VA-LIPID STATIN RX CVD/DM (VER1.0) (1539)    REMINDER DEFINITION (811.9)

• EDIT DATE:   2012-10-18 15:55:00
  EDIT BY:   USER,SEVENTEEN
  EDIT COMMENTS:   

  Exchange Install
  

Applicable to diabetics and patients with CVD ages 18-75 who have had an 
The age range is set by using 2 function findings so that if there is a 
decision to use different age ranges for the different diagnoses, then 
this functionality is already available in the reminder.
LDL in the past 2 years.
 
Resolved by LDL<100, moderate or high dose statin, contraindication to
statins, other provider actions/documentation.
 
Frequency: set at 99 years (although this is somewhat arbitrary since the 
reminder would work just as well with this set to anything 2Y or more).
 

• FINDING ITEM:   VA-DIABETES HEDIS
  OCCURRENCE COUNT:   2
  NO. OF FOUND TEXT LINES:   0
  NO. NOT FOUND TEXT LINES:   0
  BEGINNING DATE/TIME:   T-2Y
• FINDING ITEM:   VA-STATIN HIGH DOSE
  RXTYPE:   I,O

  STATUS LIST:

  • STATUS:   ACTIVE
  • STATUS:   DISCONTINUED
  • STATUS:   DISCONTINUED (EDIT)
  • STATUS:   DISCONTINUED (RENEWAL)
  • STATUS:   EXPIRED
  • STATUS:   SUSPENDED

  NO. OF FOUND TEXT LINES:   0
  NO. NOT FOUND TEXT LINES:   0
  BEGINNING DATE/TIME:   T-30
• FINDING ITEM:   VA-STATIN MODERATE DOSE
  RXTYPE:   I,O
  OCCURRENCE COUNT:   4

  STATUS LIST:

  • STATUS:   ACTIVE
  • STATUS:   DISCONTINUED
  • STATUS:   DISCONTINUED (EDIT)
  • STATUS:   DISCONTINUED (RENEWAL)
  • STATUS:   EXPIRED
  • STATUS:   SUSPENDED

  NO. OF FOUND TEXT LINES:   0
  NO. NOT FOUND TEXT LINES:   0
  BEGINNING DATE/TIME:   T-30
• FINDING ITEM:   VA-LDL
  CONDITION:   I +V>0
  CONDITION CASE SENSITIVE:   NO
  OCCURRENCE COUNT:   4
  USE STATUS/COND IN SEARCH:   YES
  INTERNAL CONDITION:   I +V>0
  NO. OF FOUND TEXT LINES:   0
  NO. NOT FOUND TEXT LINES:   0
  BEGINNING DATE/TIME:   T-2Y
• FINDING ITEM:   VA-LDL
  CONDITION:   I +V>0&(V<100)
  CONDITION CASE SENSITIVE:   NO
  OCCURRENCE COUNT:   2
  USE STATUS/COND IN SEARCH:   YES
  INTERNAL CONDITION:   I +V>0&(V<100)
  NO. OF FOUND TEXT LINES:   0
  NO. NOT FOUND TEXT LINES:   0
• FINDING ITEM:   VA-OUTSIDE LDL <100
  NO. OF FOUND TEXT LINES:   0
  NO. NOT FOUND TEXT LINES:   0
• FINDING ITEM:   VA-LDL
  CONDITION:   I +V>0&(V>99)
  CONDITION CASE SENSITIVE:   NO
  OCCURRENCE COUNT:   2
  USE STATUS/COND IN SEARCH:   YES
  INTERNAL CONDITION:   I +V>0&(V>99)
  NO. OF FOUND TEXT LINES:   1
  NO. NOT FOUND TEXT LINES:   0
  FOUND TEXT:   

  Most recent LDL that was 100 or higher.
  

  USE IN RESOLUTION LOGIC:   AND NOT
• FINDING ITEM:   VA-OUTSIDE LDL 100-119
  NO. OF FOUND TEXT LINES:   0
  NO. NOT FOUND TEXT LINES:   0
• FINDING ITEM:   VA-OUTSIDE LDL 120-129
  NO. OF FOUND TEXT LINES:   0
  NO. NOT FOUND TEXT LINES:   0
• FINDING ITEM:   VA-OUTSIDE LDL >129
  NO. OF FOUND TEXT LINES:   0
  NO. NOT FOUND TEXT LINES:   0
• FINDING ITEM:   VA-DIABETES HEDIS PROB LIST
  NO. OF FOUND TEXT LINES:   0
  NO. NOT FOUND TEXT LINES:   0
• FINDING ITEM:   VA-STATIN ADD/ADJUST
  WITHIN CATEGORY RANK:   0
  NO. OF FOUND TEXT LINES:   0
  NO. NOT FOUND TEXT LINES:   0
  BEGINNING DATE/TIME:   T-2M
• FINDING ITEM:   VA-STATIN DECLINES
  NO. OF FOUND TEXT LINES:   0
  NO. NOT FOUND TEXT LINES:   0
  BEGINNING DATE/TIME:   T-2M
• FINDING ITEM:   VA-LDL NON-ADHERENCE WITH RX
  NO. OF FOUND TEXT LINES:   0
  NO. NOT FOUND TEXT LINES:   0
  BEGINNING DATE/TIME:   T-2M
• FINDING ITEM:   VA-STATIN ON HIGHEST TOLERATED DOSE
  WITHIN CATEGORY RANK:   0
  NO. OF FOUND TEXT LINES:   0
  NO. NOT FOUND TEXT LINES:   0
  BEGINNING DATE/TIME:   T-1Y
• FINDING ITEM:   VA-STATIN NON-VA MOD/HI DOSE THERAPY
  WITHIN CATEGORY RANK:   0
  NO. OF FOUND TEXT LINES:   0
  NO. NOT FOUND TEXT LINES:   0
• FINDING ITEM:   VA-LIPID PROFILE ORDERABLE
  ENDING DATE/TIME:   T+2M

  STATUS LIST:

  • STATUS:   ACTIVE
  • STATUS:   PENDING

  NO. OF FOUND TEXT LINES:   0
  NO. NOT FOUND TEXT LINES:   0
  USE START DATE:   YES
  BEGINNING DATE/TIME:   T-14D
• FINDING ITEM:   VA-ORDER LIPID PROFILE HEALTH FACTOR
  NO. OF FOUND TEXT LINES:   0
  NO. NOT FOUND TEXT LINES:   0
  BEGINNING DATE/TIME:   T-1M
• FINDING ITEM:   VA-STATIN DRUGS
  RXTYPE:   N

  STATUS LIST:

  • STATUS:   ACTIVE

  NO. OF FOUND TEXT LINES:   0
  NO. NOT FOUND TEXT LINES:   0
• FINDING ITEM:   VA-STATIN ADR
  NO. OF FOUND TEXT LINES:   0
  NO. NOT FOUND TEXT LINES:   0
• FINDING ITEM:   VA-STATIN ADR ALL HF
  WITHIN CATEGORY RANK:   0
  NO. OF FOUND TEXT LINES:   0
  NO. NOT FOUND TEXT LINES:   0
• FINDING ITEM:   VA-DIABETES MEDICATIONS
  RXTYPE:   O,N

  STATUS LIST:

  • STATUS:   ACTIVE
  • STATUS:   DISCONTINUED
  • STATUS:   DISCONTINUED (EDIT)
  • STATUS:   EXPIRED
  • STATUS:   SUSPENDED

  NO. OF FOUND TEXT LINES:   0
  NO. NOT FOUND TEXT LINES:   0
  BEGINNING DATE/TIME:   T-270
• FINDING ITEM:   VA-STATIN TEMPORARY CONTRAIND
  WITHIN CATEGORY RANK:   0
  NO. OF FOUND TEXT LINES:   0
  NO. NOT FOUND TEXT LINES:   0
  BEGINNING DATE/TIME:   T-1Y
• FINDING ITEM:   VA-FILEMAN DATE
  NO. OF FOUND TEXT LINES:   0
  NO. NOT FOUND TEXT LINES:   0
  COMPUTED FINDING PARAMETER:   T-365D
  USE IN RESOLUTION LOGIC:   AND
• FINDING ITEM:   VA-LDL DIABETES AGE RANGE
  NO. OF FOUND TEXT LINES:   0
  NO. NOT FOUND TEXT LINES:   0
• FINDING ITEM:   VA-LDL IHD/ASCVD AGE RANGE
  NO. OF FOUND TEXT LINES:   0
  NO. NOT FOUND TEXT LINES:   0
• FINDING ITEM:   VA-DIABETES DX INCORRECT
  WITHIN CATEGORY RANK:   0
  NO. OF FOUND TEXT LINES:   0
  NO. NOT FOUND TEXT LINES:   0
• FINDING ITEM:   VA-IHD AND ASVD
  OCCURRENCE COUNT:   2
  NO. OF FOUND TEXT LINES:   0
  NO. NOT FOUND TEXT LINES:   0
  BEGINNING DATE/TIME:   T-2Y
• FINDING ITEM:   VA-IHD/ASVD DX INCORRECT
  WITHIN CATEGORY RANK:   0
  NO. OF FOUND TEXT LINES:   0
  NO. NOT FOUND TEXT LINES:   0
• FINDING ITEM:   VA-LIFE EXPECTANCY <6 MONTHS
  NO. OF FOUND TEXT LINES:   0
  NO. NOT FOUND TEXT LINES:   0
  USE IN PATIENT COHORT LOGIC:   AND NOT
  BEGINNING DATE/TIME:   T-6M
• FINDING ITEM:   VA-CHD RISK >20%
  NO. OF FOUND TEXT LINES:   0
  NO. NOT FOUND TEXT LINES:   0
• FINDING ITEM:   VA-CHD RISK <=20%
  NO. OF FOUND TEXT LINES:   0
  NO. NOT FOUND TEXT LINES:   0

• LOGIC:   FN(1)>1
  FUNCTION STRING:   COUNT(1)>1
  NO. FOUND TEXT LINES:   0
  NO. NOT FOUND TEXT LINES:   0

  FUNCTION LIST:

  • FUNCTION NUMBER:   1
    FUNCTION:   COUNT

    FUNCTION PARAMETER LIST:

• FOUND TEXT:   

  \\
  The patient is on a moderate or high dose statin.
  

  LOGIC:   FN(1)!FN(2)&((FN(3)/FN(4))>.6)
  FUNCTION STRING:   FI(10)!FI(11)&((NUMERIC(11,1,"QTY")/NUMERIC(11,1,"DAYS SUPPLY"))>.6)
  NO. FOUND TEXT LINES:   2
  NO. NOT FOUND TEXT LINES:   0

  FUNCTION LIST:

  • FUNCTION NUMBER:   1
    FUNCTION:   FI

    FUNCTION PARAMETER LIST:

  • FUNCTION NUMBER:   2
    FUNCTION:   FI

    FUNCTION PARAMETER LIST:

  • FUNCTION NUMBER:   3
    FUNCTION:   NUMERIC

    FUNCTION PARAMETER LIST:

    • FUNCTION PARAMETER:   QTY

  • FUNCTION NUMBER:   4
    FUNCTION:   NUMERIC

    FUNCTION PARAMETER LIST:

    • FUNCTION PARAMETER:   DAYS SUPPLY

• FOUND TEXT:   

  The patient has a recent fill of a moderate or high dose statin.  
  \\
  

  LOGIC:   FN(1)!FN(2)&((FN(3)/FN(4))>.6)
  FUNCTION STRING:   FI(10)!FI(11)&((NUMERIC(11,2,"QTY")/NUMERIC(11,2,"DAYS SUPPLY"))>.6)
  NO. FOUND TEXT LINES:   2
  NO. NOT FOUND TEXT LINES:   0

  FUNCTION LIST:

  • FUNCTION NUMBER:   1
    FUNCTION:   FI

    FUNCTION PARAMETER LIST:

  • FUNCTION NUMBER:   2
    FUNCTION:   FI

    FUNCTION PARAMETER LIST:

  • FUNCTION NUMBER:   3
    FUNCTION:   NUMERIC

    FUNCTION PARAMETER LIST:

    • FUNCTION PARAMETER:   QTY

  • FUNCTION NUMBER:   4
    FUNCTION:   NUMERIC

    FUNCTION PARAMETER LIST:

    • FUNCTION PARAMETER:   DAYS SUPPLY

• LOGIC:   FN(1)>FN(2)
  FUNCTION STRING:   MRD(13,14)>MRD(15,17,18,19)
  NO. FOUND TEXT LINES:   0
  NO. NOT FOUND TEXT LINES:   0

  FUNCTION LIST:

  • FUNCTION NUMBER:   1
    FUNCTION:   MRD

    FUNCTION PARAMETER LIST:

  • FUNCTION NUMBER:   2
    FUNCTION:   MRD

    FUNCTION PARAMETER LIST:

• FOUND TEXT:   

  An outside LDL is the most recent LDL result.
  

  LOGIC:   FN(1)!FN(2)!FN(3)!FN(4)&(FN(5)>FN(6))
  FUNCTION STRING:   FI(14)!FI(17)!FI(18)!FI(19)&(MRD(14,17,18,19)>MRD(12))
  NO. FOUND TEXT LINES:   1
  NO. NOT FOUND TEXT LINES:   0

  FUNCTION LIST:

  • FUNCTION NUMBER:   1
    FUNCTION:   FI

    FUNCTION PARAMETER LIST:

  • FUNCTION NUMBER:   2
    FUNCTION:   FI

    FUNCTION PARAMETER LIST:

  • FUNCTION NUMBER:   3
    FUNCTION:   FI

    FUNCTION PARAMETER LIST:

  • FUNCTION NUMBER:   4
    FUNCTION:   FI

    FUNCTION PARAMETER LIST:

  • FUNCTION NUMBER:   5
    FUNCTION:   MRD

    FUNCTION PARAMETER LIST:

  • FUNCTION NUMBER:   6
    FUNCTION:   MRD

    FUNCTION PARAMETER LIST:

• LOGIC:   FN(1)>FN(2)
  FUNCTION STRING:   MRD(29)>MRD(32)
  NO. FOUND TEXT LINES:   0
  NO. NOT FOUND TEXT LINES:   0

  FUNCTION LIST:

  • FUNCTION NUMBER:   1
    FUNCTION:   MRD

    FUNCTION PARAMETER LIST:

  • FUNCTION NUMBER:   2
    FUNCTION:   MRD

    FUNCTION PARAMETER LIST:

• LOGIC:   FN(1)>FN(2)
  FUNCTION STRING:   MRD(1,2,3)>MRD(4)
  NO. FOUND TEXT LINES:   0
  NO. NOT FOUND TEXT LINES:   0

  FUNCTION LIST:

  • FUNCTION NUMBER:   1
    FUNCTION:   MRD

    FUNCTION PARAMETER LIST:

  • FUNCTION NUMBER:   2
    FUNCTION:   MRD

    FUNCTION PARAMETER LIST:

• LOGIC:   FN(1)>FN(2)
  FUNCTION STRING:   MRD(5)>MRD(6)
  NO. FOUND TEXT LINES:   0
  NO. NOT FOUND TEXT LINES:   0

  FUNCTION LIST:

  • FUNCTION NUMBER:   1
    FUNCTION:   MRD

    FUNCTION PARAMETER LIST:

  • FUNCTION NUMBER:   2
    FUNCTION:   MRD

    FUNCTION PARAMETER LIST:

• LOGIC:   FN(1)>FN(2)
  FUNCTION STRING:   MRD(8)>MRD(9)
  NO. FOUND TEXT LINES:   0
  NO. NOT FOUND TEXT LINES:   0

  FUNCTION LIST:

  • FUNCTION NUMBER:   1
    FUNCTION:   MRD

    FUNCTION PARAMETER LIST:

  • FUNCTION NUMBER:   2
    FUNCTION:   MRD

    FUNCTION PARAMETER LIST:

Cohort logic (inclusion/exclusion criteria):
 
 
 
Update 4  5/25/12
  Add the national health factors back to the outside LDL dialog elements 
that are for high and low ranges.
  Change the age range for both IHD and diabetes to 18-75
  Remove local lab tests for LDL from the national terms except leave one 
LDL cholesterol with the condition as an example.
  Remove the age ranges from the branching logic reminders.
 
 
Update 5  7/19/12
  Update the dialog to include additional informational text in the 
section on guidance - include moderate dose statin information and also a 
link to the memo from Dr. Francis in June 2012.
  Update the definition of the reminder term for lipid panel orderable 
items since this term is used to resolve the reminder and the old 
definition states that the term does not resolve the reminders.
 
Update 6 8/2/12
FF11 was failing to work if there was no prior statin fill - 0-0'>10
2.  CVD - any diagnosis of CVD in the past 2 years that is more 
Using division will work but the strings have to be separated to avoid 
0/0.
 
Change 
FF11:  FI(10)!FI(11)&(((NUMERIC(11,1,"DAYS 
SUPPLY")-NUMERIC(11,1,"QTY"))'>10)!((NUMERIC(11,2,"DAYS 
SUPPLY")-NUMERIC(11,2,"QTY"))'>10))
 
Resolution Logic:
((FI(13)!FI(14))&FF(13))!FI(10)!(FI(11)&FF(11))!(FI(24)&FI(27))!FI(20)!FI(
recent than any entry of incorrect diagnosis of CVD and age 50-75.  
21)!FI(22)!FI(23)!FI(25)!FI(26)!(FI(29)&(FI(28)!FF(29)))!FI(30)
 
To
FF11
FI(10)!FI(11)&((NUMERIC(11,1,"QTY")/NUMERIC(11,1,"DAYS SUPPLY"))>.6) 
 
FF12   
FI(10)!FI(11)&((NUMERIC(11,2,"QTY")/NUMERIC(11,2,"DAYS SUPPLY"))>.6) 
 
 
 
Resolution Logic:
((FI(13)!FI(14))&FF(13))!FI(10)!(FI(11)&(FF(11)!FF(12)))!(FI(24)&FI(27))!F
I(20)!FI(21)!FI(22)!FI(23)!FI(25)!FI(26)!(FI(29)&(FI(28)!FF(29)))!FI(30)
 
 
Update 7  8/7/12
Because the presence of an LDL in the past 2 years was included in the 
cohort logic as FI(12), patients with only an outside LDL would never 
have the reminder applicable.
 
!(FI(VA-IHD AND ASVD)&FF(6)&FI(VA-LDL IHD/ASCVD AGE RANGE))
Replace FI(12) in the cohort logic with FI(12) or one of the terms for 
outside LDL which are included in FF14.
 
(((FI(1)&FF(1))!FI(2)!FI(3))&FF(4)&FI(33))!(FI(5)&FF(6)&FI(34))!
(FI(8)&FF(8))&'FI(7)&FI(12)
   
(((FI(1)&FF(1))!FI(2)!FI(3))&FF(4)&FI(33))!(FI(5)&FF(6)&FI(34))!
(FI(8)&FF( 8)) &'FI(7)&(FI(12)!FF(14))
 
 
 
Update 8 8/27/12
Change the dialog so that if the reminder is NOT due, no interpretation 
of the LDL values, statin status or diagnosis is included in the header 
informational text.  When the reminder was not due, that information was 
not always correct.
 
3.  Any entry of high risk for CVD entered as a health factor and 
linked to the CHD RISK>20% reminder term.  Sites that use a CHD 
 
calculator may have these patients designated and may want to include 
them in this lipid management reminder. 
 
!(FI(VA-CHD RISK >20%)&FF(8))
 
 
4. Exclude those with limited life expectancy - a national reminder term 
already exists for this.
 
&'FI(VA-LIFE EXPECTANCY <6 MONTHS)
1.  Diabetes - 2 diagnoses in the past 2 years, or a problem list 
 
 
The age range is set by using 2 function findings so that if there is a 
decision to use different age ranges for the different diagnoses, then 
this functionality is already available in the reminder and these ranges 
can be adjusted locally if needed.
 
 
5. Require an LDL done in the past 2 years - if not done, then the local 
site should have a reminder for doing a lipid panel on a regular basis 
entry, or a prescription of medication for diabetes that was active in the
and that needs to be done first.  Two years was chosen so that a recent 
lipid panel that was done but not done in the past 12 months, would still 
trigger the thought and assessment about statin use since this is the 
most important intervention and treating to goal is less critical.
 
 
Resolution logic:
1.    LDL - LDL<100 at the VA or LDL <100 outside the VA and this is 
         the most recent value (FF13)
         Compare date of FI(13) or FI(14) to any prior LDL that was over 
previous 9 months and the diagnosis or prescription is more recent than
             99 (Findings 15,17,18,19)
 
2.   Statin
  a.    High dose statin tablets prescribed - VA prescription FI(10).
  b.    Moderate dose statin - VA prescription for a moderate dose and 
         the tablets are not being split (FF11 compares the days supply to
         the quantity supplied and if there is a large discrepancy, tablet
         splitting is assumed.  FI(11)&FF(11).
  c.    Non-VA statin and the verification by staff using a health factor 
          that this is a moderate or high dose of a statin since the dose
any entry of an incorrect diagnosis (FF4).  And age is 50-75.
          of non-VA meds could not be evaluated by the reminder.  
          FI(27)&FI(24).
 
3.   Other action or documentation
  a.    FI(20): Add statin or adjust dose health factors, 2 months.
  b.    FI(21): Patient refusal, 2 months.
  c.    FI(22): Documentation of non-adherence, 2 months.
  d.    FI(23): Documentation that the patient is already on the highest
           tolerated dose, 1 year.
  e.    FI(25): Order for repeat LDL, T-14 days to T+ 2 months.
 
  f.    FI(26): Entry of a health factor indicating that a lipid profile 
           was ordered, 1 month.
  g.    (FI(29)&(FI(28)!FF(29))): Entry of a health factor indicating ADR 
           to all available statins FI(29) entered in the past 1 year
           (FF29) or the health factor plus an actual entry in the
           allergy/ADR list (FI28) ever. 
  h.    FI(30): Temporary contraindication to a statin (pregnancy),
           1 year.
 
Update 1  3/26/12
(((FI(VA-DIABETES HEDIS)&FF(1))!FI(VA-DIABETES HEDIS PROB 
   
Update 2  5/7/12
  Use RT.VA-LDL instead of VA-LDL 100-119 and VA-LDL >119 so that the 
     condition can have a +V>0 statement (ignore commented LDLs)
  Change print name
  Remove Finding 16 VA-LDL >119
  Add +V>0 to conditions and use in search set to Yes.
  Set begin date on FI12 to T-2Y and add to cohort logic
  Change frequency to 99Y - 1 year will not work since the reminder is 
     resolved by an LDL<100 - at 1 year, it would turn back on unless a
LIST)!FI(VA-DIABETES MEDICATIONS))&FF(4)&FI(VA-LDL DIABETES AGE RANGE))
     new LDL was done.
 
 
Update 3  5/23/12
  Update reminder dialog elements for life expectancy and declines statin 
       adjustment with better text 
  Rename dialog to match reminder (but without 'v1') 
  Text for dialog elements with orders as actions updated to 'see orders' 
  New health factors for declinations - no longer use the more generic HFs
       that were exported with the IHD QUERI reminders.

• REMINDER FREQUENCY:   99Y
  NO. OF AGE MATCH LINES:   0
  NO. OF AGE NO MATCH LINES:   0