Intervention (QDM)

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The CQI Workgroup reviewed this page in April 2018 consistent with QDM version 5.3. There are no updates to the content required based on QDM version 5.4 (reviewed June 7, 2018). Note that while the QDM categories Intervention and Procedure are modeled identically and interoperability standards do not differentiate between them, both are retained in the QDM as they are more clinically expressive for clinicians to understand the measure intent.

QDM defines Intervention as a course of action intended to achieve a result in the care of persons with health problems that does not involve direct physical contact with a patient. Examples include patient education and therapeutic communication. QDM defines three contexts for intervention: Intervention, Order; Intervention, Performed; Intervention, Recommended.

Intervention, Order

QDM Attribute	QI Core Metadata Element	Comment
Intervention, Order	ProcedureRequest.intent	Procedure Request intent uses the concepts proposal, plan, order, original-order, reflex-order, filler-order, instance-order, option. Constrain to "order" from the intent value set for QDM datatypes with the order context.
Negation Rationale	ProcedureRequest.extension (http://hl7.org/fhir/StructureDefinition/procedurerequest-reasonRefused)	QDM matched to QI Core / FHIR
Reason	ProcedureRequest.reasonCode	QDM matched to QI Core / FHIR
Author dateTime	ProcedureRequest.AuthoredOn	Note - ProcedureRequest.occurrence(x) defines a dateTime when the event should occur - not addressed in QDM
Code	ProcedureRequest.code	QDM matched to QI Core / FHIR
id	ProcedureRequest.id	QDM matched to QI Core / FHIR
Source	ProcedureRequest.requester	Author, orderer - note also, ProcedureRequest.requester.agent for device, practitioner or organization who initiated the request; or ProcedureRequest.requester.onBehalfOf - the organization the device or practitioner was acting on behalf of

Intervention, Recommended

QDM Attribute	QI Core Metadata Element	Comment
Intervention, Recommended	ProcedureRequest.intent	Procedure Request intent uses the concepts proposal, plan, order, original-order, reflex-order, filler-order, instance-order, option. "Proposal" is most consistent with the ProcedureRequest when applied to clinical decision support (CDS) in which the CDS proposes an action to a provider or to a patient. The QDM concept Recommended addresses expectations a provider gives to a patient. Such recommendations are most consistent with the ProcedureRequest.intent value of "plan" (an intension to ensure something occurs without providing an authorization to act).
Negation Rationale	ProcedureRequest.extension (http://hl7.org/fhir/StructureDefinition/procedurerequest-reasonRefused)	QDM matched to QI Core / FHIR
Reason	ProcedureRequest.reasonCode	QDM matched to QI Core / FHIR
Author dateTime	ProcedureRequest.AuthoredOn	Note - ProcedureRequest.occurrence(x) defines a dateTime when the event should occur - not addressed in QDM
Code	ProcedureRequest.code	QDM matched to QI Core / FHIR
id	ProcedureRequest.id	QDM matched to QI Core / FHIR
Source	ProcedureRequest.requester	Author, orderer - note also, ProcedureRequest.requester.agent for device, practitioner or organization who initiated the request; or ProcedureRequest.requester.onBehalfOf - the organization the device or practitioner was acting on behalf of

Intervention, Performed

QDM Attribute	QI Core Metadata Element	Comment
Intervention, Performed	Procedure (the .status metadata allows conformance to the specific QDM datatype context)	QDM matched to QI Core / FHIR
Relevant Period	Procedure.performed[x]	QDM matched to QI Core / FHIR
Negation Rationale	Procedure.notDoneReason	QDM matched to QI Core / FHIR
Reason	Procedure.reasonCode	QDM matched to QI Core / FHIR
Result	Procedure.outcome	QDM matched to QI Core / FHIR
Author dateTime	FHIR.provenance.recorded	FHIR references authorDatetime as part of the provenance resource for all resources. Is authorDatetime still appropriate for this datatype?
Status	Procedure.status	QDM matched to QI Core / FHIR
Code	Procedure.code	QDM matched to QI Core / FHIR
id	Procedure.id	QDM matched to QI Core / FHIR
Source	Procedure.performer	QDM matched to QI Core / FHIR