Addressing Social Needs (ASN) in the Inpatient Setting

"Initial Population"

"Inpatient Encounter" Hospitalization
  where Hospitalization.dischargeDisposition in "Discharge To Acute Care Facility"
    or Hospitalization.dischargeDisposition in "Left Against Medical Advice"
    or Hospitalization.dischargeDisposition in "Patient Expired"

( ["Assessment, Not Performed": "In the last 12 months, did any of the children ever not eat for a whole day because there wasnt enough money for food [U.S. FSS]"]
    union ["Assessment, Not Performed": "In the last 12 months, did any of the children ever skip meals because there wasnt enough money for food [U.S. FSS]"]
    union ["Assessment, Not Performed": "In the last 12 months, did you ever cut the size of any of the childrens meals or skip meals because there wasnt enough money for food [U.S. FSS]"]
    union ["Assessment, Not Performed": "In the last 12 months, did you ever cut the size of your meals or skip meals because there wasnt enough money for food [U.S. FSS]"]
    union ["Assessment, Not Performed": "In the last 12 months, did you ever eat less than you felt you should because there wasnt enough money for food [U.S. FSS]"]
    union ["Assessment, Not Performed": "In the last 12 months, did you ever not eat for a whole day because there wasnt enough money for food [U.S. FSS]"]
    union ["Assessment, Not Performed": "In the last 12 months, did you lose weight because there wasnt enough money for food [U.S. FSS]"]
    union ["Assessment, Not Performed": "In the last 12 months, how often did any of the children skip meals because there wasnt enough money for food [U.S. FSS]"]
    union ["Assessment, Not Performed": "In the last 12 months, how often did you cut the size of your meals or skip meals because there wasnt enough money for food [U.S. FSS]"]
    union ["Assessment, Not Performed": "In the last 12 months, how often did you not eat for a whole day because there wasnt enough money for food [U.S. FSS]"]
    union ["Assessment, Not Performed": "In the last 12 months, I couldnt feed my children a balanced meal, because I couldnt afford that [U.S. FSS]"]
    union ["Assessment, Not Performed": "In the last 12 months, I relied on only a few kinds of low-cost food to feed my children because I was running out of money to buy food [U.S. FSS]"]
    union ["Assessment, Not Performed": "In the last 12 months, my children were not eating enough because I just couldnt afford enough food [U.S. FSS]"]
    union ["Assessment, Not Performed": "In the last 12 months, we couldnt afford to eat balanced meals [U.S. FSS]"]
    union ["Assessment, Not Performed": "In the last 12 months, were the children ever hungry but you just couldnt afford more food [U.S. FSS]"]
    union ["Assessment, Not Performed": "In the last 12 months, were you ever hungry but didnt eat because there wasnt enough money for food [U.S. FSS]"]
    union ["Assessment, Not Performed": "Which of these statements best describes the food eaten in your household in the last 12 months [U.S. FSS]"]
    union ["Assessment, Not Performed": "Within the past 12 months the food we bought just didnt last and we didnt have money to get more Caregiver [U.S. FSS]"]
    union ["Assessment, Not Performed": "Within the past 12 months we worried whether our food would run out before we got money to buy more [U.S. FSS]"]
    union ["Assessment, Not Performed": "Within the past 12 months we worried whether our food would run out before we got money to buy more Caregiver [U.S. FSS]"]
    union ["Assessment, Not Performed": "Within the past 12 months the food we bought just didnt last and we didnt have money to get more [U.S. FSS]"]
)

( ["Assessment, Performed": "In the last 12 months, did any of the children ever not eat for a whole day because there wasnt enough money for food [U.S. FSS]"]
    union ["Assessment, Performed": "In the last 12 months, did any of the children ever skip meals because there wasnt enough money for food [U.S. FSS]"]
    union ["Assessment, Performed": "In the last 12 months, did you ever cut the size of any of the childrens meals or skip meals because there wasnt enough money for food [U.S. FSS]"]
    union ["Assessment, Performed": "In the last 12 months, did you ever cut the size of your meals or skip meals because there wasnt enough money for food [U.S. FSS]"]
    union ["Assessment, Performed": "In the last 12 months, did you ever eat less than you felt you should because there wasnt enough money for food [U.S. FSS]"]
    union ["Assessment, Performed": "In the last 12 months, did you ever not eat for a whole day because there wasnt enough money for food [U.S. FSS]"]
    union ["Assessment, Performed": "In the last 12 months, did you lose weight because there wasnt enough money for food [U.S. FSS]"]
    union ["Assessment, Performed": "In the last 12 months, how often did any of the children skip meals because there wasnt enough money for food [U.S. FSS]"]
    union ["Assessment, Performed": "In the last 12 months, how often did you cut the size of your meals or skip meals because there wasnt enough money for food [U.S. FSS]"]
    union ["Assessment, Performed": "In the last 12 months, how often did you not eat for a whole day because there wasnt enough money for food [U.S. FSS]"]
    union ["Assessment, Performed": "In the last 12 months, I couldnt feed my children a balanced meal, because I couldnt afford that [U.S. FSS]"]
    union ["Assessment, Performed": "In the last 12 months, I relied on only a few kinds of low-cost food to feed my children because I was running out of money to buy food [U.S. FSS]"]
    union ["Assessment, Performed": "In the last 12 months, my children were not eating enough because I just couldnt afford enough food [U.S. FSS]"]
    union ["Assessment, Performed": "In the last 12 months, we couldnt afford to eat balanced meals [U.S. FSS]"]
    union ["Assessment, Performed": "In the last 12 months, were the children ever hungry but you just couldnt afford more food [U.S. FSS]"]
    union ["Assessment, Performed": "In the last 12 months, were you ever hungry but didnt eat because there wasnt enough money for food [U.S. FSS]"]
    union ["Assessment, Performed": "Which of these statements best describes the food eaten in your household in the last 12 months [U.S. FSS]"]
    union ["Assessment, Performed": "Within the past 12 months the food we bought just didnt last and we didnt have money to get more Caregiver [U.S. FSS]"]
    union ["Assessment, Performed": "Within the past 12 months we worried whether our food would run out before we got money to buy more [U.S. FSS]"]
    union ["Assessment, Performed": "Within the past 12 months we worried whether our food would run out before we got money to buy more Caregiver [U.S. FSS]"]
    union ["Assessment, Performed": "Within the past 12 months the food we bought just didnt last and we didnt have money to get more [U.S. FSS]"]
)

"Inpatient Encounter" Hospitalization
  with ( ["Intervention, Performed": "Intervention for Positive Food Insecurity Screen"]
    union ["Intervention, Order": "Intervention for Positive Food Insecurity Screen"] ) FoodInsecurityIntervention
    such that ( Global."NormalizeInterval" ( FoodInsecurityIntervention.relevantDatetime, FoodInsecurityIntervention.relevantPeriod ) starts during Hospitalization.relevantPeriod )
      or FoodInsecurityIntervention.authorDatetime during Hospitalization.relevantPeriod

"Inpatient Encounter" Hospitalization
  with ["Diagnosis": "Food Insecurity Diagnosis"] FoodDiagnosis
    such that FoodDiagnosis.prevalencePeriod starts during Hospitalization.relevantPeriod
      or FoodDiagnosis.authorDatetime during Hospitalization.relevantPeriod

"Inpatient Encounter" Hospitalization
  with "Food Insecurity Assessment Performed" FoodScreen
    such that ( ( FoodScreen.result ~ "No" )
        or ( FoodScreen.result ~ "Never true" )
        or ( FoodScreen.result ~ "Enough of the kinds of food we want to eat" )
        or ( FoodScreen.result ~ "Enough but not always the kinds of food we want" )
        or ( FoodScreen.result ~ "Only 1 or 2 months" )
        or ( FoodScreen.result ~ "Dont know/refused" )
        or ( FoodScreen.result ~ "DK or Refused" )
        or ( FoodScreen.result ~ "DK" )
    )
      and Global."NormalizeInterval" ( FoodScreen.relevantDatetime, FoodScreen.relevantPeriod ) during Hospitalization.relevantPeriod

/*Food Insecurity Numerator 1: No Food Insecurity Screen And No Food Insecurity ICD10CM Diagnosis*/

"Inpatient Encounter" Hospitalization
  where exists ( "Food Insecurity Screen No Result"
      union "No Food Insecurity Screen"
  )
    and not exists "Food Insecurity ICD10CM Diagnosis"
    and not exists "Food Insecurity Screen Declined by Patient"

/*Food Insecurity Numerator 2: Food Insecurity Screen Declined*/

"Inpatient Encounter" Hospitalization
  where exists "Food Insecurity Screen Declined by Patient"

/*Food Insecurity Numerator 3: Food Insecurity Positive With No Intervention*/

"Inpatient Encounter" Hospitalization
  where exists ( "Food Insecurity Positive Screen"
      union "Food Insecurity ICD10CM Diagnosis"
  )
    and not exists "Food Insecurity Follow-Up Intervention Ordered or Performed"

/*Food Insecurity Numerator 4: Food Insecurity Screen Positive With Intervention Performed*/

"Inpatient Encounter" Hospitalization
  where exists ( "Food Insecurity ICD10CM Diagnosis"
      union "Food Insecurity Positive Screen"
  )
    and exists "Food Insecurity Follow-Up Intervention Ordered or Performed"

/*Food Insecurity Numerator 5: Food Insecurity Screen Negative*/

"Inpatient Encounter" Hospitalization
  where exists "Food Insecurity Negative Screen"
    and not exists "Food Insecurity ICD10CM Diagnosis"

/*Food Insecurity Overall Domain Score: Food Insecurity Screen Negative or Screen Positive With Intervention (Sum of Numerators 4 and 5)*/

( "Inpatient Encounter" Hospitalization
    where exists "Food Insecurity Negative Screen"
      and not exists "Food Insecurity ICD10CM Diagnosis"
)
  union ( "Inpatient Encounter" Hospitalization
      where exists ( "Food Insecurity ICD10CM Diagnosis"
          union "Food Insecurity Positive Screen"
      )
        and exists "Food Insecurity Follow-Up Intervention Ordered or Performed"
  )

"Inpatient Encounter" Hospitalization
  with "Food Insecurity Assessment Performed" FoodScreen
    such that ( ( FoodScreen.result ~ "Yes" )
        or ( FoodScreen.result ~ "Often true" )
        or ( FoodScreen.result ~ "Sometimes true" )
        or ( FoodScreen.result ~ "Almost every month" )
        or ( FoodScreen.result ~ "Some months but not every month" )
        or ( FoodScreen.result ~ "Sometimes not enough to eat" )
        or ( FoodScreen.result ~ "Often not enough to eat" )
    )
      and Global."NormalizeInterval" ( FoodScreen.relevantDatetime, FoodScreen.relevantPeriod ) during Hospitalization.relevantPeriod

"Inpatient Encounter" Hospitalization
  with "Food Insecurity Assessment Not Performed" FoodScreen
    such that FoodScreen.authorDatetime during Hospitalization.relevantPeriod
      and FoodScreen.negationRationale in "ASN Screening Declined"

"Inpatient Encounter" Hospitalization
  where exists "Food Insecurity Screen Declined"
    and exists "No Food Insecurity Screen"
    and not exists "Food Insecurity ICD10CM Diagnosis"

"Inpatient Encounter" Hospitalization
  with "Food Insecurity Assessment Performed" FoodScreen
    such that Global."NormalizeInterval" ( FoodScreen.relevantDatetime, FoodScreen.relevantPeriod ) during Hospitalization.relevantPeriod
      and FoodScreen.result is null

( ["Assessment, Not Performed": "Housing status"]
    union ["Assessment, Not Performed": "Homeless in past 12 months"]
    union ["Assessment, Not Performed": "Are you homeless or worried that you might be in the future [WellRx]"]
)

( ["Assessment, Performed": "Housing status"]
    union ["Assessment, Performed": "Homeless in past 12 months"]
    union ["Assessment, Performed": "Are you homeless or worried that you might be in the future [WellRx]"]
)

"Inpatient Encounter" Hospitalization
  with ( ["Intervention, Performed": "Intervention for Positive Homelessness Screen"]
    union ["Intervention, Order": "Intervention for Positive Homelessness Screen"] ) HomelessnessIntervention
    such that ( Global."NormalizeInterval" ( HomelessnessIntervention.relevantDatetime, HomelessnessIntervention.relevantPeriod ) starts during Hospitalization.relevantPeriod )
      or HomelessnessIntervention.authorDatetime during Hospitalization.relevantPeriod

"Inpatient Encounter" Hospitalization
  with ["Diagnosis": "Homelessness Diagnosis"] HomelessnessDiagnosis
    such that HomelessnessDiagnosis.prevalencePeriod starts during Hospitalization.relevantPeriod
      or HomelessnessDiagnosis.authorDatetime during Hospitalization.relevantPeriod

"Inpatient Encounter" Hospitalization
  with ( "Homelessness Assessment Performed" ) HomelessnessScreen
    such that ( HomelessnessScreen.result ~ "I have housing"
        or HomelessnessScreen.result ~ "I have a steady place to live"
        or HomelessnessScreen.result ~ "I have a place to live today, but I am worried about losing it in the future"
        or HomelessnessScreen.result ~ "No"
    )
      and Global."NormalizeInterval" ( HomelessnessScreen.relevantDatetime, HomelessnessScreen.relevantPeriod ) during Hospitalization.relevantPeriod

"Inpatient Encounter" Hospitalization
  with ( "Homelessness Assessment Performed" ) HomelessnessScreen
    such that ( ( HomelessnessScreen.result ~ "Yes" )
        or ( HomelessnessScreen.result ~ "I do not have housing (staying with others, in a hotel, in a shelter, living outside on the street, on a beach, in a car, or in a park)" )
        or ( HomelessnessScreen.result ~ "I do not have a steady place to live (I am temporarily staying with others, in a hotel, in a shelter, living outside on the street, on a beach, in a car, abandoned building, bus or train station, or in a park)" )
    )
      and Global."NormalizeInterval" ( HomelessnessScreen.relevantDatetime, HomelessnessScreen.relevantPeriod ) during Hospitalization.relevantPeriod

"Inpatient Encounter" Hospitalization
  where exists ( "Homelessness Positive Screen"
      union "Homelessness ICD10CM Diagnosis"
  )
    and exists "Homelessness Follow-Up Intervention Ordered or Performed"

"Inpatient Encounter" Hospitalization
  where exists ( "Homelessness Positive Screen"
      union "Homelessness ICD10CM Diagnosis"
  )
    and not exists "Homelessness Follow-Up Intervention Ordered or Performed"

"Inpatient Encounter" Hospitalization
  with ( ["Assessment, Performed": "Housing status"] ) PRAPAREHomelessnessScreen
    such that Global."NormalizeInterval" ( PRAPAREHomelessnessScreen.relevantDatetime, PRAPAREHomelessnessScreen.relevantPeriod ) during Hospitalization.relevantPeriod
      and PRAPAREHomelessnessScreen.result ~ "I choose not to answer this question"

"Inpatient Encounter" Hospitalization
  with ( "Homelessness Assessment Not Performed" ) HomelessnessNotScreen
    such that HomelessnessNotScreen.authorDatetime during Hospitalization.relevantPeriod
      and HomelessnessNotScreen.negationRationale in "ASN Screening Declined"

"Inpatient Encounter" Hospitalization
  where exists "Homelessness Screen Declined"
    and exists "No Homelessness Screen"
    and not exists "Homelessness ICD10CM Diagnosis"

"Inpatient Encounter" Hospitalization
  with ( "Homelessness Assessment Performed" ) HomelessnessScreen
    such that Global."NormalizeInterval" ( HomelessnessScreen.relevantDatetime, HomelessnessScreen.relevantPeriod ) during Hospitalization.relevantPeriod
      and HomelessnessScreen.result is null

/*Housing Insecurity Numerator 1: No Housing Instability or Homelessness Screen and No ICD10CM Diagnoses*/

"Inpatient Encounter" Hospitalization
  where not exists "Homelessness ICD10CM Diagnosis"
    and not exists "Housing Instability ICD10CM Diagnosis"
    and not exists "Housing Instability PRAPARE Decline to Answer"
    and not exists "Housing Instability Screen Declined by Patient"
    and not exists "Homelessness PRAPARE Decline to Answer"
    and not exists "Homelessness Screen Declined by Patient"
    and ( "Negative Homelessness Screen And No Housing Instability Screen"
        or "Negative Housing Instability Screen And No Homelessness Screen"
        or "No Housing Insecurity Screen"
    )

/*Housing Insecurity Numerator 2: Housing Instability or Homelessness Screen Declined*/

"Inpatient Encounter" Hospitalization
  where exists ( "Housing Instability PRAPARE Decline to Answer"
      union "Housing Instability Screen Declined by Patient"
      union "Homelessness PRAPARE Decline to Answer"
      union "Homelessness Screen Declined by Patient"
  )
    and not exists "Homelessness ICD10CM Diagnosis"
    and not exists "Housing Instability ICD10CM Diagnosis"

/*Housing Insecurity Numerator 3: Housing Instability or Homelessness Screen Positive With No Intervention*/

"Inpatient Encounter" Hospitalization
  where exists ( "Housing Instability Positive With No Intervention"
      union "Homelessness Positive With No Intervention"
  )

/*Housing Insecurity Numerator 4: Housing Instability or Homelessness Screen Positive for Either With Intervention*/

"Inpatient Encounter" Hospitalization
  where exists ( "Housing Instability Positive With Intervention"
      union "Homelessness Positive With Intervention"
  )

/*Housing Insecurity Numerator 5: Housing Instability or Homelessness Both Screen Negative Without ICD10CM Diagnoses*/

"Inpatient Encounter" Hospitalization
  where exists "Housing Instability Negative Screen"
    and exists "Homelessness Negative Screen"
    and not exists "Housing Instability ICD10CM Diagnosis"
    and not exists "Homelessness ICD10CM Diagnosis"

/*Housing Insecurity Overall Domain Score: Housing Instability or Homelessness Both Screen Negative or Housing Instability or Homelessness With Intervention Screen Positive for Either (Sum of Numerators 4 and 5)*/

( "Inpatient Encounter" Hospitalization
    where exists "Housing Instability Negative Screen"
      and exists "Homelessness Negative Screen"
      and not exists "Housing Instability ICD10CM Diagnosis"
      and not exists "Homelessness ICD10CM Diagnosis"
)
  union ( "Inpatient Encounter" Hospitalization
      where exists ( "Housing Instability Positive With Intervention"
          union "Homelessness Positive With Intervention"
      )
  )

( ["Assessment, Not Performed": "Housing status"]
    union ["Assessment, Not Performed": "Are you worried about losing your housing [PRAPARE]"]
    union ["Assessment, Not Performed": "Worried about housing stability in next 2 months"]
    union ["Assessment, Not Performed": "Behind on rent or mortgage in past 12 months"]
    union ["Assessment, Not Performed": "Number of residential moves in past 12 months"]
    union ["Assessment, Not Performed": "Homeless in past 12 months"]
    union ["Assessment, Not Performed": "Are you homeless or worried that you might be in the future [WellRx]"]
)

( ["Assessment, Performed": "Housing status"]
    union ["Assessment, Performed": "Are you worried about losing your housing [PRAPARE]"]
    union ["Assessment, Performed": "Worried about housing stability in next 2 months"]
    union ["Assessment, Performed": "Behind on rent or mortgage in past 12 months"]
    union ["Assessment, Performed": "Number of residential moves in past 12 months"]
    union ["Assessment, Performed": "Homeless in past 12 months"]
    union ["Assessment, Performed": "Are you homeless or worried that you might be in the future [WellRx]"]
)

"Inpatient Encounter" Hospitalization
  with ( ["Intervention, Performed": "Intervention for Positive Housing Instability Screen"]
    union ["Intervention, Order": "Intervention for Positive Housing Instability Screen"] ) HousingInstabilityIntervention
    such that ( Global."NormalizeInterval" ( HousingInstabilityIntervention.relevantDatetime, HousingInstabilityIntervention.relevantPeriod ) starts during Hospitalization.relevantPeriod )
      or HousingInstabilityIntervention.authorDatetime during Hospitalization.relevantPeriod

"Inpatient Encounter" Hospitalization
  with ["Diagnosis": "Housing Instability Diagnosis"] HousingInstabilityDiagnosis
    such that HousingInstabilityDiagnosis.prevalencePeriod starts during Hospitalization.relevantPeriod
      or HousingInstabilityDiagnosis.authorDatetime during Hospitalization.relevantPeriod

"Inpatient Encounter" Hospitalization
  with ( "Housing Instability Assessment Performed" ) HousingInstabilityScreen
    such that ( HousingInstabilityScreen.result ~ "No"
        or HousingInstabilityScreen.result ~ "I do not have a steady place to live (I am temporarily staying with others, in a hotel, in a shelter, living outside on the street, on a beach, in a car, abandoned building, bus or train station, or in a park)"
        or HousingInstabilityScreen.result ~ "I have a steady place to live"
        or HousingInstabilityScreen.result < 2
    )
      and Global."NormalizeInterval" ( HousingInstabilityScreen.relevantDatetime, HousingInstabilityScreen.relevantPeriod ) during Hospitalization.relevantPeriod

"Inpatient Encounter" Hospitalization
  with ( "Housing Instability Assessment Performed" ) HousingInstabilityScreen
    such that ( ( HousingInstabilityScreen.result ~ "Yes" )
        or ( HousingInstabilityScreen.result ~ "I have a place to live today, but I am worried about losing it in the future" )
        or ( HousingInstabilityScreen.result >= 2 )
    )
      and Global."NormalizeInterval" ( HousingInstabilityScreen.relevantDatetime, HousingInstabilityScreen.relevantPeriod ) during Hospitalization.relevantPeriod

"Inpatient Encounter" Hospitalization
  where exists ( "Housing Instability Positive Screen"
      union "Housing Instability ICD10CM Diagnosis"
  )
    and exists "Housing Instability Follow-Up Intervention Ordered or Performed"

"Inpatient Encounter" Hospitalization
  where exists ( "Housing Instability Positive Screen"
      union "Housing Instability ICD10CM Diagnosis"
  )
    and not exists "Housing Instability Follow-Up Intervention Ordered or Performed"

"Inpatient Encounter" Hospitalization
  with ( ["Assessment, Performed": "Are you worried about losing your housing [PRAPARE]"] ) PRAPAREHousingInstabilityScreen
    such that Global."NormalizeInterval" ( PRAPAREHousingInstabilityScreen.relevantDatetime, PRAPAREHousingInstabilityScreen.relevantPeriod ) during Hospitalization.relevantPeriod
      and PRAPAREHousingInstabilityScreen.result ~ "I choose not to answer this question"

"Inpatient Encounter" Hospitalization
  with ( "Housing Instability Assessment Not Performed" ) HousingInstabilityNotScreen
    such that HousingInstabilityNotScreen.authorDatetime during Hospitalization.relevantPeriod
      and HousingInstabilityNotScreen.negationRationale in "ASN Screening Declined"

"Inpatient Encounter" Hospitalization
  where exists "Housing Instability Screen Declined"
    and exists "No Housing Instability Screen"
    and not exists "Housing Instability ICD10CM Diagnosis"

"Inpatient Encounter" Hospitalization
  with ( "Housing Instability Assessment Performed" ) HousingInstabilityScreen
    such that Global."NormalizeInterval" ( HousingInstabilityScreen.relevantDatetime, HousingInstabilityScreen.relevantPeriod ) during Hospitalization.relevantPeriod
      and ( HousingInstabilityScreen.result is null
          or HousingInstabilityScreen.result ~ "I have housing"
      )

"Inpatient Encounter"

["Encounter, Performed": "Encounter Inpatient"] EncounterInpatient
  where EncounterInpatient.relevantPeriod ends during day of "Measurement Period"

exists "Homelessness Negative Screen"
  and exists ( "No Housing Instability Screen"
      union "Housing Instability Screen No Result"
  )

exists "Housing Instability Negative Screen"
  and exists ( "No Homelessness Screen"
      union "Homelessness Screen No Result"
  )

"Inpatient Encounter" Hospitalization
  without "Food Insecurity Assessment Performed" WithoutFoodScreen
    such that Global."NormalizeInterval" ( WithoutFoodScreen.relevantDatetime, WithoutFoodScreen.relevantPeriod ) during Hospitalization.relevantPeriod

"Inpatient Encounter" Hospitalization
  without ( "Homelessness Assessment Performed" ) WithoutHomelessnessScreen
    such that Global."NormalizeInterval" ( WithoutHomelessnessScreen.relevantDatetime, WithoutHomelessnessScreen.relevantPeriod ) during Hospitalization.relevantPeriod

exists "No Homelessness Screen"
  and exists "No Housing Instability Screen"
  and exists "Homelessness Screen No Result"
  and exists "Housing Instability Screen No Result"

"Inpatient Encounter" Hospitalization
  without ( "Housing Instability Assessment Performed" ) WithoutHousingInstabilityScreen
    such that Global."NormalizeInterval" ( WithoutHousingInstabilityScreen.relevantDatetime, WithoutHousingInstabilityScreen.relevantPeriod ) during Hospitalization.relevantPeriod

"Inpatient Encounter" Hospitalization
  without "Transportation Insecurity Assessment Performed" WithoutTransportScreen
    such that Global."NormalizeInterval" ( WithoutTransportScreen.relevantDatetime, WithoutTransportScreen.relevantPeriod ) during Hospitalization.relevantPeriod

"Inpatient Encounter" Hospitalization
  without "Utility Insecurity Assessment Performed" WithoutUtilityScreen
    such that Global."NormalizeInterval" ( WithoutUtilityScreen.relevantDatetime, WithoutUtilityScreen.relevantPeriod ) during Hospitalization.relevantPeriod

["Patient Characteristic Birthdate": "Birth date"]

["Patient Characteristic Ethnicity": "Ethnicity"]

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

["Patient Characteristic Race": "Race"]

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

( ["Assessment, Not Performed": "Do you have trouble finding or paying for transportation [WellRx]"]
    union ["Assessment, Not Performed": "Has lack of transportation kept you from medical appointments, meetings, work, or from getting things needed for daily living"]
    union ["Assessment, Not Performed": "Delayed medical care due to distance or lack of transportation"]
    union ["Assessment, Not Performed": "Went without health care due to lack of transportation in last 12 months"]
    union ["Assessment, Not Performed": "Has lack of transportation kept you from medical appointments, meetings, work, or from getting things needed for daily living [CMS Assessment]"]
)

( ["Assessment, Performed": "Do you have trouble finding or paying for transportation [WellRx]"]
    union ["Assessment, Performed": "Has lack of transportation kept you from medical appointments, meetings, work, or from getting things needed for daily living"]
    union ["Assessment, Performed": "Delayed medical care due to distance or lack of transportation"]
    union ["Assessment, Performed": "Went without health care due to lack of transportation in last 12 months"]
    union ["Assessment, Performed": "Has lack of transportation kept you from medical appointments, meetings, work, or from getting things needed for daily living [CMS Assessment]"]
)

"Inpatient Encounter" Hospitalization
  with ( ["Assessment, Performed": "Has lack of transportation kept you from medical appointments, meetings, work, or from getting things needed for daily living [CMS Assessment]"] ) CMSAssessmentTransportScreen
    such that Global."NormalizeInterval" ( CMSAssessmentTransportScreen.relevantDatetime, CMSAssessmentTransportScreen.relevantPeriod ) during Hospitalization.relevantPeriod
      and CMSAssessmentTransportScreen.result ~ "Resident declines to respond"

"Inpatient Encounter" Hospitalization
  with ( ["Intervention, Performed": "Intervention for Positive Transportation Insecurity Screen"]
    union ["Intervention, Order": "Intervention for Positive Transportation Insecurity Screen"] ) TransportInsecurityIntervention
    such that ( Global."NormalizeInterval" ( TransportInsecurityIntervention.relevantDatetime, TransportInsecurityIntervention.relevantPeriod ) starts during Hospitalization.relevantPeriod )
      or TransportInsecurityIntervention.authorDatetime during Hospitalization.relevantPeriod

"Inpatient Encounter" Hospitalization
  with ["Diagnosis": "Transportation Insecurity Diagnosis"] TransportDiagnosis
    such that TransportDiagnosis.prevalencePeriod starts during Hospitalization.relevantPeriod
      or TransportDiagnosis.authorDatetime during Hospitalization.relevantPeriod

"Inpatient Encounter" Hospitalization
  with "Transportation Insecurity Assessment Performed" TransportScreen
    such that ( TransportScreen.result ~ "No"
        or TransportScreen.result ~ "Resident unable to respond"
    )
      and Global."NormalizeInterval" ( TransportScreen.relevantDatetime, TransportScreen.relevantPeriod ) during Hospitalization.relevantPeriod

/*Transportation Insecurity Numerator 1: No Transportation Insecurity Screen And No Transportation Insecurity ICD10CM Diagnosis*/

"Inpatient Encounter" Hospitalization
  where exists ( "Transportation Insecurity Screen No Result"
      union "No Transportation Insecurity Screen"
  )
    and not exists "Transportation Insecurity ICD10CM Diagnosis"
    and not exists "Transportation Insecurity PRAPARE Decline to Answer"
    and not exists "Transportation Insecurity Screen Declined by Patient"
    and not exists "Transportation Insecurity CMS Assessments Screen Declined"

/*Transportation Insecurity Numerator 2: Transportation Insecurity Screen Declined*/

"Inpatient Encounter" Hospitalization
  where exists "Transportation Insecurity PRAPARE Decline to Answer"
    or exists "Transportation Insecurity Screen Declined by Patient"
    or exists "Transportation Insecurity CMS Assessments Screen Declined"

/*Transportation Insecurity Numerator 3: Transportation Insecurity Positive With No Intervention*/

"Inpatient Encounter" Hospitalization
  where exists ( "Transportation Insecurity Positive Screen"
      union "Transportation Insecurity ICD10CM Diagnosis"
  )
    and not exists "Transportation Insecurity Follow-Up Intervention Ordered or Performed"

/*Transportation Insecurity Numerator 4: Transportation Insecurity Screen Positive With Intervention Performed*/

"Inpatient Encounter" Hospitalization
  where exists ( "Transportation Insecurity ICD10CM Diagnosis"
      union "Transportation Insecurity Positive Screen"
  )
    and exists "Transportation Insecurity Follow-Up Intervention Ordered or Performed"

/*Transportation Insecurity Numerator 5: Transportation Insecurity Screen Negative*/

"Inpatient Encounter" Hospitalization
  where exists "Transportation Insecurity Negative Screen"
    and not exists "Transportation Insecurity ICD10CM Diagnosis"

/*Transportation Insecurity Overall Domain Score: Transportation Insecurity Screen Negative or Screen Positive With Intervention (Sum of Numerators 4 and 5)*/

( "Inpatient Encounter" Hospitalization
    where exists "Transportation Insecurity Negative Screen"
      and not exists "Transportation Insecurity ICD10CM Diagnosis"
)
  union ( "Inpatient Encounter" Hospitalization
      where exists ( "Transportation Insecurity ICD10CM Diagnosis"
          union "Transportation Insecurity Positive Screen"
      )
        and exists "Transportation Insecurity Follow-Up Intervention Ordered or Performed"
  )

"Inpatient Encounter" Hospitalization
  with "Transportation Insecurity Assessment Performed" TransportScreen
    such that ( ( TransportScreen.result ~ "Yes" )
        or ( TransportScreen.result ~ "Yes, it has kept me from medical appointments or from getting my medications" )
        or ( TransportScreen.result ~ "Yes, it has kept me from non-medical meetings, appointments, work, or from getting things that I need" )
    )
      and Global."NormalizeInterval" ( TransportScreen.relevantDatetime, TransportScreen.relevantPeriod ) during Hospitalization.relevantPeriod

"Inpatient Encounter" Hospitalization
  with ( ["Assessment, Performed": "Has lack of transportation kept you from medical appointments, meetings, work, or from getting things needed for daily living"] ) PRAPARETransportScreen
    such that Global."NormalizeInterval" ( PRAPARETransportScreen.relevantDatetime, PRAPARETransportScreen.relevantPeriod ) during Hospitalization.relevantPeriod
      and PRAPARETransportScreen.result ~ "I choose not to answer this question"

"Inpatient Encounter" Hospitalization
  with "Transportation Insecurity Assessment Not Performed" TransportScreen
    such that TransportScreen.authorDatetime during Hospitalization.relevantPeriod
      and TransportScreen.negationRationale in "ASN Screening Declined"

"Inpatient Encounter" Hospitalization
  where exists "Transportation Insecurity Screen Declined"
    and exists "No Transportation Insecurity Screen"
    and not exists "Transportation Insecurity ICD10CM Diagnosis"

"Inpatient Encounter" Hospitalization
  with "Transportation Insecurity Assessment Performed" TransportScreen
    such that Global."NormalizeInterval" ( TransportScreen.relevantDatetime, TransportScreen.relevantPeriod ) during Hospitalization.relevantPeriod
      and TransportScreen.result is null

( ["Assessment, Not Performed": "Do you have trouble paying for your gas or electricity bills [WellRx]"]
    union ["Assessment, Not Performed": "Has the electric, gas, oil, or water company threatened to shut off services in your home in past 12 months"]
    union ["Assessment, Not Performed": "Have you or any family members you live with been unable to get any of the following when it was really needed in past 1 year [PRAPARE]"]
)

( ["Assessment, Performed": "Do you have trouble paying for your gas or electricity bills [WellRx]"]
    union ["Assessment, Performed": "Has the electric, gas, oil, or water company threatened to shut off services in your home in past 12 months"]
    union ["Assessment, Performed": "Have you or any family members you live with been unable to get any of the following when it was really needed in past 1 year [PRAPARE]"]
)

"Inpatient Encounter" Hospitalization
  with ( ["Intervention, Performed": "Intervention for Positive Utility Insecurity Screen"]
    union ["Intervention, Order": "Intervention for Positive Utility Insecurity Screen"] ) UtilityInsecurityIntervention
    such that ( Global."NormalizeInterval" ( UtilityInsecurityIntervention.relevantDatetime, UtilityInsecurityIntervention.relevantPeriod ) starts during Hospitalization.relevantPeriod )
      or UtilityInsecurityIntervention.authorDatetime during Hospitalization.relevantPeriod

"Inpatient Encounter" Hospitalization
  with ["Diagnosis": "Utility Insecurity Diagnosis"] UtilityDiagnosis
    such that UtilityDiagnosis.prevalencePeriod starts during Hospitalization.relevantPeriod
      or UtilityDiagnosis.authorDatetime during Hospitalization.relevantPeriod

"Inpatient Encounter" Hospitalization
  with "Utility Insecurity Assessment Performed" UtilityScreen
    such that UtilityScreen.result ~ "No"
      and not ( UtilityScreen.result ~ "Utilities" )
      and Global."NormalizeInterval" ( UtilityScreen.relevantDatetime, UtilityScreen.relevantPeriod ) during Hospitalization.relevantPeriod

/*Utility Insecurity Numerator 1: No Utility Insecurity Screen And No Utility Insecurity ICD10CM Diagnosis*/

"Inpatient Encounter" Hospitalization
  where exists ( "Utility Insecurity Screen No Result"
      union "No Utility Insecurity Screen"
  )
    and not exists "Utility Insecurity ICD10CM Diagnosis"
    and not exists "Utility Insecurity PRAPARE Decline to Answer"
    and not exists "Utility Insecurity Screen Declined by Patient"

/*Utility Insecurity Numerator 2: Utility Insecurity Screen Declined*/

"Inpatient Encounter" Hospitalization
  where exists "Utility Insecurity PRAPARE Decline to Answer"
    or exists "Utility Insecurity Screen Declined by Patient"

/*Utility Insecurity Numerator 3: Utility Insecurity Positive With No Intervention*/

"Inpatient Encounter" Hospitalization
  where exists ( "Utility Insecurity Positive Screen"
      union "Utility Insecurity ICD10CM Diagnosis"
  )
    and not exists "Utility Insecurity Follow-Up Intervention Ordered or Performed"

/*Utility Insecurity Numerator 4: Utility Insecurity Screen Positive With Intervention Performed*/

"Inpatient Encounter" Hospitalization
  where exists ( "Utility Insecurity ICD10CM Diagnosis"
      union "Utility Insecurity Positive Screen"
  )
    and exists "Utility Insecurity Follow-Up Intervention Ordered or Performed"

/*Utility Insecurity Numerator 5: Utility Insecurity Screen Negative*/

"Inpatient Encounter" Hospitalization
  where exists "Utility Insecurity Negative Screen"
    and not exists "Utility Insecurity ICD10CM Diagnosis"

/*Utility Insecurity Overall Domain Score: Utility Insecurity Screen Negative or Screen Positive With Intervention (Sum of Numerators 4 and 5)*/

( "Inpatient Encounter" Hospitalization
    where exists "Utility Insecurity Negative Screen"
      and not exists "Utility Insecurity ICD10CM Diagnosis"
)
  union ( "Inpatient Encounter" Hospitalization
      where exists ( "Utility Insecurity ICD10CM Diagnosis"
          union "Utility Insecurity Positive Screen"
      )
        and exists "Utility Insecurity Follow-Up Intervention Ordered or Performed"
  )

"Inpatient Encounter" Hospitalization
  with "Utility Insecurity Assessment Performed" UtilityScreen
    such that ( ( UtilityScreen.result ~ "Yes" )
        or ( UtilityScreen.result ~ "Already shut off" )
        or ( UtilityScreen.result ~ "Utilities" )
    )
      and Global."NormalizeInterval" ( UtilityScreen.relevantDatetime, UtilityScreen.relevantPeriod ) during Hospitalization.relevantPeriod

"Inpatient Encounter" Hospitalization
  with ( ["Assessment, Performed": "Have you or any family members you live with been unable to get any of the following when it was really needed in past 1 year [PRAPARE]"] ) PRAPAREUtilityScreen
    such that Global."NormalizeInterval" ( PRAPAREUtilityScreen.relevantDatetime, PRAPAREUtilityScreen.relevantPeriod ) during Hospitalization.relevantPeriod
      and PRAPAREUtilityScreen.result ~ "I choose not to answer this question"

"Inpatient Encounter" Hospitalization
  with "Utility Insecurity Assessment Not Performed" UtilityScreen
    such that UtilityScreen.authorDatetime during Hospitalization.relevantPeriod
      and UtilityScreen.negationRationale in "ASN Screening Declined"

"Inpatient Encounter" Hospitalization
  where exists "Utility Insecurity Screen Declined"
    and exists "No Utility Insecurity Screen"
    and not exists "Utility Insecurity ICD10CM Diagnosis"

"Inpatient Encounter" Hospitalization
  with "Utility Insecurity Assessment Performed" UtilityScreen
    such that Global."NormalizeInterval" ( UtilityScreen.relevantDatetime, UtilityScreen.relevantPeriod ) during Hospitalization.relevantPeriod
      and UtilityScreen.result is null

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