eCQM Title

Difference in Median Time to Pain Medication Between Adult Patients With a Diagnosis of Sickle Cell Disease (SCD) With Vaso-Occlusive Episode (VOE) and Adult Patients with a Diagnosis of Renal Colic

CMS ID

eCQM Version Number

0.1.000

CBE Number

Not Applicable

GUID

c2a2a84b-2708-44c0-a866-b122b745678a

Measurement Period

January 1, 2026 through December 31, 2027

Measure Steward

American Society of Hematology

Measure Developer

Health Services Advisory Group

Endorsed By

None

Description

Difference in median time (in minutes) from Emergency Department (ED) arrival to initial administration of pain medication between adult patients with a principal diagnosis of sickle cell disease (SCD) with vaso-occlusive episode (VOE) and those with a principal diagnosis of renal colic

LOINC (R) copyright 2004-2024, Regenstrief Institute, Inc. SNOMED Clinical Terms (R) (SNOMED CT [R]) copyright 2004-2024, The International Health Terminology Standards Development Organisation (IHTSDO). ICD-10 is copyright 2024 World Health Organization. All Rights Reserved.

The copyrights in the Current Procedural Terminology (“CPT”) codes are owned by the American Medical Association (“AMA”). Copyright 2024 American Medical Association. All rights are reserved by the AMA. You cannot, without express written permission from the AMA, copy, modify, distribute, display, or use CPT for any commercial purpose, including for productive use in a clinical setting. Any such use requires a separate license from the AMA.

(R) or [R] represents Registered Trademark, and (c) represents Copyright.

Disclaimer

This measure, including specifications (“Measure”), is not a clinical guideline, does not establish a standard of medical care, and has not been tested for all potential applications. The Measure is not intended to diagnose or treat disease or other conditions. The Measure is not a medical device and has not been evaluated by the Food and Drug Administration. Information provided through the Measure is not intended to direct or substitute for the independent assessment or judgment of a qualified healthcare professional. The American Society of Hematology (“ASH”) assumes no liability for use of the Measure, or data contained or not contained in the Measure.

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USE OF THE MEASURE (INCLUDING ANY CPT CODES) IS AT YOUR SOLE RISK. THE MEASURE IS PROVIDED “AS IS” WITHOUT EXPRESS OR IMPLIED WARRANTIES OF ANY KIND, INCLUDING IMPLIED WARRANTIES OF MERCHANTABILITY, FITNESS FOR A PARTICULAR PURPOSE, OR NONINFRINGEMENT. ASH EXPRESSLY DISCLAIMS ANY AND ALL RESPONSIBILITY OR LIABILITY FOR DAMAGES OF ANY KIND ARISING OUT OF USE, REFERENCE TO, OR RELIANCE ON THE MEASURE.

Measure Scoring

Continuous Variable

Measure Type

Process

Stratification

None

Risk Adjustment

None

Rate Aggregation

This measure is intended to have one overall performance rate, which is the difference between the individual rates for each of the two populations.

Population 1: ED encounters that have a principal encounter diagnosis of SCD with VOE.

Population 2: ED encounters that have a principal encounter diagnosis of Renal Colic.

For the purposes of this measure, an overall performance rate can be calculated as follows:

Performance Rate = Median (Population 2 Observations) – Median (Population 1 Observations)

Rationale

Sickle Cell Disease (SCD) is the most common inherited blood disorder and is estimated to affect approximately 100,000 individuals in the United States (Hassell, 2010). SCD is also most prominent among Black or African American patients—affecting 1 out of 365 Black or African American births (Hassell, 2010)—and the average life expectancy of publicly insured individuals with SCD is reported to be approximately 52.6 years of age (Jiao et al., 2023). Based on a 2022 systematic review, total annual costs (medical and non-medical) were estimated to range from $14,012 to $80,842 per patient per year (Baldwin et al., 2022).

Evidence suggests that up to 60% of patients with SCD surveyed reported avoiding care in the ED (Crego et al., 2021). When they do seek emergency care due to an acute severe pain crisis, studies have shown patients wait an average of 90 minutes before analgesics are given (Tanabe, 2007; Lin, Strouse, Whiteman, Anders, & Stewart, 2016). Updated data from the National Hospital Ambulatory Medical Care Survey (NHAMCS) show that from 1999 to 2020, of the 222,612 estimated yearly average number of ED visits by patients with a diagnosis of SCD, three-fourths were due to a complaint of pain (Attell et al., 2024). Compared with prior estimates (1999-2007), the overall volume of ED visits has increased by nearly 13% (Attell et al., 2024). Individuals with SCD face health inequities stemming from socioeconomic factors, including disease stigma, racial prejudice, and lack of access to specialized care (Haywood et al., 2014; Pokhrel, Olayemi, Ogbonda, Nair, & Wang, 2023; Telfair, Haque, Etienne, Tang, & Strasser, 2003; Wahab et al., 2024). These inequities were demonstrated in a study of adult patients with acute pain from SCD and renal colic in an ED. This study showed that despite higher arrival pain scores and triage acuity levels in patients with SCD, SCD patients experienced longer time to initial analgesia when compared with renal colic patients (Lazio et al., 2010).

To promote rapid, effective, and safe analgesic management and resolution of VOE, the 2014 National Heart, Lung, and Blood Institute (NHLBI) Evidence-Based Management of Sickle Cell Disease Expert Panel Report recommends the use of an individualized prescribing and monitoring protocol or an SCD-specific protocol whenever possible (National Institutes of Health [NIH] & NHLBI, 2014). Individualized care plans, developed by the patient’s SCD clinician, are based on the patient’s home opioid consumption and effective dosing from previous ED visits. The plan is made available to ED clinicians via the electronic health record and provides direction on pain management. Individualized prescribing and monitoring protocols in patients with SCD have demonstrated decreased time to first opioid, shorter ED and hospital length of stay, and more rapid reduction in pain scores, when compared with weight-based dosing (Della-Moretta et al., 2020; Tanabe et al., 2023a; Tanabe et al., 2023b; Welch-Coltrane et al., 2021).

The implementation of this eCQM targeting timing to administration of pain medication for adult patients with SCD presenting to the ED may significantly improve pain management and other outcomes, including admission rates (Wachnik et al., 2022), hospital length of stay (Wachnik et al., 2022; Brandow et al., 2016; King, Albright, & Murry, 2023), length of ED stay (Lin et al., 2016; King et al., 2023; Mathias & McCavit, 2015), and patient satisfaction (Kim, Brathwaite, & Kim, 2017).

Renal colic serves as a clinically relevant comparator cohort for patients with SCD and VOE because both conditions are characterized by sudden onset of severe pain requiring urgent intervention. Both groups frequently report pain scores of 8 out of 10 or higher at triage, making this comparison valuable for assessing timeliness and equity in emergency pain management (Patrick, Rosenthal, Iezzi, & Brand, 2015). Additionally, renal colic patients have a similarly urgent need for treatment. The Emergency Severity Index (ESI) Handbook recommends assigning these patients the same triage level, stating, “Patients experiencing severe pain or distress as a result of a systemic disruption, for example, renal colic, cancer, or sickle cell crisis, should be triaged as ESI level 2, and placement should be facilitated as quickly as possible” (Emergency Nurses Association, 2023).

Typically caused by ureteral obstruction from kidney stones, renal colic presents abruptly with severe flank or abdominal pain that is often described as among the most intense types of acute pain encountered in clinical settings (Bultitude & Rees, 2012). Given the severity of renal colic, prompt and effective pain relief is a primary goal in the ED to alleviate patient suffering while awaiting definitive diagnosis or further treatment, reduce the risk of return ED visits, and avoid prolonged hospital stays (O'Connor, Schug, & Cardwell, 2000).

In the United States, renal colic accounts for an estimated 1 to 2 million ED visits annually, based on national data from 2011 and extrapolated estimates published through 2019. These visits are associated with significant healthcare expenditures, exceeding $10 billion annually (Schoenfeld et al., 2019). In the United States, the lifetime prevalence of kidney stones among adults has remained relatively stable over the past decade at around 9–10%, with a significant rise observed among women (Chen et al., 2025). Timely and effective pain control is a central objective in the emergency management of renal colic (Bultitude & Rees, 2012). Several meta-analyses and systematic reviews, including evidence-based clinical resource information on “acute pain control for renal colic,” recommend nonsteroidal anti-inflammatory drugs (NSAIDs) as a preferred initial treatment due to their demonstrated efficacy in reducing pain severity, lowering the need for rescue analgesia, and minimizing side effects such as nausea when compared to opioids (Afshar K, 2015; Bultitude & Rees, 2012; Holdgate & Pollock, 2004; Pathan, Mitra, & Cameron, 2018). When NSAIDs are contraindicated or insufficient, opioids remain an appropriate and effective option for achieving rapid pain control, particularly when tailored to the patient's clinical presentation. This treatment framework parallels that used in the treatment of severe acute pain, such as in patients with SCD and VOE, where both NSAIDs and opioids can be effective treatment options based on the patient’s individualized care plan. While no universal benchmark for analgesic timing exists for patients who present to the ED with symptoms of renal colic, expert recommendations support pain medication administration within 30 to 60 minutes of ED arrival to improve outcomes and patient experience (Fontenelle & Sarti, 2019; Patrick et al., 2015).

Clinical Recommendation Statement

The measure is supported by several clinical practice guidelines recommending rapid initiation of treatment with analgesia for patients with SCD and renal colic. The clinical recommendation statements from the supporting guidelines are noted below:

The American Society of Hematology 2020 guidelines for sickle cell disease: management of acute and chronic pain (Brandow et al., 2020)

Statement: Recommendation 1A - For adults and children with SCD presenting to an acute care setting with acute pain related to SCD, the ASH guideline panel recommends rapid (within 1 hour of emergency department [ED] arrival) assessment and administration of analgesia with frequent reassessments (every 30-60 minutes) to optimize pain control (strong recommendation based on low certainty in the evidence about effects).
The 2014 National Heart, Lung, and Blood Institute (NHLBI): Evidence-Based Management of Sickle Cell Disease Expert Panel Report (NIH & NHLBI, 2014)

Statement: In adults and children with SCD and a vaso-occlusive crisis (VOC):

a) Rapidly initiate treatment with parenteral opioids associated with severe pain (Strong Recommendation, High-Quality Evidence) OR

b) Rapidly initiate analgesic therapy within 30 minutes of triage or within 60 minutes of registration. (Consensus–Panel Expertise – Expert Opinion).
European Association of Urology: 2025 Guidelines on Urolithiasis (Skolarikos et al., 2025)

Statement: Relevant evidence and recommendations for the management of renal colic:

a) Offer a non-steroidal anti-inflammatory as the first drug of choice; depending on cardiovascular risk factors and side effects (Strong Recommendation, Grade 1b – Individual RCT with narrow confidence interval) OR

b) b) Offer opiates (hydromorphine, pentazocine or tramadol) as a second choice (Weak Recommendation, Grade 1b – Individual RCT with narrow confidence interval)

Improvement Notation

Decreased score indicates improvement -

This measure is intended to have one overall performance rate, which is the difference between the individual rates for each of the two populations. Having a decreased overall performance rate indicates less pain treatment delay for patients with SCD.

Reference

Reference Type: Citation

Reference Text:

Afshar K, J. S., Marks AJ, Eekhari A, MacNeily AE. (2015). Nonsteroidal anti-inflammatory drugs (NSAIDs) and non-opioids for acute renal colic. Cochrane Database of Systematic Reviews, 2015(6), CD006027. doi:10.1002/14651858.CD006027.pub2

Reference

Reference Type: Citation

Reference Text:

Attell, B. K., Barrett, P. M., Pace, B. S., McLemore, M. L., McGee, B. T., Oshe, R., . . . Snyder, A. B. (2024). Characteristics of emergency department visits made by individuals with sickle cell disease in the U.S., 1999-2020. AJPM Focus, 3(1), 100158. doi:10.1016/j.focus.2023.100158

Reference

Reference Type: Citation

Reference Text:

Baldwin, Z., Jiao, B., Basu, A., Roth, J., Bender, M. A., Elsisi, Z., . . . Devine, B. (2022). Medical and non-medical costs of sickle cell disease and treatments from a US perspective: A systematic review and landscape analysis. PharmacoEconomics Open, 6(4), 469-481. doi:10.1007/s41669-022-00330-w

Reference

Reference Type: Citation

Reference Text:

Brandow, A. M., Carroll, C. P., Creary, S., Edwards-Elliott, R., Glassberg, J., Hurley, R. W., . . . Lang, E. (2020). American Society of Hematology 2020 guidelines for sickle cell disease: management of acute and chronic pain. Blood Advances, 4(12), 2656-2701. doi:10.1182/bloodadvances.2020001851

Reference

Reference Type: Citation

Reference Text:

Brandow, A. M., Nimmer, M., Simmons, T., Charles Casper, T., Cook, L. J., Chumpitazi, C. E., . . . Brousseau, D. C. (2016). Impact of emergency department care on outcomes of acute pain events in children with sickle cell disease. American Journal of Hematology, 91(12), 1175-1180. doi:10.1002/ajh.24534

Reference

Reference Type: Citation

Reference Text: Bultitude, M., & Rees, J. (2012). Management of renal colic. BMJ: British Medical Journal, 345(7872), 30-35. doi:10.1136/bmj.e5499

Reference

Reference Type: Citation

Reference Text:

Chen, K. W., Meskawi, M., Miller, L. E., Bhattacharyya, S., Tailly, T., Chew, B. H., & Bhojanl, N. (2025). Trends in kidney stone prevalence among U.S. adults: A concerning contemporary gender analysis from the NHANES database. Canadian Urological Association Journal, 19(2), 58-60. doi:10.5489/cuaj.8935

Reference

Reference Type: Citation

Reference Text:

Crego, N., Masese, R., Bonnabeau, E., Douglas, C., Rains, G., Shah, N., & Tanabe, P. (2021). Patient perspectives of sickle cell management in the emergency department. Critical Care Nursing Quarterly, 44(2), 160-174. doi:10.1097/CNQ.0000000000000350

Reference

Reference Type: Citation

Reference Text:

Della-Moretta, S., Delatore, L., Purcell, M., Huang, Y., Heinlein, M., Adkins, E., & Desai, P. (2020). The effect of use of individualized pain plans in sickle cell patients presenting to the emergency department. Annals of Emergency Medicine, 76(3S), S21-S27. doi:10.1016/j.annemergmed.2020.08.008

Reference

Reference Type: Citation

Reference Text:

Emergency Nurses Association. (2023). Emergency Severity Index Handbook 5th Edition. Retrieved from Schaumburg, IL: https://media.emscimprovement.center/documents/Emergency_Severity_Index_Handbook.pdf

Reference

Reference Type: Citation

Reference Text:

Fontenelle, L. F., & Sarti, T. D. (2019). Kidney stones: Treatment and prevention. American Family Physician, 99(8), 490-496. Retrieved from https://www.aafp.org/pubs/afp/issues/2019/0415/p490.html

Reference

Reference Type: Citation

Reference Text:

Hassell, K. L. (2010). Population estimates of sickle cell disease in the U.S. American Journal of Preventive Medicine, 38, S512–S521. doi:10.1016/j.amepre.2009.12.022

Reference

Reference Type: Citation

Reference Text:

Haywood, C., Jr., Diener-West, M., Strouse, J., Carroll, C. P., Bediako, S., Lanzkron, S., . . . IMPORT Investigators. (2014). Perceived discrimination in health care is associated with a greater burden of pain in sickle cell disease. Journal of Pain and Symptom Management, 48(5), 934-943. doi:10.1016/j.jpainsymman.2014.02.002

Reference

Reference Type: Citation

Reference Text:

Holdgate, A., & Pollock, T. (2004). Systematic review of the relative efficacy of non-steroidal anti-inflammatory drugs and opioids in the treatment of acute renal colic. BMJ: British Medical Journal, 328(7453), 1401-1404. doi:10.1136/bmj.38119.581991.55

Reference

Reference Type: Citation

Reference Text:

Jiao, B., Johnson, K. M., Ramsey, S. D., Bender, M. A., Devine, B., & Basu, A. (2023). Long-term survival with sickle cell disease: a nationwide cohort study of Medicare and Medicaid beneficiaries. Blood Advances, 7(13), 3276-3283. doi:10.1182/bloodadvances.2022009202

Reference

Reference Type: Citation

Reference Text:

Kim, S., Brathwaite, R., & Kim, O. (2017). Evidence-based practice standard care for acute pain management in adults with sickle cell disease in an urgent care center. Quality Management in Health Care, 26(2), 108-115. doi:10.1097/QMH.0000000000000135

Reference

Reference Type: Citation

Reference Text:

King, H., Albright, A., & Murry, M. (2023). Delayed management of sickle cell disease vaso-occlusive episodes and the impact on prolonged hospitalizations at a single academic center. Blood, 142(Supplement 1), 7201. doi:10.1182/blood-2023-190385

Reference

Reference Type: Citation

Reference Text:

Lazio, M. P., Costello, H. H., Courtney, D. M., Martinovich, Z., Myers, R., Zosel, A., & Tanabe, P. (2010). A comparison of analgesic management for emergency department patients with sickle cell disease and renal colic. The Clinical Journal of Pain, 26(3), 199-205. doi:10.1097/AJP.0b013e3181bed10c

Reference

Reference Type: Citation

Reference Text:

Lin, S. M., Strouse, J. J., Whiteman, L. N., Anders, J., & Stewart, R. W. (2016). Improving quality of care for sickle cell patients in the pediatric emergency department. Pediatric Emergency Care, 32(1), 14-16. doi:10.1097/PEC.0000000000000369

Reference

Reference Type: Citation

Reference Text:

Mathias, M. D., & McCavit, T. L. (2015). Timing of opioid administration as a quality indicator for pain crises in sickle cell disease. Pediatrics, 135(3), 475-482. doi:10.1542/peds.2014-2874

Reference

Reference Type: Citation

Reference Text:

National Institutes of Health, & National Heart, Lung, and Blood Institute. (2014). Evidence-based Management of Sickle Cell Disease Expert Panel Report. Bethesda, MD. Retrieved from https://www.nhlbi.nih.gov/health-topics/evidence-based-management-sickle-cell-disease

Reference

Reference Type: Citation

Reference Text:

O'Connor, A., Schug, S. A., & Cardwell, H. (2000). A comparison of the efficacy and safety of morphine and pethidine as analgesia for suspected renal colic in the emergency setting. Journal of Accident & Emergency Medicine, 17(4), 261-264. doi:10.1136/emj.17.4.261

Reference

Reference Type: Citation

Reference Text:

Pathan, S. A., Mitra, B., & Cameron, P. A. (2018). A systematic review and meta-analysis comparing the efficacy of nonsteroidal anti-inflammatory drugs, opioids, and paracetamol in the treatment of acute renal colic. European Urology, 73(4), 583–595. doi:10.1016/j.eururo.2017.11.001

Reference

Reference Type: Citation

Reference Text:

Patrick, P. A., Rosenthal, B. M., Iezzi, C. A., & Brand, D. A. (2015). Timely pain management in the emergency department. Journal of Emergency Medicine, 48(3), 267-273. doi:10.1016/j.jemermed.2014.09.009

Reference

Reference Type: Citation

Reference Text:

Pokhrel, A., Olayemi, A., Ogbonda, S., Nair, K., & Wang, J. C. (2023). Racial and ethnic differences in sickle cell disease within the United States: From demographics to outcomes. European Journal Haematology, 110(5), 554-563. doi:10.1111/ejh.13936

Reference

Reference Type: Citation

Reference Text:

Schoenfeld, E. M., Shieh, M. S., Pekow, P. S., Scales, C. D., Jr., Munger, J. M., & Lindenauer, P. K. (2019). Association of patient and visit characteristics with rate and timing of urologic procedures for patients discharged from the emergency department with renal colic. JAMA Network Open, 2(12), e1916454. doi:10.1001/jamanetworkopen.2019.16454

Reference

Reference Type: Citation

Reference Text:

Skolarikos, A., Jung, H., Neisius, A., Petřík, A., Kamphuis, G. M., Davis, N. F., . . . Sayer, J. A. (2025). European Association of Urology (EAU) guidelines on urolithiasis. Retrieved from https://d56bochluxqnz.cloudfront.net/documents/full-guideline/EAU-Guidelines-on-Urolithiasis-2025.pdf

Reference

Reference Type: Citation

Reference Text:

Tanabe, P., Bosworth, H. B., Crawford, R. D., Glassberg, J., Miller, C. N., Paice, J. A., & Silva, S. (2023). Time to pain relief: A randomized controlled trial in the emergency department during vaso-occlusive episodes in sickle cell disease. European Journal of Haematology, 110(5), 518–526. doi:10.1111/ejh.13924

Reference

Reference Type: Citation

Reference Text:

Tanabe, P., Ibemere, S., Pierce, A. E., Freiermuth, C. E., Bosworth, H. B., Yang, H., . . . Barnhart, H. X. (2023). A comparison of the effect of patient-specific versus weight-based protocols to treat vaso-occlusive episodes in the emergency department. Academic Emergency Medicine, 30(12), 1210-1222. doi:10.1111/acem.14805

Reference

Reference Type: Citation

Reference Text:

Tanabe, P., Myers, R., Zosel, A., Brice, J., Ansari, A. H., Evans, J., . . . Paice, J. A. (2007). Emergency department management of acute pain episodes in sickle cell disease. Academic Emergency Medicine, 14(5), 419-425. doi:10.1197/j.aem.2006.11.033

Reference

Reference Type: Citation

Reference Text:

Telfair, J., Haque, A., Etienne, M., Tang, S., & Strasser, S. (2003). Rural/urban differences in access to and utilization of services among people in Alabama with sickle cell disease. Public Health Reports, 118(1), 27-36. doi:10.1093/phr/118.1.27

Reference

Reference Type: Citation

Reference Text:

Wachnik, A. A., Welch-Coltrane, J. L., Adams, M. C. B., Blumstein, H. A., Pariyadath, M., Robinson, S. G., . . . Hurley, R. W. (2022). A standardized emergency department order set decreases admission rates and in-patient length of stay for adults patients with sickle cell disease. Pain Medicine, 23(12), 2050-2060. doi:10.1093/pm/pnac096

Reference

Reference Type: Citation

Reference Text:

Wahab, S., Kelly, K., Klingler, M., Pirovic, A., Futch, K., Rennie, C., . . . Costin, J. M. (2024). Impact of race, socioeconomic status, and geography on healthcare outcomes for children with sickle cell disease in the United States: A scoping review. Cureus: Journal of Medical Science, 16(3), e56089. doi:10.7759/cureus.56089

Definition

A qualifying encounter is defined as an ED visit for adult patients for which the discharge time occurred during the two-year measurement period and the following criteria are met:

The ED visit requires a principal diagnosis of SCD with VOE or renal colic, and
The ED visit requires at least one qualifying pain medication administered during the ED encounter

Guidance

This eCQM is an episode-based measure. An episode is defined as a qualifying emergency department encounter that ends during the measurement period.

The measure uses a two-year measurement period from January 1, XXXX through December 31, XXXX.

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.

Transmission Format

TBD

Initial Population

ED encounters with a discharge time during the two-year measurement period for all patients aged 18 years or older at the start of the ED encounter, that meet criteria for one of the following:

Population 1: ED encounters that have a principal encounter diagnosis of SCD with VOE AND at least one qualifying pain medication administered during the ED encounter.

Population 2: ED encounters that have a principal encounter diagnosis of Renal Colic AND at least one qualifying pain medication administered during the ED encounter.

Measure Population

Equals Initial Population

Measure Population Exclusions

None

Measure Observations

Time (in minutes) from ED arrival to initial administration of pain medication

Supplemental Data Elements

For every patient evaluated by this measure also identify payer, race, ethnicity and sex

Population Criteria
Definitions
Functions
Terminology
Data Criteria (QDM Data Elements)
Supplemental Data Elements
Risk Adjustment Variables

Population Criteria

Population Criteria 1

Initial Population

  "Eligible Encounters With Principal Diagnosis Of SCD With VOE"

- Measure Population
  - "Initial Population 1"
- Measure Population Exclusions
  - None
- Stratification
  - None

Measure Observation

Median (
  duration in minutes of Interval[
    start of SCDwVOEEncounterWithPainMed.relevantPeriod, 
      Global.EarliestOf(
        FirstPainMedForSCD(SCDwVOEEncounterWithPainMed).relevantDatetime, 
        FirstPainMedForSCD(SCDwVOEEncounterWithPainMed).relevantPeriod 
      )
  ]
)

Population Criteria 2

Initial Population

  "Eligible Encounters With Principal Diagnosis Of Renal Colic"

- Measure Population
  - "Initial Population 2"
- Measure Population Exclusions
  - None
- Stratification
  - None

Measure Observation

Median (
  duration in minutes of Interval[
    start of RenalEncounterWithPainMed.relevantPeriod, 
      Global.EarliestOf(
        FirstPainMedForRenal(RenalEncounterWithPainMed).relevantDatetime, 
        FirstPainMedForRenal(RenalEncounterWithPainMed).relevantPeriod 
      )
  ]
)

Definitions

Eligible Encounters With Pain Medication

  ["Encounter, Performed": "Emergency Department Evaluation and Management Visit"] EDEncounter
    with ["Medication, Administered": "Analgesics for Acute Pain"] PainMed
      such that Global."EarliestOf"(PainMed.relevantDatetime, PainMed.relevantPeriod) 
        during EDEncounter.relevantPeriod
      and EDEncounter.relevantPeriod ends during day of "Measurement Period"
      and AgeInYearsAt(date from start of EDEncounter.relevantPeriod) >= 18

Eligible Encounters With Principal Diagnosis Of Renal Colic

  "Eligible Encounters With Pain Medication" EDEncounter
    with EDEncounter.diagnoses EncounterDiagnosis
      such that EncounterDiagnosis.code in "Renal Colic"
        and EncounterDiagnosis.rank = 1

Eligible Encounters With Principal Diagnosis Of SCD With VOE

  "Eligible Encounters With Pain Medication" EDEncounter
    with EDEncounter.diagnoses EncounterDiagnosis
      such that EncounterDiagnosis.code in "Sickle Cell Disease with Vaso Occlusive Episode"
        and EncounterDiagnosis.rank = 1

Initial Population 1

  "Eligible Encounters With Principal Diagnosis Of SCD With VOE"

Initial Population 2

  "Eligible Encounters With Principal Diagnosis Of Renal Colic"

Measure Population 1
- - "Initial Population 1"

Measure Population 2
- - "Initial Population 2"

SDE Ethnicity

    ["Patient Characteristic Ethnicity": "Ethnicity"]

SDE Payer

    ["Patient Characteristic Payer": "Payer Type"]

SDE Race

    ["Patient Characteristic Race": "Race"]

SDE Sex

    ["Patient Characteristic Sex": "Federal Administrative Sex"]

Functions

FirstPainMedForRenal(RenalEncounterWithPainMed "Encounter, Performed")

  First(["Medication, Administered": "Analgesics for Acute Pain"] PainMed
    where Global."EarliestOf"(PainMed.relevantDatetime, PainMed.relevantPeriod)
      during RenalEncounterWithPainMed.relevantPeriod
    sort by Global.EarliestOf(relevantDatetime, relevantPeriod)
  )

FirstPainMedForSCD(SCDwVOEEncounterWithPainMed "Encounter, Performed")

  First(["Medication, Administered": "Analgesics for Acute Pain"] PainMed
    where Global."EarliestOf"(PainMed.relevantDatetime, PainMed.relevantPeriod)
      during SCDwVOEEncounterWithPainMed.relevantPeriod
    sort by Global.EarliestOf(relevantDatetime, relevantPeriod)
  )

Global.Earliest(period Interval<DateTime>)

  if ( HasStart(period)) then start of period 
    else 
  end of period

Global.EarliestOf(pointInTime DateTime, period Interval<DateTime>)
- - Earliest(NormalizeInterval(pointInTime, period))

Global.HasStart(period Interval<DateTime>)

  not ( start of period is null
      or start of period = minimum DateTime
  )

Global.NormalizeInterval(pointInTime DateTime, period Interval<DateTime>)

  if pointInTime is not null then Interval[pointInTime, pointInTime]
    else if period is not null then period 
    else null as Interval<DateTime>

Observation1(SCDwVOEEncounterWithPainMed "Encounter, Performed")

  duration in minutes of Interval[
    start of SCDwVOEEncounterWithPainMed.relevantPeriod, 
      Global.EarliestOf(
        FirstPainMedForSCD(SCDwVOEEncounterWithPainMed).relevantDatetime, 
        FirstPainMedForSCD(SCDwVOEEncounterWithPainMed).relevantPeriod 
      )
  ]

Observation2(RenalEncounterWithPainMed "Encounter, Performed")

  duration in minutes of Interval[
    start of RenalEncounterWithPainMed.relevantPeriod, 
      Global.EarliestOf(
        FirstPainMedForRenal(RenalEncounterWithPainMed).relevantDatetime, 
        FirstPainMedForRenal(RenalEncounterWithPainMed).relevantPeriod 
      )
  ]

Terminology

valueset "Analgesics for Acute Pain" (2.16.840.1.113762.1.4.1160.43)
valueset "Emergency Department Evaluation and Management Visit" (2.16.840.1.113883.3.464.1003.101.12.1010)
valueset "Ethnicity" (2.16.840.1.114222.4.11.837)
valueset "Federal Administrative Sex" (2.16.840.1.113762.1.4.1021.121)
valueset "Payer Type" (2.16.840.1.114222.4.11.3591)
valueset "Race" (2.16.840.1.114222.4.11.836)
valueset "Renal Colic" (2.16.840.1.113762.1.4.1160.86)
valueset "Sickle Cell Disease with Vaso Occlusive Episode" (2.16.840.1.113762.1.4.1160.42)

Data Criteria (QDM Data Elements)

"Encounter, Performed: Emergency Department Evaluation and Management Visit" using "Emergency Department Evaluation and Management Visit (2.16.840.1.113883.3.464.1003.101.12.1010)"
"Medication, Administered: Analgesics for Acute Pain" using "Analgesics for Acute Pain (2.16.840.1.113762.1.4.1160.43)"
"Patient Characteristic Ethnicity: Ethnicity" using "Ethnicity (2.16.840.1.114222.4.11.837)"
"Patient Characteristic Payer: Payer Type" using "Payer Type (2.16.840.1.114222.4.11.3591)"
"Patient Characteristic Race: Race" using "Race (2.16.840.1.114222.4.11.836)"
"Patient Characteristic Sex: Federal Administrative Sex" using "Federal Administrative Sex (2.16.840.1.113762.1.4.1021.121)"

Supplemental Data Elements

SDE Ethnicity

    ["Patient Characteristic Ethnicity": "Ethnicity"]

SDE Payer

    ["Patient Characteristic Payer": "Payer Type"]

SDE Race

    ["Patient Characteristic Race": "Race"]

SDE Sex

    ["Patient Characteristic Sex": "Federal Administrative Sex"]

Risk Adjustment Variables

None

Measure Set

None