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  1. FHIR Specification Feedback
  2. FHIR-42976

Does improvementNotation field need to allow for additional guidance?

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    • Icon: Change Request Change Request
    • Resolution: Persuasive
    • Icon: Medium Medium
    • US Quality Measures (FHIR)
    • 4.0.0
    • Clinical Quality Information
    • CQFM Measure [deprecated]
    • improvementNotation element
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      Agree that additional text guidance is needed for improvement notation (especially if a concept outside of the 'increase' or 'decrease' current codes is included).  Ask an additional ballot question (related to the ballot question in 42116) that asks:

      If an additional code is added to the improvement notation (like normative reference range as suggested), where is guidance about the reference range best included in the specification for implementer use?  Some suggestions include: the guidance field, the rate aggregation field or adding an extension to improvementNotation to add text.

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      Agree that additional text guidance is needed for improvement notation (especially if a concept outside of the 'increase' or 'decrease' current codes is included).  Ask an additional ballot question (related to the ballot question in 42116) that asks: If an additional code is added to the improvement notation (like normative reference range as suggested), where is guidance about the reference range best included in the specification for implementer use?  Some suggestions include: the guidance field, the rate aggregation field or adding an extension to improvementNotation to add text.
    • Jen Seeman/ Juliet Rubini: 18-0-0
    • Clarification
    • Non-substantive

    Description

      Does the improvementNotation field need to also allow a string (or another field) to capture narrative descriptions that explain the "within optimal range" as seen in the https://ecqi.healthit.gov/ecqm/eh/2024/cms0334v5 example

      Within Optimal Range. The Joint Commission does not want to encourage inappropriately low Cesarean rates that may be unsafe to patients. Acceptable PC-02 rates are 30% or lower, however there is not an established threshold for what rate may be too low. PC-06 serves as a balancing measure for PC-02 to guard against any unanticipated or unintended consequences and to identify unforeseen complications that might arise as a result of quality improvement activities and efforts for this measure. In order to identify areas for improvement, hospitals may want to review results based on specific ICD-10 codes or patient populations. Data could then be analyzed further determine specific patterns or trends to help reduce cesarean births.

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            abdullah.rafiqi Abdullah Rafiqi
            jrubini Juliet K. Rubini
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