Most clinical quality measures have some sort of age criteria. Consider NQF 0418, the depression screening and follow-up measure. The basic description is:
Percentage of patients aged 12 years and older screened for depression on the date of the encounter using an age-appropriate standardized depression screening tool AND if positive, a follow-up plan is documented on the date of the positive screen.
When you go to actually calculate the measure you can quickly get stuck on that age criteria – what does “aged 12 years and older”actually mean?
The UDS manual actually spells this out fairly well. On page 95 of the 2018 manual (http://www.bphcdata.net/docs/uds_rep_instr.pdf), for the measurement period calendar year 2018, it says “Include patients who were born on or before December 31, 2005.
Since Azara calculates these measures for more than just calendar year measurement periods, our measure logic checks the patient’s age at the end of the reporting period. So, for the depression screening measure we check that the patient’s age at the end of the measurement period is greater than or equal to 13. This is always a point of confusion, that the age we check at the end of the period is 1 year greater than the age in the measure description. But let’s test out the logic to prove it’s sound.
The UDS manual says a patient born on 12/31/2005 is the youngest possible patient to include in the measure. That patient would be 13 on the last day of the measurement period (12/31/2018) so their age at the end of the reporting period is greater than or equal to 13.
What about a patient 1 day younger, someone born on 1/1/2006? That patient would be 12 on the last day of the measurement period, so they would not be included. The Azara logic checks out!
As we all know, the UDS manual explicitly references when a measure aligns with the eCQMs, so let’s see how the eCQM is defined. The way the eCQMs express age criteria has changed a good deal over the years, so let’s look at a few different versions:
CMS2v4 (from a few years ago) – “Patient Characteristic Birthdate: birth date” >= 12 year(s) starts before start of “Measurement Period”
CMS2v7 (this year’s measure) – Age>= 12 year(s) at: “Measurement Period”
CMS2v8 (next year’s measure) – “Patient Age 12 Years or Older at Start of Measurement Period”
It’s certainly challenging that the syntax for these eCQMs seems to change every year, but these are all basically saying the same thing – the patient’s age at the start of the measurement period must be >= 12. This is kind of the opposite of the Azara logic, in that it assesses the patient’s age at the start of the period, but it produces the same outcomes.
Using the patient example from above, a patient born on 12/31/2005 would be >= 12 at the start of the measurement period 1/1/2018.
A patient one day younger, someone born on 1/1/2006, is potentially contentious. If you use the logic from CMS2v4 this patient would not be included because their 12th birthday does not start before the start of the measurement period. Using the logic from CMS2v7 or CMS2v8 is a little less clear – should a patient born on 1/1/2018 be included? It’s unclear to me if Age >= 12 year(s) at: “Measurement Period” changes the logic from “starts before start of “to “starts before or at start of”.
I think it’s a good idea to assume that changes in the measure definition syntax don’t result in changes to the measure intent. The UDS manual still interprets the eCQM spec the same way with respect to age logic, and so does Azara. Furthermore, including patients who turn 12 on 1/1/2018 doesn’t necessarily align with the clinical intent of the measure, which is to give them a depression screening within a year, because these patients would not be non-compliant until 1/1/2019 (one year after their 12th birthday) which falls outside the measurement period.