eCQM Title | Addressing Social Needs (ASN) Merit-based Incentive Payment System (in the Outpatient Setting) Part 1 of 4 – Food Domain |
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CMS ID | eCQM Version Number | Draft based on 0.0.000 | |
CBE Number | Not Applicable | GUID | f7927f32-1ad5-4811-a028-7950b10bba46 |
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 1 is to report the Food Domain. Refer to Transportation, Utility, Housing 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: '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: '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: '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 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-10CM 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-10CM 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 food insecurity and there was no documented ICD-10-CM diagnosis for food insecurity during the measurement period. Numerator 2: Patients (or proxies, e.g. caregivers, parents, guardians, and so forth) who declined food insecurity screening during the measurement period. Numerator 3: Patients (or proxies, e.g. caregivers, parents, guardians, and so forth) screened positive for food insecurity or with a documented ICD-10-CM diagnosis of food 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 food insecurity or have an ICD-10-CM diagnosis for food 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 food insecurity during the measurement period, with no ICD-10-CM diagnosis for food insecurity. Numerator 6: Food Insecurity Overall Domain Score: Food 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
/*Food Insecurity Numerator 1: No Food Insecurity Screen (not done or missing result) And No Food Insecurity ICD10CM Diagnosis*/ not exists "Food Insecurity Assessment Performed With Positive Result" and not exists "Food Insecurity Assessment Performed With Negative Result" and not exists "Food Insecurity ICD10CM Diagnosis" and not exists "Food Insecurity Screen Declined"
None
None
None
"Has Qualifying Encounter During Measurement Period"
"Initial Population"
None
/*Food Insecurity Numerator 2: Food Insecurity Screen Declined*/ exists "Food Insecurity Screen Declined" and not exists "Food Insecurity Assessment Performed With Positive Result" and not exists "Food Insecurity Assessment Performed With Negative Result" and not exists "Food Insecurity ICD10CM Diagnosis"
None
None
None
"Has Qualifying Encounter During Measurement Period"
"Initial Population"
None
/*Food Insecurity Numerator 3: Food Insecurity Positive With No Intervention*/ "First Positive Food Screen by Assessment or Diagnosis Without Followup Ordered or Performed" is not null
None
None
None
"Has Qualifying Encounter During Measurement Period"
"Initial Population"
None
/*Food Insecurity Numerator 4: Food Insecurity Screen Positive With Intervention Performed*/ "First Positive Food Screen by Assessment or Diagnosis with Followup Ordered or Performed" is not null
None
None
None
"Has Qualifying Encounter During Measurement Period"
"Initial Population"
None
/*Food Insecurity Numerator 5: Food Insecurity Screen Negative*/ "Last Negative Food Screen" is not null and "First Positive Food Screen By Assessment or Diagnosis" is null and not exists "Food Insecurity Follow-Up Intervention Ordered or Performed" and not exists "Food Insecurity ICD10CM Diagnosis"
None
None
None
"Has Qualifying Encounter During Measurement Period"
"Initial Population"
None
/*Food Insecurity Overall Domain Score: Food Insecurity Screen Negative or Screen Positive With Intervention (Sum of Numerators 4 and 5)*/ "Food Insecurity Numerator 4: Food Insecurity Screen Positive With Intervention Performed" or "Food Insecurity Numerator 5: Food 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 ((("Food Insecurity ICD10CM Diagnosis" FIDx return Tuple{"id": FIDx.DiagnosisID, "code": FIDx.FoodDiagnosisCode, "occurrenceDatetime": FIDx.FoodDiagnosisDatetime} ) union ("Food Insecurity Assessment Performed With Positive Result" ScreenPositive return Tuple{"id": ScreenPositive.AssessId, "code": ScreenPositive.FoodAssessCode, "occurrenceDatetime": ScreenPositive.FoodAssessmentTiming } ) ) ScreeningOrDiagnosis sort by occurrenceDatetime )
"First Positive Food Screen By Assessment or Diagnosis" ScreeningOrDiagnosis with "Food Insecurity Follow-Up Intervention Ordered or Performed" FoodFollowUpIntervention such that FoodFollowUpIntervention.FoodFollowUpDatetime 16 days or less on or after day of ScreeningOrDiagnosis.occurrenceDatetime
"First Positive Food Screen By Assessment or Diagnosis" ScreeningOrDiagnosis without "Food Insecurity Follow-Up Intervention Ordered or Performed" FoodFollowUpIntervention such that FoodFollowUpIntervention.FoodFollowUpDatetime 16 days or less on or after day of ScreeningOrDiagnosis.occurrenceDatetime
( ["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]"]) NotPerformedFoodScreen where NotPerformedFoodScreen.authorDatetime during "Measurement Period"
( ["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]"] ) FoodAssessmentPerformed with "Any Interaction Between Clinician and Patient" AnyInteraction such that Coalesce( FoodAssessmentPerformed.authorDatetime, Global."EarliestOf"(FoodAssessmentPerformed.relevantDatetime, FoodAssessmentPerformed.relevantPeriod) ) 14 days or less on or before day of AnyInteraction.InteractionDatetime and FoodAssessmentPerformed.result is not null return Tuple { AssessId: FoodAssessmentPerformed.id, FoodAssessCode: FoodAssessmentPerformed.code, FoodAssessResult: FoodAssessmentPerformed.result as Code, FoodAssessmentTiming: Coalesce( FoodAssessmentPerformed.authorDatetime,Global."EarliestOf" (FoodAssessmentPerformed.relevantDatetime, FoodAssessmentPerformed.relevantPeriod) ) }
( "Food Insecurity Assessment Performed" FoodAssess where FoodAssess.FoodAssessResult in {"No", "Never true", "Enough of the kinds of food we want to eat", "Enough but not always the kinds of food we want", "Only 1 or 2 months", "Dont know/refused", "DK or Refused", "DK"} )
( "Food Insecurity Assessment Performed" FoodAssess where FoodAssess.FoodAssessResult in {"Yes", "Often true", "Sometimes true", "Almost every month", "Some months but not every month", "Sometimes not enough to eat", "Often not enough to eat"} )
(["Intervention, Performed": "Intervention for Positive Food Insecurity Screen"] union ["Intervention, Order": "Intervention for Positive Food Insecurity Screen"]) FoodFollowUp with "Any Interaction Between Clinician and Patient" Interaction such that ( start of Global."NormalizeInterval" ( FoodFollowUp.relevantDatetime, FoodFollowUp.relevantPeriod ) 2 days or less on or after day of end of Interaction.InteractionDatetime or FoodFollowUp.authorDatetime 2 days or less on or after day of end of Interaction.InteractionDatetime ) return Tuple { FollowUpID: FoodFollowUp.id, FollowUpCode: FoodFollowUp.code, FoodFollowUpDatetime: Coalesce( FoodFollowUp.authorDatetime, Global."EarliestOf" (FoodFollowUp.relevantDatetime, FoodFollowUp.relevantPeriod) ) }
["Diagnosis": "Food Insecurity Diagnosis"] FoodDiagnosis with "Any Interaction Between Clinician and Patient" AnyInteractionDuringMP such that FoodDiagnosis.prevalencePeriod starts 14 days or less on or before day of AnyInteractionDuringMP.InteractionDatetime or FoodDiagnosis.authorDatetime 14 days or less on or before day of AnyInteractionDuringMP.InteractionDatetime return Tuple { DiagnosisID: FoodDiagnosis.id, FoodDiagnosisCode: FoodDiagnosis.code, FoodDiagnosisDatetime: Coalesce(start of FoodDiagnosis.prevalencePeriod, FoodDiagnosis.authorDatetime) }
/*Food Insecurity Numerator 1: No Food Insecurity Screen (not done or missing result) And No Food Insecurity ICD10CM Diagnosis*/ not exists "Food Insecurity Assessment Performed With Positive Result" and not exists "Food Insecurity Assessment Performed With Negative Result" and not exists "Food Insecurity ICD10CM Diagnosis" and not exists "Food Insecurity Screen Declined"
/*Food Insecurity Numerator 2: Food Insecurity Screen Declined*/ exists "Food Insecurity Screen Declined" and not exists "Food Insecurity Assessment Performed With Positive Result" and not exists "Food Insecurity Assessment Performed With Negative Result" and not exists "Food Insecurity ICD10CM Diagnosis"
/*Food Insecurity Numerator 3: Food Insecurity Positive With No Intervention*/ "First Positive Food Screen by Assessment or Diagnosis Without Followup Ordered or Performed" is not null
/*Food Insecurity Numerator 4: Food Insecurity Screen Positive With Intervention Performed*/ "First Positive Food Screen by Assessment or Diagnosis with Followup Ordered or Performed" is not null
/*Food Insecurity Numerator 5: Food Insecurity Screen Negative*/ "Last Negative Food Screen" is not null and "First Positive Food Screen By Assessment or Diagnosis" is null and not exists "Food Insecurity Follow-Up Intervention Ordered or Performed" 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)*/ "Food Insecurity Numerator 4: Food Insecurity Screen Positive With Intervention Performed" or "Food Insecurity Numerator 5: Food Insecurity Screen Negative"
"Food Insecurity Assessment Not Performed" FoodScreenNotDone with "Any Interaction Between Clinician and Patient" QualifyingInteraction such that FoodScreenNotDone.authorDatetime 14 days or less on or before day of start of QualifyingInteraction.InteractionDatetime and FoodScreenNotDone.negationRationale in "ASN Screening Declined"
exists ["Encounter, Performed": "Office and Wellness Visits for General Screening"] EncounterSDOH where EncounterSDOH.relevantPeriod ends during day of "Measurement Period"
"Has Qualifying Encounter During Measurement Period"
Last ("Food Insecurity Assessment Performed With Negative Result" ScreenNegative return Tuple{"id": ScreenNegative.AssessId, "code": ScreenNegative.FoodAssessCode, "occurrenceDatetime": ScreenNegative.FoodAssessmentTiming } )
["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 Birthdate": "Birth date"]
["Patient Characteristic Ethnicity": "Ethnicity"]
["Patient Characteristic Payer": "Payer Type"]
["Patient Characteristic Race": "Race"]
["Patient Characteristic Sex": "ONC Administrative Sex"]
Measure Set |
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