria 2

Initial Population

  ( AgeInYearsAt(date from start of "Measurement Period") in Interval[15, 44]
      and exists ( ["Patient Characteristic Sex": "Female"] )
      and exists ( "Qualifying Encounters" )
  )

Denominator

  ( "Contraceptive Use Non-Postpartum Initial Population" )

Denominator Exclusions

( ( exists ( "Had Live Birth Delivery" )
      or ( exists ( "Had Estimated Delivery Date" )
        and not exists ( "Had Live Birth Delivery" )
        and not exists ( "Had Non Live Birth Event" ) )
    and ( "Prenatal Care Visits Group" ) )
    or exists ( "Is Anatomically Infecund" ) 
    or ( exists ( "Answered No SINC") 
    and not exists ( "Most and Moderately Effective Contraceptive Use and Provision") ) )

- Numerator
  - exists ( "LARC Provision" )
- Numerator Exclusions
  - None
- Denominator Exceptions
  - None
- Stratification
  - None

Answered No SINC

( ( ["Assessment, Performed": "Do you want to talk about contraception or pregnancy prevention during your visit today"] )
  union ( ["Assessment, Performed": "No - I am already using contraception"] ) 
  union ( ["Assessment, Performed": "No - I am hoping to become pregnant in the near future"] )  
  union ( ["Assessment, Performed": "No - I am unsure or dont want to use contraception"] )
  union ( ["Assessment, Performed": "No - I do not want to talk about contraception today because I am here for something else"] )
  union ( ["Assessment, Performed": "No - This question does not apply to me/I prefer not to answer"] ) ) SINCNoAnswers
  where Global."NormalizeInterval" ( SINCNoAnswers.relevantDatetime, SINCNoAnswers.relevantPeriod ) during day of "Measurement Period"

Contraceptive Use Non-Postpartum Denominator Exclusions

( ( exists ( "Had Live Birth Delivery" )
      or ( exists ( "Had Estimated Delivery Date" )
        and not exists ( "Had Live Birth Delivery" )
        and not exists ( "Had Non Live Birth Event" ) )
    and ( "Prenatal Care Visits Group" ) )
    or exists ( "Is Anatomically Infecund" ) 
    or ( exists ( "Answered No SINC") 
    and not exists ( "Most and Moderately Effective Contraceptive Use and Provision") ) )

Contraceptive Use Non-Postpartum Initial Population

  ( AgeInYearsAt(date from start of "Measurement Period") in Interval[15, 44]
      and exists ( ["Patient Characteristic Sex": "Female"] )
      and exists ( "Qualifying Encounters" )
  )

Had Estimated Delivery Date

  ( ["Assessment, Performed": "Delivery date Estimated"] ) EstimatedDeliveryDatePerformed
   where  Global."NormalizeInterval" ( EstimatedDeliveryDatePerformed.relevantDatetime, EstimatedDeliveryDatePerformed.relevantPeriod ) starts 3 months or less on or before start of "Measurement Period"
  or Global."NormalizeInterval" ( EstimatedDeliveryDatePerformed.relevantDatetime, EstimatedDeliveryDatePerformed.relevantPeriod ) starts 9 months or less on or after start of "Measurement Period"

Had General Prenatal Care Visit

   ( ( ["Encounter, Performed": "General Prenatal Care Visits"] )
    union ( ["Encounter, Performed": "Telephone Visits"] )
    union ( ["Encounter, Performed": "Virtual Encounter"] ) ) GeneralPrenatalCareVisitPerformed
    where Global."NormalizeInterval" ( GeneralPrenatalCareVisitPerformed.authorDatetime, GeneralPrenatalCareVisitPerformed.relevantPeriod ) starts 12 months or less on or before start of "Measurement Period"
     or Global."NormalizeInterval" ( GeneralPrenatalCareVisitPerformed.authorDatetime, GeneralPrenatalCareVisitPerformed.relevantPeriod ) starts 9 months or less on or after start of "Measurement Period"

Had LARC Provision Encounter

  ( ["Encounter, Performed": "Contraceptive Implant ICD10CM Provision Encounters"] )
    union ( ["Encounter, Performed": "Intrauterine Devices ICD10CM Provision Encounters"] ) LARCProvisionEncounters
     where LARCProvisionEncounters.relevantPeriod during day of "Measurement Period"

Had LARC Provision Procedure

  ( ["Procedure, Performed": "Contraceptive Implant Provision Procedures"] )
    union ( ["Procedure, Performed": "IUD Provision Procedures"] ) LARCProvisionProcedures
      where LARCProvisionProcedures.relevantPeriod during day of "Measurement Period"

Had Live Birth Delivery

( ( ["Assessment, Performed": "Date and time of obstetric delivery"] )
    union ( ["Procedure, Performed": "Live Birth Delivery Procedures"] ) ) LiveBirthDeliveryReported
      where Global."NormalizeInterval" ( LiveBirthDeliveryReported.relevantDatetime, LiveBirthDeliveryReported.relevantPeriod ) starts 3 months or less on or before start of "Measurement Period"
    or Global."NormalizeInterval" ( LiveBirthDeliveryReported.relevantDatetime, LiveBirthDeliveryReported.relevantPeriod ) starts 9 months or less on or after start of "Measurement Period"

Had Non Live Birth Event

( ( ["Diagnosis": "Non Live Birth Diagnoses"] )
    union ( ["Procedure, Performed": "Non Live Birth Procedures"] ) ) NonLiveBirthReported
     where Global."NormalizeInterval" ( NonLiveBirthReported.relevantDatetime, NonLiveBirthReported.relevantPeriod ) starts 3 months or less on or before start of "Measurement Period"
    or Global."NormalizeInterval" ( NonLiveBirthReported.relevantDatetime, NonLiveBirthReported.relevantPeriod ) starts 12 months or less on or after start of "Measurement Period"

Had Pregnancy Related Diagnoses

 ( ["Diagnosis": "Pregnancy Related Diagnoses"] ) PregnancyRelatedDiagnoses
    where Global."NormalizeInterval" ( PregnancyRelatedDiagnoses.authorDatetime, PregnancyRelatedDiagnoses.prevalencePeriod ) starts 12 months or less on or before start of "Measurement Period"
    or Global."NormalizeInterval" ( PregnancyRelatedDiagnoses.authorDatetime, PregnancyRelatedDiagnoses.prevalencePeriod ) starts 9 months or less on or after start of "Measurement Period"

Had Prenatal Care Bundle Visit

  ( ["Encounter, Performed": "Prenatal Care Bundle Visits"] ) PrenatalCareBundleVisit
    where Global."NormalizeInterval" ( PrenatalCareBundleVisit.authorDatetime, PrenatalCareBundleVisit.relevantPeriod ) starts 12 months or less on or before start of "Measurement Period"
    or Global."NormalizeInterval" ( PrenatalCareBundleVisit.authorDatetime, PrenatalCareBundleVisit.relevantPeriod ) starts 9 months or less on or after start of "Measurement Period"

Had Prenatal Care Specific Visit

  ( ["Encounter, Performed": "Prenatal Care Specific Visits"] ) PrenatalCareSpecificVisit
    where  Global."NormalizeInterval" ( PrenatalCareSpecificVisit.authorDatetime, PrenatalCareSpecificVisit.relevantPeriod ) starts 12 months or less on or before start of "Measurement Period"
    or Global."NormalizeInterval" ( PrenatalCareSpecificVisit.authorDatetime, PrenatalCareSpecificVisit.relevantPeriod ) starts 9 months or less on or after start of "Measurement Period"

Is Anatomically Infecund

  ( ( ["Assessment, Performed": "Infecund Not for Contraceptive Reasons SNOMED Findings"] )
    union ( ["Encounter, Performed": "Infecund Not for Contraceptive Reasons ICD10CM"] )
    union ( ["Procedure, Performed": "Infecund Not for Contraceptive Reasons Procedures"] ) ) AnatomicallyInfecund
    where Global."NormalizeInterval" ( AnatomicallyInfecund.relevantDatetime, AnatomicallyInfecund.relevantPeriod ) starts 12 months or less on or before start of "Measurement Period"
    or  Global."NormalizeInterval" ( AnatomicallyInfecund.relevantDatetime, AnatomicallyInfecund.relevantPeriod ) starts 12 months or less on or after start of "Measurement Period"

LARC Numerator
- - exists ( "LARC Provision" )

LARC Provision

  ( "Provided LARC Device" )
    union ( "Had LARC Provision Encounter" )
    union ( "Provided LARC Medication" )
    union ( "Had LARC Provision Procedure" ) LARCProvided
      where Global."NormalizeInterval" ( LARCProvided.relevantDatetime, LARCProvided.relevantPeriod ) during day of "Measurement Period"

Most and Moderately Effective Contraceptive Devices

 ( ["Device, Order": "Permanent implantable contraceptive intratubal occlusion device(s) and delivery system"] )
    union ( ["Device, Order": "IUD Devices"] )
    union ( ["Device, Order": "Contraceptive Implant Devices"] )
    union ( ["Device, Order": "Contraceptive Patch Devices"] )
    union ( ["Device, Order": "Contraceptive Ring HCPCS Devices"] ) MostModDevices
      where MostModDevices.authorDatetime during day of "Measurement Period"

Most and Moderately Effective Contraceptive Encounters

  ( ["Encounter, Performed": "Encounter for sterilization"] )
    union ( ["Encounter, Performed": "Tubal ligation status"] )
    union ( ["Encounter, Performed": "Contraceptive Implant ICD10CM Provision Encounters"] )
    union ( ["Encounter, Performed": "Contraceptive Implant ICD10CM Surveillance"] )
    union ( ["Encounter, Performed": "Intrauterine Devices ICD10CM Provision Encounters"] )
    union ( ["Encounter, Performed": "Intrauterine Devices ICD10CM Surveillance"] )
    union ( ["Encounter, Performed": "Injectable Contraceptive ICD10CM Provision Encounters"] )
    union ( ["Encounter, Performed": "Injectable Contraceptive ICD10CM Surveillance"] )
    union ( ["Encounter, Performed": "Oral Contraceptive Pill ICD10CM Provision Encounters"] )
    union ( ["Encounter, Performed": "Oral Contraceptive Pill ICD10CM Surveillance"] )
    union ( ["Encounter, Performed": "Contraceptive Patch ICD10CM Provision Encounters"] )
    union ( ["Encounter, Performed": "Contraceptive Patch ICD10CM Surveillance"] )
    union ( ["Encounter, Performed": "Contraceptive Ring ICD10CM Provision Encounters"] )
    union ( ["Encounter, Performed": "Contraceptive Ring ICD10CM Surveillance"] ) MostModEncounters
      where MostModEncounters.relevantPeriod during day of "Measurement Period"

Most and Moderately Effective Contraceptive Findings

    ( ["Assessment, Performed": "Sterilization SNOMED Findings" ] )
    union ( ["Assessment, Performed": "Partner had vasectomy (situation)"] )
    union ( ["Assessment, Performed": "Contraceptive Implant SNOMED Findings"] )
    union ( ["Assessment, Performed": "Intrauterine Devices SNOMED Findings"] )
    union ( ["Assessment, Performed": "Injectable Contraceptive SNOMED Findings"] )
    union ( ["Assessment, Performed": "Oral Contraceptive Pill SNOMED Findings"] )
    union ( ["Assessment, Performed": "Contraceptive Patch SNOMED Findings"] )
    union ( ["Assessment, Performed": "Contraceptive Ring SNOMED Findings"] ) MostModFindings
      where MostModFindings.relevantPeriod during day of "Measurement Period"

Most and Moderately Effective Contraceptive LOINC

  ( ["Assessment, Performed": "Female sterilization"] )
    union ( ["Assessment, Performed": "Contraceptive Implant LOINC"] )
    union ( ["Assessment, Performed": "Intrauterine Devices LOINC"] )
    union ( ["Assessment, Performed": "Injectable Contraceptive LOINC"] )
    union ( ["Assessment, Performed": "Oral Contraceptive Pill LOINC"] )
    union ( ["Assessment, Performed": "Contraceptive Patch LOINC"] )
    union ( ["Assessment, Performed": "Contraceptive Ring LOINC"] ) MostModLOINC
      where MostModLOINC.relevantPeriod during day of "Measurement Period"

Most and Moderately Effective Contraceptive Procedures

  ( ["Procedure, Performed": "Female Sterilization Provision Procedures"] )
    union ( ["Procedure, Performed": "Contraceptive Implant Provision Procedures"] )
    union ( ["Procedure, Performed": "Contraceptive Implant SNOMED Surveillance Procedures"] )
    union ( ["Procedure, Performed": "IUD Provision Procedures"] )
    union ( ["Procedure, Performed": "Intrauterine Devices SNOMED Surveillance Procedures"] )
    union ( ["Procedure, Performed": "Injectable Contraceptive Provision Procedures"] )
    union ( ["Procedure, Performed": "Oral Contraceptive Pill Provision Procedures"] )
    union ( ["Procedure, Performed": "Contraceptive Patch SNOMED Provision Procedures"] ) MostModProcedures
      where MostModProcedures.relevantPeriod during day of "Measurement Period"

Most and Moderately Effective Contraceptive Provision

  ( ["Medication, Order": "Contraceptive Implants RXNORM Medications"] )
    union ( ["Medication, Order": "Intrauterine Devices RXNORM Medications"] )
    union ( ["Medication, Order": "Injectable Contraceptive RXNORM Medications"] )
    union ( ["Medication, Order": "Oral Contraceptive Pills RXNORM Medications"] )
    union ( ["Medication, Order": "Contraceptive Patch RXNORM Medications"] )
    union ( ["Medication, Order": "Contraceptive Ring RXNORM Medications"] ) MostModPrescriptions
      where MostModPrescriptions.relevantPeriod during day of "Measurement Period"

Most and Moderately Effective Contraceptive Use

  ( ["Medication, Active": "Contraceptive Implants RXNORM Medications"] )
    union ( ["Medication, Active": "Intrauterine Devices RXNORM Medications"] )
    union ( ["Medication, Active": "Injectable Contraceptive RXNORM Medications"] )
    union ( ["Medication, Active": "Oral Contraceptive Pills RXNORM Medications"] )
    union ( ["Medication, Active": "Contraceptive Patch RXNORM Medications"] )
    union ( ["Medication, Active": "Contraceptive Ring RXNORM Medications"] ) MostModMedications
      where MostModMedications.relevantPeriod during day of "Measurement Period"

Most and Moderately Effective Contraceptive Use and Provision

  ( "Most and Moderately Effective Contraceptive Encounters" )
    union ( "Most and Moderately Effective Contraceptive Procedures" )
    union ( "Most and Moderately Effective Contraceptive Devices" )
    union ( "Most and Moderately Effective Contraceptive Provision" )
    union ( "Most and Moderately Effective Contraceptive Use" )
    union ( "Most and Moderately Effective Contraceptive Findings" )
    union ( "Most and Moderately Effective Contraceptive LOINC" ) MostModUse
      where MostModUse.relevantPeriod during day of "Measurement Period"

MostMod Numerator

  exists ( "Most and Moderately Effective Contraceptive Use and Provision" )

Non-Postpartum Denominator

  ( "Contraceptive Use Non-Postpartum Initial Population" )

Prenatal Care Visits Group

  exists ( "Had Prenatal Care Specific Visit" )
    or exists ( "Had Prenatal Care Bundle Visit" )
    or ( exists ( "Had Pregnancy Related Diagnoses" )
        and exists ( "Had General Prenatal Care Visit" ) )

Provided LARC Device

  ( ["Device, Order": "Contraceptive Implant Devices"] )
    union ( ["Device, Order": "IUD Devices"] ) LARCProvisionDevices
      where LARCProvisionDevices.authorDatetime during day of "Measurement Period"

Provided LARC Medication

  ( ["Medication, Order": "Contraceptive Implants RXNORM Medications"] )
    union ( ["Medication, Order": "Intrauterine Devices RXNORM Medications"] ) LARCProvisionMedications
      where LARCProvisionMedications.relevantPeriod during day of "Measurement Period"

Qualifying Encounters

   ( ( ["Encounter, Performed": "Office Visit"] )
    union ( ["Encounter, Performed": "Preventive Care Services Established Office Visit, 18 and Up"] )
    union ( ["Encounter, Performed": "Preventive Care Services Initial Office Visit, 18 and Up"] )
    union ( ["Encounter, Performed": "Preventive Care Services, Initial Office Visit, 0 to 17"] )
    union ( ["Encounter, Performed": "Preventive Care, Established Office Visit, 0 to 17"] )
    union ( ["Encounter, Performed": "Home Healthcare Services"] ) 
    union ( ["Encounter, Performed": "Telephone Visits"] ) 
    union ( ["Encounter, Performed": "Virtual Encounter"] ) )
    ValidEncounters
	where  Global."NormalizeInterval" ( ValidEncounters.authorDatetime, ValidEncounters.relevantPeriod ) during day of "Measurement Period"

SDE Ethnicity

  ["Patient Characteristic Ethnicity": "Ethnicity"]

SDE Payer

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

SDE Race

  ["Patient Characteristic Race": "Race"]

Global.NormalizeInterval(pointInTime DateTime, period Interval<DateTime>)

  if pointInTime is not null then Interval[pointInTime, pointInTime]
    else if period is not null then period 
    else null as Interval<DateTime>

code "Date and time of obstetric delivery" ("LOINC Code (93857-1)")
code "Delivery date Estimated" ("LOINC Code (11778-8)")
code "Do you want to talk about contraception or pregnancy prevention during your visit today" ("LOINC Code (98076-3)")
code "Encounter for sterilization" ("ICD10CM Code (Z30.2)")
code "Female" ("AdministrativeGender Code (F)")
code "Female sterilization" ("LOINC Code (LA27905-1)")
code "No - I am already using contraception" ("LOINC Code (LA32393-3)")
code "No - I am hoping to become pregnant in the near future" ("LOINC Code (LA32392-5)")
code "No - I am unsure or dont want to use contraception" ("LOINC Code (LA32391-7)")
code "No - I do not want to talk about contraception today because I am here for something else" ("LOINC Code (LA32389-1)")
code "No - This question does not apply to me/I prefer not to answer" ("LOINC Code (LA32390-9)")
code "Partner had vasectomy (situation)" ("SNOMEDCT Code (830148006)")
code "Permanent implantable contraceptive intratubal occlusion device(s) and delivery system" ("HCPCS Code (A4264)")
code "Tubal ligation status" ("ICD10CM Code (Z98.51)")
valueset "Contraceptive Implant Devices" (2.16.840.1.113762.1.4.1166.201)
valueset "Contraceptive Implant ICD10CM Provision Encounters" (2.16.840.1.113762.1.4.1166.170)
valueset "Contraceptive Implant ICD10CM Surveillance" (2.16.840.1.113762.1.4.1166.171)
valueset "Contraceptive Implant LOINC" (2.16.840.1.113762.1.4.1166.167)
valueset "Contraceptive Implant Provision Procedures" (2.16.840.1.113762.1.4.1166.202)
valueset "Contraceptive Implant SNOMED Findings" (2.16.840.1.113762.1.4.1166.164)
valueset "Contraceptive Implant SNOMED Surveillance Procedures" (2.16.840.1.113762.1.4.1166.192)
valueset "Contraceptive Implants RXNORM Medications" (2.16.840.1.113762.1.4.1166.130)
valueset "Contraceptive Patch Devices" (2.16.840.1.113762.1.4.1166.174)
valueset "Contraceptive Patch ICD10CM Provision Encounters" (2.16.840.1.113762.1.4.1166.146)
valueset "Contraceptive Patch ICD10CM Surveillance" (2.16.840.1.113762.1.4.1166.147)
valueset "Contraceptive Patch LOINC" (2.16.840.1.113762.1.4.1166.150)
valueset "Contraceptive Patch RXNORM Medications" (2.16.840.1.113762.1.4.1166.76)
valueset "Contraceptive Patch SNOMED Findings" (2.16.840.1.113762.1.4.1166.145)
valueset "Contraceptive Patch SNOMED Provision Procedures" (2.16.840.1.113762.1.4.1166.144)
valueset "Contraceptive Ring HCPCS Devices" (2.16.840.1.113762.1.4.1166.159)
valueset "Contraceptive Ring ICD10CM Provision Encounters" (2.16.840.1.113762.1.4.1166.156)
valueset "Contraceptive Ring ICD10CM Surveillance" (2.16.840.1.113762.1.4.1166.157)
valueset "Contraceptive Ring LOINC" (2.16.840.1.113762.1.4.1166.160)
valueset "Contraceptive Ring RXNORM Medications" (2.16.840.1.113762.1.4.1166.129)
valueset "Contraceptive Ring SNOMED Findings" (2.16.840.1.113762.1.4.1166.155)
valueset "Ethnicity" (2.16.840.1.114222.4.11.837)
valueset "Female Sterilization Provision Procedures" (2.16.840.1.113762.1.4.1166.142)
valueset "General Prenatal Care Visits" (2.16.840.1.113762.1.4.1166.135)
valueset "Home Healthcare Services" (2.16.840.1.113883.3.464.1003.101.12.1016)
valueset "Infecund Not for Contraceptive Reasons ICD10CM" (2.16.840.1.113762.1.4.1166.97)
valueset "Infecund Not for Contraceptive Reasons Procedures" (2.16.840.1.113762.1.4.1166.151)
valueset "Infecund Not for Contraceptive Reasons SNOMED Findings" (2.16.840.1.113762.1.4.1166.96)
valueset "Injectable Contraceptive ICD10CM Provision Encounters" (2.16.840.1.113762.1.4.1166.185)
valueset "Injectable Contraceptive ICD10CM Surveillance" (2.16.840.1.113762.1.4.1166.186)
valueset "Injectable Contraceptive LOINC" (2.16.840.1.113762.1.4.1166.188)
valueset "Injectable Contraceptive Provision Procedures" (2.16.840.1.113762.1.4.1166.197)
valueset "Injectable Contraceptive RXNORM Medications" (2.16.840.1.113762.1.4.1166.131)
valueset "Injectable Contraceptive SNOMED Findings" (2.16.840.1.113762.1.4.1166.183)
valueset "Intrauterine Devices ICD10CM Provision Encounters" (2.16.840.1.113762.1.4.1166.83)
valueset "Intrauterine Devices ICD10CM Surveillance" (2.16.840.1.113762.1.4.1166.84)
valueset "Intrauterine Devices LOINC" (2.16.840.1.113762.1.4.1166.80)
valueset "Intrauterine Devices RXNORM Medications" (2.16.840.1.113762.1.4.1166.85)
valueset "Intrauterine Devices SNOMED Findings" (2.16.840.1.113762.1.4.1166.87)
valueset "Intrauterine Devices SNOMED Surveillance Procedures" (2.16.840.1.113762.1.4.1166.89)
valueset "IUD Devices" (2.16.840.1.113762.1.4.1166.140)
valueset "IUD Provision Procedures" (2.16.840.1.113762.1.4.1166.139)
valueset "Live Birth Delivery Procedures" (2.16.840.1.113762.1.4.1166.143)
valueset "Non Live Birth Diagnoses" (2.16.840.1.113762.1.4.1166.137)
valueset "Non Live Birth Procedures" (2.16.840.1.113762.1.4.1166.136)
valueset "Office Visit" (2.16.840.1.113883.3.464.1003.101.12.1001)
valueset "Oral Contraceptive Pill ICD10CM Provision Encounters" (2.16.840.1.113762.1.4.1166.193)
valueset "Oral Contraceptive Pill ICD10CM Surveillance" (2.16.840.1.113762.1.4.1166.194)
valueset "Oral Contraceptive Pill LOINC" (2.16.840.1.113762.1.4.1166.196)
valueset "Oral Contraceptive Pill Provision Procedures" (2.16.840.1.113762.1.4.1166.199)
valueset "Oral Contraceptive Pill SNOMED Findings" (2.16.840.1.113762.1.4.1166.191)
valueset "Oral Contraceptive Pills RXNORM Medications" (2.16.840.1.113762.1.4.1166.132)
valueset "Payer Type" (2.16.840.1.114222.4.11.3591)
valueset "Pregnancy Related Diagnoses" (2.16.840.1.113762.1.4.1166.133)
valueset "Prenatal Care Bundle Visits" (2.16.840.1.113762.1.4.1166.205)
valueset "Prenatal Care Specific Visits" (2.16.840.1.113762.1.4.1166.114)
valueset "Preventive Care Services Established Office Visit, 18 and Up" (2.16.840.1.113883.3.464.1003.101.12.1025)
valueset "Preventive Care Services Initial Office Visit, 18 and Up" (2.16.840.1.113883.3.464.1003.101.12.1023)
valueset "Preventive Care Services, Initial Office Visit, 0 to 17" (2.16.840.1.113883.3.464.1003.101.12.1022)
valueset "Preventive Care, Established Office Visit, 0 to 17" (2.16.840.1.113883.3.464.1003.101.12.1024)
valueset "Race" (2.16.840.1.114222.4.11.836)
valueset "Sterilization SNOMED Findings" (2.16.840.1.113762.1.4.1166.109)
valueset "Telephone Visits" (2.16.840.1.113883.3.464.1003.101.12.1080)
valueset "Virtual Encounter" (2.16.840.1.113883.3.464.1003.101.12.1089)

"Assessment, Performed: Contraceptive Implant LOINC" using "Contraceptive Implant LOINC (2.16.840.1.113762.1.4.1166.167)"
"Assessment, Performed: Contraceptive Implant SNOMED Findings" using "Contraceptive Implant SNOMED Findings (2.16.840.1.113762.1.4.1166.164)"
"Assessment, Performed: Contraceptive Patch LOINC" using "Contraceptive Patch LOINC (2.16.840.1.113762.1.4.1166.150)"
"Assessment, Performed: Contraceptive Patch SNOMED Findings" using "Contraceptive Patch SNOMED Findings (2.16.840.1.113762.1.4.1166.145)"
"Assessment, Performed: Contraceptive Ring LOINC" using "Contraceptive Ring LOINC (2.16.840.1.113762.1.4.1166.160)"
"Assessment, Performed: Contraceptive Ring SNOMED Findings" using "Contraceptive Ring SNOMED Findings (2.16.840.1.113762.1.4.1166.155)"
"Assessment, Performed: Date and time of obstetric delivery" using "Date and time of obstetric delivery (LOINC Code 93857-1)"
"Assessment, Performed: Delivery date Estimated" using "Delivery date Estimated (LOINC Code 11778-8)"
"Assessment, Performed: Do you want to talk about contraception or pregnancy prevention during your visit today" using "Do you want to talk about contraception or pregnancy prevention during your visit today (LOINC Code 98076-3)"
"Assessment, Performed: Female sterilization" using "Female sterilization (LOINC Code LA27905-1)"
"Assessment, Performed: Infecund Not for Contraceptive Reasons SNOMED Findings" using "Infecund Not for Contraceptive Reasons SNOMED Findings (2.16.840.1.113762.1.4.1166.96)"
"Assessment, Performed: Injectable Contraceptive LOINC" using "Injectable Contraceptive LOINC (2.16.840.1.113762.1.4.1166.188)"
"Assessment, Performed: Injectable Contraceptive SNOMED Findings" using "Injectable Contraceptive SNOMED Findings (2.16.840.1.113762.1.4.1166.183)"
"Assessment, Performed: Intrauterine Devices LOINC" using "Intrauterine Devices LOINC (2.16.840.1.113762.1.4.1166.80)"
"Assessment, Performed: Intrauterine Devices SNOMED Findings" using "Intrauterine Devices SNOMED Findings (2.16.840.1.113762.1.4.1166.87)"
"Assessment, Performed: No - I am already using contraception" using "No - I am already using contraception (LOINC Code LA32393-3)"
"Assessment, Performed: No - I am hoping to become pregnant in the near future" using "No - I am hoping to become pregnant in the near future (LOINC Code LA32392-5)"
"Assessment, Performed: No - I am unsure or dont want to use contraception" using "No - I am unsure or dont want to use contraception (LOINC Code LA32391-7)"
"Assessment, Performed: No - I do not want to talk about contraception today because I am here for something else" using "No - I do not want to talk about contraception today because I am here for something else (LOINC Code LA32389-1)"
"Assessment, Performed: No - This question does not apply to me/I prefer not to answer" using "No - This question does not apply to me/I prefer not to answer (LOINC Code LA32390-9)"
"Assessment, Performed: Oral Contraceptive Pill LOINC" using "Oral Contraceptive Pill LOINC (2.16.840.1.113762.1.4.1166.196)"
"Assessment, Performed: Oral Contraceptive Pill SNOMED Findings" using "Oral Contraceptive Pill SNOMED Findings (2.16.840.1.113762.1.4.1166.191)"
"Assessment, Performed: Partner had vasectomy (situation)" using "Partner had vasectomy (situation) (SNOMEDCT Code 830148006)"
"Assessment, Performed: Sterilization SNOMED Findings" using "Sterilization SNOMED Findings (2.16.840.1.113762.1.4.1166.109)"
"Device, Order: Contraceptive Implant Devices" using "Contraceptive Implant Devices (2.16.840.1.113762.1.4.1166.201)"
"Device, Order: Contraceptive Patch Devices" using "Contraceptive Patch Devices (2.16.840.1.113762.1.4.1166.174)"
"Device, Order: Contraceptive Ring HCPCS Devices" using "Contraceptive Ring HCPCS Devices (2.16.840.1.113762.1.4.1166.159)"
"Device, Order: IUD Devices" using "IUD Devices (2.16.840.1.113762.1.4.1166.140)"
"Device, Order: Permanent implantable contraceptive intratubal occlusion device(s) and delivery system" using "Permanent implantable contraceptive intratubal occlusion device(s) and delivery system (HCPCS Code A4264)"
"Diagnosis: Non Live Birth Diagnoses" using "Non Live Birth Diagnoses (2.16.840.1.113762.1.4.1166.137)"
"Diagnosis: Pregnancy Related Diagnoses" using "Pregnancy Related Diagnoses (2.16.840.1.113762.1.4.1166.133)"
"Encounter, Performed: Contraceptive Implant ICD10CM Provision Encounters" using "Contraceptive Implant ICD10CM Provision Encounters (2.16.840.1.113762.1.4.1166.170)"
"Encounter, Performed: Contraceptive Implant ICD10CM Surveillance" using "Contraceptive Implant ICD10CM Surveillance (2.16.840.1.113762.1.4.1166.171)"
"Encounter, Performed: Contraceptive Patch ICD10CM Provision Encounters" using "Contraceptive Patch ICD10CM Provision Encounters (2.16.840.1.113762.1.4.1166.146)"
"Encounter, Performed: Contraceptive Patch ICD10CM Surveillance" using "Contraceptive Patch ICD10CM Surveillance (2.16.840.1.113762.1.4.1166.147)"
"Encounter, Performed: Contraceptive Ring ICD10CM Provision Encounters" using "Contraceptive Ring ICD10CM Provision Encounters (2.16.840.1.113762.1.4.1166.156)"
"Encounter, Performed: Contraceptive Ring ICD10CM Surveillance" using "Contraceptive Ring ICD10CM Surveillance (2.16.840.1.113762.1.4.1166.157)"
"Encounter, Performed: Encounter for sterilization" using "Encounter for sterilization (ICD10CM Code Z30.2)"
"Encounter, Performed: General Prenatal Care Visits" using "General Prenatal Care Visits (2.16.840.1.113762.1.4.1166.135)"
"Encounter, Performed: Home Healthcare Services" using "Home Healthcare Services (2.16.840.1.113883.3.464.1003.101.12.1016)"
"Encounter, Performed: Infecund Not for Contraceptive Reasons ICD10CM" using "Infecund Not for Contraceptive Reasons ICD10CM (2.16.840.1.113762.1.4.1166.97)"
"Encounter, Performed: Injectable Contraceptive ICD10CM Provision Encounters" using "Injectable Contraceptive ICD10CM Provision Encounters (2.16.840.1.113762.1.4.1166.185)"
"Encounter, Performed: Injectable Contraceptive ICD10CM Surveillance" using "Injectable Contraceptive ICD10CM Surveillance (2.16.840.1.113762.1.4.1166.186)"
"Encounter, Performed: Intrauterine Devices ICD10CM Provision Encounters" using "Intrauterine Devices ICD10CM Provision Encounters (2.16.840.1.113762.1.4.1166.83)"
"Encounter, Performed: Intrauterine Devices ICD10CM Surveillance" using "Intrauterine Devices ICD10CM Surveillance (2.16.840.1.113762.1.4.1166.84)"
"Encounter, Performed: Office Visit" using "Office Visit (2.16.840.1.113883.3.464.1003.101.12.1001)"
"Encounter, Performed: Oral Contraceptive Pill ICD10CM Provision Encounters" using "Oral Contraceptive Pill ICD10CM Provision Encounters (2.16.840.1.113762.1.4.1166.193)"
"Encounter, Performed: Oral Contraceptive Pill ICD10CM Surveillance" using "Oral Contraceptive Pill ICD10CM Surveillance (2.16.840.1.113762.1.4.1166.194)"
"Encounter, Performed: Prenatal Care Bundle Visits" using "Prenatal Care Bundle Visits (2.16.840.1.113762.1.4.1166.205)"
"Encounter, Performed: Prenatal Care Specific Visits" using "Prenatal Care Specific Visits (2.16.840.1.113762.1.4.1166.114)"
"Encounter, Performed: Preventive Care Services Established Office Visit, 18 and Up" using "Preventive Care Services Established Office Visit, 18 and Up (2.16.840.1.113883.3.464.1003.101.12.1025)"
"Encounter, Performed: Preventive Care Services Initial Office Visit, 18 and Up" using "Preventive Care Services Initial Office Visit, 18 and Up (2.16.840.1.113883.3.464.1003.101.12.1023)"
"Encounter, Performed: Preventive Care Services, Initial Office Visit, 0 to 17" using "Preventive Care Services, Initial Office Visit, 0 to 17 (2.16.840.1.113883.3.464.1003.101.12.1022)"
"Encounter, Performed: Preventive Care, Established Office Visit, 0 to 17" using "Preventive Care, Established Office Visit, 0 to 17 (2.16.840.1.113883.3.464.1003.101.12.1024)"
"Encounter, Performed: Telephone Visits" using "Telephone Visits (2.16.840.1.113883.3.464.1003.101.12.1080)"
"Encounter, Performed: Tubal ligation status" using "Tubal ligation status (ICD10CM Code Z98.51)"
"Encounter, Performed: Virtual Encounter" using "Virtual Encounter (2.16.840.1.113883.3.464.1003.101.12.1089)"
"Medication, Active: Contraceptive Implants RXNORM Medications" using "Contraceptive Implants RXNORM Medications (2.16.840.1.113762.1.4.1166.130)"
"Medication, Active: Contraceptive Patch RXNORM Medications" using "Contraceptive Patch RXNORM Medications (2.16.840.1.113762.1.4.1166.76)"
"Medication, Active: Contraceptive Ring RXNORM Medications" using "Contraceptive Ring RXNORM Medications (2.16.840.1.113762.1.4.1166.129)"
"Medication, Active: Injectable Contraceptive RXNORM Medications" using "Injectable Contraceptive RXNORM Medications (2.16.840.1.113762.1.4.1166.131)"
"Medication, Active: Intrauterine Devices RXNORM Medications" using "Intrauterine Devices RXNORM Medications (2.16.840.1.113762.1.4.1166.85)"
"Medication, Active: Oral Contraceptive Pills RXNORM Medications" using "Oral Contraceptive Pills RXNORM Medications (2.16.840.1.113762.1.4.1166.132)"
"Medication, Order: Contraceptive Implants RXNORM Medications" using "Contraceptive Implants RXNORM Medications (2.16.840.1.113762.1.4.1166.130)"
"Medication, Order: Contraceptive Patch RXNORM Medications" using "Contraceptive Patch RXNORM Medications (2.16.840.1.113762.1.4.1166.76)"
"Medication, Order: Contraceptive Ring RXNORM Medications" using "Contraceptive Ring RXNORM Medications (2.16.840.1.113762.1.4.1166.129)"
"Medication, Order: Injectable Contraceptive RXNORM Medications" using "Injectable Contraceptive RXNORM Medications (2.16.840.1.113762.1.4.1166.131)"
"Medication, Order: Intrauterine Devices RXNORM Medications" using "Intrauterine Devices RXNORM Medications (2.16.840.1.113762.1.4.1166.85)"
"Medication, Order: Oral Contraceptive Pills RXNORM Medications" using "Oral Contraceptive Pills RXNORM Medications (2.16.840.1.113762.1.4.1166.132)"
"Patient Characteristic Ethnicity: Ethnicity" using "Ethnicity (2.16.840.1.114222.4.11.837)"
"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: Female" using "Female (AdministrativeGender Code F)"
"Procedure, Performed: Contraceptive Implant Provision Procedures" using "Contraceptive Implant Provision Procedures (2.16.840.1.113762.1.4.1166.202)"
"Procedure, Performed: Contraceptive Implant SNOMED Surveillance Procedures" using "Contraceptive Implant SNOMED Surveillance Procedures (2.16.840.1.113762.1.4.1166.192)"
"Procedure, Performed: Contraceptive Patch SNOMED Provision Procedures" using "Contraceptive Patch SNOMED Provision Procedures (2.16.840.1.113762.1.4.1166.144)"
"Procedure, Performed: Female Sterilization Provision Procedures" using "Female Sterilization Provision Procedures (2.16.840.1.113762.1.4.1166.142)"
"Procedure, Performed: Infecund Not for Contraceptive Reasons Procedures" using "Infecund Not for Contraceptive Reasons Procedures (2.16.840.1.113762.1.4.1166.151)"
"Procedure, Performed: Injectable Contraceptive Provision Procedures" using "Injectable Contraceptive Provision Procedures (2.16.840.1.113762.1.4.1166.197)"
"Procedure, Performed: Intrauterine Devices SNOMED Surveillance Procedures" using "Intrauterine Devices SNOMED Surveillance Procedures (2.16.840.1.113762.1.4.1166.89)"
"Procedure, Performed: IUD Provision Procedures" using "IUD Provision Procedures (2.16.840.1.113762.1.4.1166.139)"
"Procedure, Performed: Live Birth Delivery Procedures" using "Live Birth Delivery Procedures (2.16.840.1.113762.1.4.1166.143)"
"Procedure, Performed: Non Live Birth Procedures" using "Non Live Birth Procedures (2.16.840.1.113762.1.4.1166.136)"
"Procedure, Performed: Oral Contraceptive Pill Provision Procedures" using "Oral Contraceptive Pill Provision Procedures (2.16.840.1.113762.1.4.1166.199)"

  ["Patient Characteristic Ethnicity": "Ethnicity"]

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

  ["Patient Characteristic Race": "Race"]

Table of Contents

Population Criteria

Definitions

Functions

Terminology

Data Criteria (QDM Data Elements)

Supplemental Data Elements

Risk Adjustment Variables