eCQM Title | Addressing Social Needs (ASN) Merit-based Incentive Payment System (in the Outpatient Setting) Part 4 of 4 – Housing Domain |
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CMS ID | eCQM Version Number | Draft based on 0.0.000 | |
CBE Number | Not Applicable | GUID | b0ecdd81-83b9-482b-9a2a-539c3303b016 |
Measurement Period | January 1, 2026 through December 31, 2026 | ||
Measure Steward | Centers for Medicare & Medicaid Services (CMS) | ||
Measure Developer | Mathematica | ||
Measure Developer | Yale New Haven Health Service Corporation/ Center for Outcomes Research and Evaluation | ||
Endorsed By | None | ||
Description |
Percentages of outpatient patients of all ages reflecting whether patients were assessed in four domains of social need: food, housing, transportation, and utilities, and whether the patient received a qualifying follow-up action within the visit for any positive social needs. Qualifying follow-up actions were identified from Gravity Project: adjustment, assistance/assisting, coordination, counseling, education, evaluation of eligibility, provision, and referral. The ASN eCQM consist of four domains. To report the ASN eCQM measure, all four domains are required. This part 4 is to report the Housing Domain. Refer to Transportation, Utility, Food Insecurity domains for remaining logic, |
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Copyright |
Limited proprietary coding is contained in these specifications for user convenience. Users of proprietary code sets should obtain all necessary licenses from the owners of the code sets. This material contains SNOMED Clinical Terms(R) (SNOMED CT[R]) copyright 2004-2023 International Health Terminology Standards Development Organisation. All rights reserved. LOINC(R) copyright 2004-2023 Regenstrief Institute, Inc. CPT(R) contained in the Measure specifications is copyright 2004-2023 American Medical Association. ICD-10 is copyright 2023 World Health Organization. All Rights Reserved. |
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Disclaimer |
These performance specifications are not clinical guidelines and do not establish a standard of medical care, and have not been tested for all potential applications. THE MEASURES AND SPECIFICATIONS ARE PROVIDED "AS IS" WITHOUT WARRANTY OF ANY KIND. Due to technical limitations, registered trademarks are indicated by (R) or [R] and unregistered trademarks are indicated by (TM) or [TM]. |
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Measure Scoring | Proportion | ||
Measure Type | Process | ||
Stratification |
None |
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Risk Adjustment |
None |
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Rate Aggregation |
None |
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Rationale |
The 2019 National Academies of Science, Engineering and Medicine (NASEM) Report Integrating Social Care into the Delivery of Health Care identified better awareness of the unmet social needs of defined patients and populations as an important strategy for improving health and social outcomes. (NASEM, 2019). Assessments for social needs also provides an opportunity to improve population health and advance health equity. The measure is aligned with CMS National Quality Strategy goal to address the disparities that underlie our health system, both within and across settings, to ensure equitable access and care for all (Centers for Medicare & Medicaid Services, n.d.). This measure, which focuses on assessment for social drivers of health, is aligned with main objectives of the CMS Universal Foundation (Jacobs et al., 2023). Historical and contemporary discrimination contribute to higher levels of unmet social needs among certain social groups. Systematic assessment and follow-up for unmet social needs may help mitigate of some race-based inequities that exist in material hardships (Odoms-Young & Bruce, 2018). There exist opportunities to improve the rates of assessment for social needs. While some hospitals and outpatient facilities currently screen patients for unmet social needs, few comprehensively and universally screen for multiple unmet needs using standardized and validated tools; collect and transfer data electronically using national interoperability standards; set person-centered goals around unmet needs; and provide goal-oriented actions, such as interventions, referrals, and direct supports (Fraze et al., 2019) Measurement using standardized and validated screening instruments that are collected and transmitted using certified electronic health records (EHRs), aims to make care coordination more effective, enable more efficient measurement, reduce administrative burden, and enhance health ecosystem efficiency. |
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Clinical Recommendation Statement |
Identifying and addressing social needs is both a national and international priority toward the goal of health equity. This is evidenced internationally by the guidance of the World Health Organization. Nationally, addressing social needs is woven into the US Department of Health and Human Services Healthy People 2030 Social Determinants of Health objectives. Lastly, commitment to addressing social needs is found in the core policies of US professional organizations such as the American Medical Association, the American Academy of Family Physicians, and the American Academy of Pediatrics. (World Health Organization), (HHS), (AAP). |
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Improvement Notation |
Output is informational. |
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Reference |
Reference Type: Citation Reference Text: ' What is the CMS National Quality Strategy? (n.d.). Cms.gov, from https://www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/Value-Based-Programs/CMS-Quality-Strategy' |
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Reference |
Reference Type: Citation Reference Text: 'American Academy of Family Physicians. (2019, December 12). Advancing Health Equity by addressing the Social Determinants of health in Family Medicine (position paper). AAFP. https://www.aafp.org/about/policies/all/social-determinants-health-family-medicine-position-paper.html' |
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Reference |
Reference Type: Citation Reference Text: 'Fraze TK, Brewster AL, Lewis VA, Beidler LB, Murray GF, Colla CH. Prevalence of Screening for Food Insecurity, Housing Instability, Utility Needs, Transportation Needs, and Interpersonal Violence by US Physician Practices and Hospitals. JAMA Netw Open. 2019;2(9):e1911514. Published 2019 Sep 4. doi:10.1001/jamanetworkopen.2019.11514' |
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Reference |
Reference Type: Citation Reference Text: 'Jacobs, D. B., Schreiber, M., Seshamani, M., Tsai, D., Fowler, E., & Fleisher, L. A. (2023). Aligning quality measures across CMS - the universal foundation. The New England Journal of Medicine. https://doi.org/10.1056/NEJMp2215539' |
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Reference |
Reference Type: Citation Reference Text: 'National Academies of Sciences, Engineering, and Medicine. 2019. Integrating Social Care into the Delivery of Health Care: Moving Upstream to Improve the Nation's Health. Washington, DC: The National Academies Press. https://doi.org/10.17226/25467' |
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Reference |
Reference Type: Citation Reference Text: 'Odoms-Young A, Bruce MA. Examining the Impact of Structural Racism on Food Insecurity: Implications for Addressing Racial/Ethnic Disparities. Fam Community Health. 2018 Apr/Jun;41 Suppl 2 Suppl, Food Insecurity and Obesity(Suppl 2 FOOD INSECURITY AND OBESITY):S3-S6. doi: 10.1097/FCH.0000000000000183. PMID: 29461310; PMCID: PMC5823283' |
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Reference |
Reference Type: Citation Reference Text: 'US Department of Health and Human Services, Office of Disease Prevention and Health Promotion. (n.d.). Social Determinants of Health. https://health.gov/healthypeople/priority-areas/social-determinants-health' |
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Reference |
Reference Type: Citation Reference Text: 'World Health Organization. (n.d.). Social Determinants of Health. https://www.who.int/teams/social-determinants-of-health' |
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Definition |
Measure consists of four social determinants of health domains: food insecurity, transportation insecurity, utility insecurity, housing insecurity (comprised of housing instability and homelessness). Five informational rates will be reported from each domain in addition to a single overall domain score. Overall domain scores are per domain; there is no single aggregated score across multiple domains. The overall domain score supports the measure’s mission to increase the percentage of patients who are either negative for social risks or if assessed positive have appropriate intervention. It represents those who are fully screened negative in addition to those who are screened positive AND have documented follow-up plan. Overall domain score = Numerator 4 + Numerator 5 / Denominator Numerator captures whether a social need was documented during the encounter, either through a positive screening during the encounter, or an ICD-10-CM code indicating a diagnosis. ICD-10-CM diagnosis throughout this header refers only to those Z-codes identified in the value sets. Assessment for social needs can be completed using one of multiple screening instruments referenced in the value sets. Approved screening questions and associated results are represented as direct reference codes (LOINC) instead of value sets. This is for ease of implementation, and ease of reevaluation in the future. Notably, Housing domain has an approved screening question that is applicable to both housing instability and homelessness, however, the resulting responses vary: Housing status (LOINC Code (71802-3)). If encounter has a response of, "I have a place to live today, but I am worried about losing it in the future" (LOINC Code (LA31994-9)), this is a POSITIVE result for housing instability; but a NEGATIVE result for homelessness. If encounter has a response of, "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)" (LOINC Code (LA31995-6)), this is a NEGATIVE result for housing instability, but a POSITIVE result for homelessness. If either of these responses are documented, a Follow-Up Intervention Ordered or Performed is required. Similarly, if an encounter has a NEGATIVE screening for homelessness and result is, "I have housing" (LOINC Code (LA30189-7)), or "I have a steady place to live" (LOINC Code (LA31993-1)), measured entity is required to ask about housing instability. |
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Guidance |
This eCQM is a patient-based measure. To encourage documentation and coding of Social Determinants of Health (SDOH) concepts, like food insecurity, this measure only allows for ICD-10-CM codes to meet the diagnosis; SNOMED-CT codes are intentionally not included to capture a diagnosis for this measure. This measure is intended to have 6 reporting rates for each domain (Numerators 1-5 and Overall Domain Score detailed in Numerator section), across four SDOH domains, equaling 24 rates overall. All domains do not aggregate into one single overall rate. Food domain is detailed as Population Criteria 1-6; Transportation domain is detailed as Population Criteria 7-12; Utility domain is detailed as Population Criteria 13-18; Housing domain is detailed as Population Criteria 19-24. For ease of reference, each Population Criteria in the human readable includes an in-line description of the domain, numerator #, and written description of the numerator output. Initial Population criteria is the same for each domain. Each encounter in the denominator will be attributed to only one of the Numerators 1, 2, 3, 4, or 5 for each domain. Housing domain logic is detailed separately as it accounts for screening and follow-up for both housing instability and homelessness. Logic for food, transportation, and utility domains: Identify initial population of inpatient encounters, removing those meeting exclusion criteria. Identify encounters that meet Numerator 1, Numerator 2, Numerator 3, Numerator 4, or Numerator 5. Numerator 1 are encounters with no documentation of screen, OR a screen but no resulting finding from screen, and no ICD-10-CM diagnosis or decline to answer. Numerator 2 are encounters with documentation of patient declined to answer screening question(s). Numerator 3 are encounters with a positive finding from screening questions or ICD-10-CM diagnosis, AND no documented Insecurity Follow-Up Intervention Ordered or Performed. Numerator 4 are encounters with a positive finding from screening questions or ICD-10-CM diagnosis, AND a documented Insecurity Follow-Up Intervention Ordered or Performed. Numerator 5 are encounters with a negative finding from screening questions and no ICD-10-CM diagnosis. Then identify those in the Overall Domain Score (Domain Insecurity Screened Negative or Screened Positive With Intervention; Sum of Numerators 4 and 5): Identify initial inpatient population encounters, removing those meeting exclusion criteria. Identify encounters that meet Numerator 4, sum with those encounters that meet Numerator 5. Logic for housing domain requires measured entity to have an assessment of both housing instability and homelessness to be considered for Numerator 5. Identify initial population of inpatient encounters, removing those meeting exclusion criteria. Identify encounters that meet Numerator 1, Numerator 2, Numerator 3, Numerator 4, or Numerator 5. Numerator 1 are encounters where patient is not fully assessed for housing instability and homelessness with no documentation of both screens, or screens but no resulting findings from screens, and no ICD-10-CM diagnosis or decline to answer. Numerator 2 are encounters with documentation of patient declined to answer screening question(s), or if encounter has one declination and one negative screen. Numerator 3 are encounters with a positive finding from either housing instability or homelessness screening questions or ICD-10-CM diagnosis for either, regardless of one being declined, AND no documented Follow-Up Intervention Ordered or Performed. Numerator 4 are encounters with a positive finding from either housing instability or homelessness screening questions or ICD-10-CM diagnosis for either, regardless of one being declined, AND a documented Insecurity Follow-Up Intervention Ordered or Performed. Numerator 5 are encounters with a negative finding from BOTH housing instability and homelessness screening questions and no ICD-10-CM diagnosis for either. 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. |
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Transmission Format |
TBD |
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Initial Population |
Patients of all ages who are seen for a qualifying outpatient visit during a one-year measurement period. |
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Denominator |
Equals Initial Population |
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Denominator Exclusions |
None |
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Numerator |
Numerator 1: Patients (or proxies, e.g. caregivers, parents, guardians, and so forth) who were not screened for housing insecurity and there was no documented ICD-10-CM diagnosis for housing insecurity during the measurement period. Numerator 2: Patients (or proxies, e.g. caregivers, parents, guardians, and so forth) who declined housing insecurity screening during the measurement period. Numerator 3: Patients (or proxies, e.g. caregivers, parents, guardians, and so forth) screened positive for housing insecurity or with a documented ICD-10-CM diagnosis of housing insecurity during the measurement period, with no followup or intervention performed. Numerator 4: Patients (or proxies, e.g. caregivers, parents, guardians, and so forth) who screened positive for housing insecurity or have an ICD-10-CM diagnosis for housing insecurity, with proper intervention or follow-up during the measurement period. Numerator 5: Patients (or proxies, e.g. caregivers, parents, guardians, and so forth) who screened negative for housing insecurity during the measurement period, with no ICD-10-CM diagnosis for housing insecurity. Numerator 6: Housing Insecurity Overall Domain Score: Housing Insecurity Screen Negative or Screen Positive With Intervention (Sum of Numerators 4 and 5) |
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Numerator Exclusions |
None |
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Denominator Exceptions |
None |
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Supplemental Data Elements |
For every patient evaluated by this measure also identify birth date, payer, race, ethnicity, and sex |
"Has Qualifying Encounter During Measurement Period"
"Initial Population"
None
/*Housing Insecurity Numerator 1: No Housing Insecurity Screen (not done or missing result) And No Housing Insecurity ICD10CM Diagnosis*/ ("Negative Homelessness Screen And No Housing Instability Screen" or "Negative Housing Instability Screen And No Homelessness Screen" or "No Housing Insecurity Screen") and not "Negative Homelessness and Housing Instability Screen" //and not "Positive Housing Instability and Negative Homelessness" and not exists "Homelessness ICD10CM Diagnosis" and not exists "Housing Instability ICD10CM Diagnosis" and not exists "Housing Instability PRAPARE Decline to Answer" and not exists "Homelessness PRAPARE Decline to Answer" and not exists "Homelessness Screen Declined" and not exists "Housing Instability Screen Declined"
None
None
None
"Has Qualifying Encounter During Measurement Period"
"Initial Population"
None
/*Housing Insecurity Numerator 2: Housing Insecurity Screen Declined*/ exists ("Housing Instability PRAPARE Decline to Answer" union "Homelessness PRAPARE Decline to Answer" union "Homelessness Screen Declined" union "Housing Instability Screen Declined") and not exists "Homelessness ICD10CM Diagnosis" and not exists "Housing Instability ICD10CM Diagnosis"
None
None
None
"Has Qualifying Encounter During Measurement Period"
"Initial Population"
None
/*Housing Insecurity Numerator 3: Housing Insecurity Positive With No Intervention*/ "First Positive Housing Instability Finding by Assessment or Diagnosis Without Followup Ordered or Performed" is not null or "First Positive Homelessness Finding by Assessment or Diagnosis Without Followup Ordered or Performed" is not null
None
None
None
"Has Qualifying Encounter During Measurement Period"
"Initial Population"
None
/*Housing Insecurity Numerator 4: Housing Insecurity Screen Positive With Intervention Performed*/ "First Positive Housing Instability Finding by Assessment or Diagnosis With Followup Ordered or Performed" is not null or "First Positive Homelessness Finding by Assessment or Diagnosis With Followup Ordered or Performed" is not null
None
None
None
"Has Qualifying Encounter During Measurement Period"
"Initial Population"
None
/*Housing Insecurity Numerator 5: Housing Insecurity Screen Negative*/ exists "Homelessness Negative Screen" and exists "Housing Instability Negative Screen" and not exists "Homelessness ICD10CM Diagnosis" and not exists "Housing Instability ICD10CM Diagnosis" and not exists "Homelessness Positive Screen" and not exists "Housing Instability Positive Screen" and not exists "Housing Instability PRAPARE Decline to Answer" and not exists "Homelessness PRAPARE Decline to Answer" and not exists "Housing Instability Screen Declined" and not exists "Homelessness Screen Declined"
None
None
None
"Has Qualifying Encounter During Measurement Period"
"Initial Population"
None
/*Housing Insecurity Overall Domain Score: Housing Insecurity Screen Negative or Screen Positive With Intervention (Sum of Numerators 4 and 5)*/ "Housing Insecurity Numerator 4: Housing Insecurity Screen Positive With Intervention Performed" or "Housing Insecurity Numerator 5: Housing Insecurity Screen Negative"
None
None
None
(["Encounter, Performed": "Patient Provider Interaction"] union ["Encounter, Performed": "Emergency Department Visit"] union ["Encounter, Performed": "Office and Wellness Visits for General Screening"] union ["Encounter, Performed": "Emergency Department Evaluation and Management Visit"]) Interaction where Interaction.relevantPeriod ends during day of "Measurement Period" return Tuple { InteractionID: Interaction.id, InteractionCode: Interaction.code, InteractionDatetime: Interaction.relevantPeriod }
"Initial Population"
First((("Homelessness ICD10CM Diagnosis" HomelessDx return Tuple{"id": HomelessDx.HomelessDiagnosisID, "code": HomelessDx.HomelessDiagnosisCode, "HomelessoccurrenceDatetime": HomelessDx.HomelessDiagnosisDatetime } ) union ("Homelessness Positive Screen" HomelessScr return Tuple{"id": HomelessScr.AssessId, "code": HomelessScr.HomelessAssessCode, "HomelessoccurrenceDatetime": HomelessScr.HomelessAssessTiming} ) ) HomelessnessScreeningOrDiagnosis sort by HomelessoccurrenceDatetime )
First ((("Housing Instability ICD10CM Diagnosis" HInstabDx return Tuple{"id": HInstabDx.HousingDiagnosisID, "code": HInstabDx.HousingDiagnosisCode, "InstabilityoccurrenceDatetime": HInstabDx.HousingDiagnosisDatetime} ) union ("Housing Instability Positive Screen" HInstabScr return Tuple{"id": HInstabScr.AssessId, "code": HInstabScr.HousingAssessCode, "InstabilityoccurrenceDatetime": HInstabScr.HousingAssessmentTiming} ) ) HInstabilityScreeningOrDiagnosis sort by InstabilityoccurrenceDatetime )
"First Homelessness Positive Finding By Assessment or Diagnosis" HomelessnessScreeningorDiagnosis with "Homelessness Follow-Up Intervention Ordered or Performed" HomelessFollowUpIntervention such that HomelessFollowUpIntervention.HomelessFollowUpDatetime 16 days or less on or after day of HomelessnessScreeningorDiagnosis.HomelessoccurrenceDatetime
"First Homelessness Positive Finding By Assessment or Diagnosis" HomelessnessScreeningorDiagnosis without "Homelessness Follow-Up Intervention Ordered or Performed" HomelessFollowUpIntervention such that HomelessFollowUpIntervention.HomelessFollowUpDatetime 16 days or less on or after day of HomelessnessScreeningorDiagnosis.HomelessoccurrenceDatetime
"First Housing Instability Positive Finding By Assessment or Diagnosis" HousingInstabScreeningorDiagnosis with "Housing Instability Follow-Up Intervention Ordered or Performed" HousingInstabilityFollowUpIntervention such that HousingInstabilityFollowUpIntervention.HInstabFollowUpDatetime 16 days or less on or after day of HousingInstabScreeningorDiagnosis.InstabilityoccurrenceDatetime
"First Housing Instability Positive Finding By Assessment or Diagnosis" HousingInstabScreeningorDiagnosis without "Housing Instability Follow-Up Intervention Ordered or Performed" HousingInstabilityFollowUpIntervention such that HousingInstabilityFollowUpIntervention.HInstabFollowUpDatetime 16 days or less on or after day of HousingInstabScreeningorDiagnosis.InstabilityoccurrenceDatetime
exists ["Encounter, Performed": "Office and Wellness Visits for General Screening"] EncounterSDOH where EncounterSDOH.relevantPeriod ends during day of "Measurement Period"
(["Assessment, Not Performed": "Are you homeless or worried that you might be in the future [WellRx]"] union ["Assessment, Not Performed": "Homeless in past 12 months"] union ["Assessment, Not Performed": "Housing status"] ) NotPerformedHomelessness where NotPerformedHomelessness.authorDatetime during "Measurement Period"
(["Assessment, Performed": "Are you homeless or worried that you might be in the future [WellRx]"] union ["Assessment, Performed": "Homeless in past 12 months"] union ["Assessment, Performed": "Housing status"] ) HomelessnessAssessmentPerformed with "Any Interaction Between Clinician and Patient" AnyInteraction such that Coalesce( HomelessnessAssessmentPerformed.authorDatetime, Global."EarliestOf" (HomelessnessAssessmentPerformed.relevantDatetime, HomelessnessAssessmentPerformed.relevantPeriod) ) occurs 14 days or less on or before day of AnyInteraction.InteractionDatetime and HomelessnessAssessmentPerformed.result is not null return Tuple { AssessId: HomelessnessAssessmentPerformed.id, HomelessAssessCode: HomelessnessAssessmentPerformed.code, HomelessAssessResult: HomelessnessAssessmentPerformed.result, HomelessAssessTiming: Coalesce( HomelessnessAssessmentPerformed.authorDatetime, Global."EarliestOf" (HomelessnessAssessmentPerformed.relevantDatetime, HomelessnessAssessmentPerformed.relevantPeriod) ) }
(["Intervention, Performed": "Intervention for Positive Homelessness Screen"] union ["Intervention, Order": "Intervention for Positive Homelessness Screen"]) HomelessnessFollowUp with "Any Interaction Between Clinician and Patient" AnyInteraction such that ( Global."NormalizeInterval" ( HomelessnessFollowUp.relevantDatetime, HomelessnessFollowUp.relevantPeriod ) 2 days or less before day of AnyInteraction.InteractionDatetime ) or HomelessnessFollowUp.authorDatetime 2 days or less before day of AnyInteraction.InteractionDatetime return Tuple { HomelessFollowUpID: HomelessnessFollowUp.id, HomelessFollowUpCode: HomelessnessFollowUp.code, HomelessFollowUpDatetime: Coalesce( HomelessnessFollowUp.authorDatetime, Global."EarliestOf" (HomelessnessFollowUp.relevantDatetime, HomelessnessFollowUp.relevantPeriod) ) }
["Diagnosis": "Homelessness Diagnosis"] HomelessDiagnosis with "Any Interaction Between Clinician and Patient" AnyInteractionDuringMP such that HomelessDiagnosis.prevalencePeriod starts 14 days or less on or before day of AnyInteractionDuringMP.InteractionDatetime or HomelessDiagnosis.authorDatetime 14 days or less on or before day of AnyInteractionDuringMP.InteractionDatetime return Tuple { HomelessDiagnosisID: HomelessDiagnosis.id, HomelessDiagnosisCode: HomelessDiagnosis.code, HomelessDiagnosisDatetime: Coalesce(start of HomelessDiagnosis.prevalencePeriod, HomelessDiagnosis.authorDatetime) }
"Homelessness Assessment Performed" HomelessnessScreen where (HomelessnessScreen.HomelessAssessResult in { "I have housing", "I have a steady place to live", "I have a place to live today, but I am worried about losing it in the future", "No"})
"Homelessness Assessment Performed" HomelessnessScreen where (HomelessnessScreen.HomelessAssessResult in {"Yes", "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)", "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)" })
( ["Assessment, Performed": "Housing status"] ) PRAPAREHomelessnessScreen with "Any Interaction Between Clinician and Patient" QualifyingInteraction such that Global."NormalizeInterval" ( PRAPAREHomelessnessScreen.relevantDatetime, PRAPAREHomelessnessScreen.relevantPeriod ) 14 days or less on or before day of QualifyingInteraction.InteractionDatetime and PRAPAREHomelessnessScreen.result ~ "I choose not to answer this question"
"Homelessness Assessment Not Performed" HomelessnessScreenNotDone with "Any Interaction Between Clinician and Patient" QualifyingInteraction such that HomelessnessScreenNotDone.authorDatetime 14 days or less on or before day of QualifyingInteraction.InteractionDatetime and HomelessnessScreenNotDone.negationRationale in "ASN Screening Declined"
"Homelessness Assessment Performed" HomelessnessScreen where HomelessnessScreen.HomelessAssessResult is null
/*Housing Insecurity Numerator 1: No Housing Insecurity Screen (not done or missing result) And No Housing Insecurity ICD10CM Diagnosis*/ ("Negative Homelessness Screen And No Housing Instability Screen" or "Negative Housing Instability Screen And No Homelessness Screen" or "No Housing Insecurity Screen") and not "Negative Homelessness and Housing Instability Screen" //and not "Positive Housing Instability and Negative Homelessness" and not exists "Homelessness ICD10CM Diagnosis" and not exists "Housing Instability ICD10CM Diagnosis" and not exists "Housing Instability PRAPARE Decline to Answer" and not exists "Homelessness PRAPARE Decline to Answer" and not exists "Homelessness Screen Declined" and not exists "Housing Instability Screen Declined"
/*Housing Insecurity Numerator 2: Housing Insecurity Screen Declined*/ exists ("Housing Instability PRAPARE Decline to Answer" union "Homelessness PRAPARE Decline to Answer" union "Homelessness Screen Declined" union "Housing Instability Screen Declined") and not exists "Homelessness ICD10CM Diagnosis" and not exists "Housing Instability ICD10CM Diagnosis"
/*Housing Insecurity Numerator 3: Housing Insecurity Positive With No Intervention*/ "First Positive Housing Instability Finding by Assessment or Diagnosis Without Followup Ordered or Performed" is not null or "First Positive Homelessness Finding by Assessment or Diagnosis Without Followup Ordered or Performed" is not null
/*Housing Insecurity Numerator 4: Housing Insecurity Screen Positive With Intervention Performed*/ "First Positive Housing Instability Finding by Assessment or Diagnosis With Followup Ordered or Performed" is not null or "First Positive Homelessness Finding by Assessment or Diagnosis With Followup Ordered or Performed" is not null
/*Housing Insecurity Numerator 5: Housing Insecurity Screen Negative*/ exists "Homelessness Negative Screen" and exists "Housing Instability Negative Screen" and not exists "Homelessness ICD10CM Diagnosis" and not exists "Housing Instability ICD10CM Diagnosis" and not exists "Homelessness Positive Screen" and not exists "Housing Instability Positive Screen" and not exists "Housing Instability PRAPARE Decline to Answer" and not exists "Homelessness PRAPARE Decline to Answer" and not exists "Housing Instability Screen Declined" and not exists "Homelessness Screen Declined"
/*Housing Insecurity Overall Domain Score: Housing Insecurity Screen Negative or Screen Positive With Intervention (Sum of Numerators 4 and 5)*/ "Housing Insecurity Numerator 4: Housing Insecurity Screen Positive With Intervention Performed" or "Housing Insecurity Numerator 5: Housing Insecurity Screen Negative"
( ["Assessment, Not Performed": "Are you homeless or worried that you might be in the future [WellRx]"] union ["Assessment, Not Performed": "Are you worried about losing your housing [PRAPARE]"] union ["Assessment, Not Performed": "Behind on rent or mortgage in past 12 months"] union ["Assessment, Not Performed": "Homeless in past 12 months"] union ["Assessment, Not Performed": "Number of residential moves in past 12 months"] union ["Assessment, Not Performed": "Worried about housing stability in next 2 months"] union ["Assessment, Not Performed": "Housing status"] ) NotPerformedHousingInstability where NotPerformedHousingInstability.authorDatetime during "Measurement Period"
( ["Assessment, Performed": "Are you homeless or worried that you might be in the future [WellRx]"] union ["Assessment, Performed": "Are you worried about losing your housing [PRAPARE]"] union ["Assessment, Performed": "Behind on rent or mortgage in past 12 months"] union ["Assessment, Performed": "Homeless in past 12 months"] union ["Assessment, Performed": "Number of residential moves in past 12 months"] union ["Assessment, Performed": "Worried about housing stability in next 2 months"] union ["Assessment, Performed": "Housing status"] ) HousingAssessmentPerformed with "Any Interaction Between Clinician and Patient" AnyInteraction such that Coalesce( HousingAssessmentPerformed.authorDatetime, Global."EarliestOf"(HousingAssessmentPerformed.relevantDatetime, HousingAssessmentPerformed.relevantPeriod) ) 14 days or less on or before day of AnyInteraction.InteractionDatetime and HousingAssessmentPerformed.result is not null return Tuple { AssessId: HousingAssessmentPerformed.id, HousingAssessCode: HousingAssessmentPerformed.code, HousingAssessResult: HousingAssessmentPerformed.result, HousingAssessmentTiming: Coalesce( HousingAssessmentPerformed.authorDatetime, Global."EarliestOf" (HousingAssessmentPerformed.relevantDatetime, HousingAssessmentPerformed.relevantPeriod) ) }
(["Intervention, Performed": "Intervention for Positive Housing Instability Screen"] union ["Intervention, Order": "Intervention for Positive Housing Instability Screen"]) HousingInstabilityFollowUp with "Any Interaction Between Clinician and Patient" AnyInteraction such that ( Global."NormalizeInterval" ( HousingInstabilityFollowUp.relevantDatetime, HousingInstabilityFollowUp.relevantPeriod ) 2 days or less before day of AnyInteraction.InteractionDatetime ) or HousingInstabilityFollowUp.authorDatetime 2 days or less before day of AnyInteraction.InteractionDatetime return Tuple { HInstabFollowUpID: HousingInstabilityFollowUp.id, HInstabFollowUpCode: HousingInstabilityFollowUp.code, HInstabFollowUpDatetime: Coalesce( HousingInstabilityFollowUp.authorDatetime, Global."EarliestOf" (HousingInstabilityFollowUp.relevantDatetime, HousingInstabilityFollowUp.relevantPeriod) ) }
["Diagnosis": "Housing Instability Diagnosis"] HousingDiagnosis with "Any Interaction Between Clinician and Patient" AnyInteractionDuringMP such that HousingDiagnosis.prevalencePeriod starts 14 days or less on or before day of AnyInteractionDuringMP.InteractionDatetime or HousingDiagnosis.authorDatetime 14 days or less on or before day of AnyInteractionDuringMP.InteractionDatetime return Tuple { HousingDiagnosisID: HousingDiagnosis.id, HousingDiagnosisCode: HousingDiagnosis.code, HousingDiagnosisDatetime: Coalesce(start of HousingDiagnosis.prevalencePeriod, HousingDiagnosis.authorDatetime) }
"Housing Instability Assessment Performed" HousingInstabilityScreen where (HousingInstabilityScreen.HousingAssessResult in { "No", "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)", "I have a steady place to live"}) or (HousingInstabilityScreen.HousingAssessResult < 2 )
"Housing Instability Assessment Performed" HousingInstabilityScreen where (HousingInstabilityScreen.HousingAssessResult in { "Yes", "I have a place to live today, but I am worried about losing it in the future"}) or (HousingInstabilityScreen.HousingAssessResult >=2)
( ["Assessment, Performed": "Are you worried about losing your housing [PRAPARE]"] ) PRAPAREHousingInstabilityScreen with "Any Interaction Between Clinician and Patient" QualifyingInteraction such that Global."NormalizeInterval" ( PRAPAREHousingInstabilityScreen.relevantDatetime, PRAPAREHousingInstabilityScreen.relevantPeriod ) 14 days or less on or before day of QualifyingInteraction.InteractionDatetime and PRAPAREHousingInstabilityScreen.result ~ "I choose not to answer this question"
"Housing Instability Assessment Not Performed" HouseInstabilityScreenNotDone with "Any Interaction Between Clinician and Patient" QualifyingInteraction such that HouseInstabilityScreenNotDone.authorDatetime 14 days or less on or before day of QualifyingInteraction.InteractionDatetime and HouseInstabilityScreenNotDone.negationRationale in "ASN Screening Declined"
"Housing Instability Assessment Performed" HousingInstabilityScreen where (HousingInstabilityScreen.HousingAssessResult is null or HousingInstabilityScreen.HousingAssessResult ~ "I have housing" or HousingInstabilityScreen.HousingAssessResult ~ "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 HousingInstabilityScreen.HousingAssessResult ~ "I choose not to answer this question")
"Has Qualifying Encounter During Measurement Period"
exists "Homelessness Negative Screen" and exists "Housing Instability Negative Screen"
"Homelessness Negative Screen" is not null and ( "Housing Instability Assessment Not Performed" is not null or "Housing Instability Screen No Result" is not null )
"Housing Instability Negative Screen" is not null and ( "Homelessness Assessment Not Performed" is not null or "Homelessness Screen No Result" is not null )
exists "Housing Instability Assessment Not Performed" and exists "Homelessness Assessment Not Performed" and exists "Housing Instability Screen No Result" and exists "Homelessness Screen No Result"
["Patient Characteristic Birthdate": "Birth date"]
["Patient Characteristic Ethnicity": "Ethnicity"]
["Patient Characteristic Payer": "Payer Type"]
["Patient Characteristic Race": "Race"]
["Patient Characteristic Sex": "ONC Administrative Sex"]
if ( HasStart(period)) then start of period else end of period
Earliest(NormalizeInterval(pointInTime, period))
not ( start of period is null or start of period = minimum DateTime )
if pointInTime is not null then Interval[pointInTime, pointInTime] else if period is not null then period else null as Interval<DateTime>
["Patient Characteristic Ethnicity": "Ethnicity"]
["Patient Characteristic Payer": "Payer Type"]
["Patient Characteristic Race": "Race"]
["Patient Characteristic Sex": "ONC Administrative Sex"]
["Patient Characteristic Birthdate": "Birth date"]
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