Supplemental Appendix 1



Supplemental Appendix 1Topic descriptions1-9 [OHSU]Topic 1 (OHSU): Pregnant women w/o psychiatric disorderWomen who have had a pregnancy when 18 years old or older, and during which they did not smoke, had an outpatient visit in the 3rd trimester (pregnancy at 27 weeks or more), and didn’t have severe intellectual disabilities, bipolar I disorder, manic disorder, major depressive disorder, schizophrenia, autism spectrum disorder, or attention deficit hyperactivity disorder.Women who had a pregnancy during which they had a 3rd trimester outpatient visit, didn’t smoke, and didn’t have intellectual disability, mood disorder, schizophrenia, autism, or ADHD.A 32-year-old woman was seen for a prenatal visit with her nurse midwife in 2012. At that visit, her pregnancy was at 34 weeks, and she had no pregnancy complications, and no past medical or surgical history. She is a former smoker, but had quit 6 months prior to this pregnancy.Women who had a pregnancy during which they had a 3rd trimester outpatient visit, didn’t smoke, and didn’t have intellectual disability, mood disorder, schizophrenia, autism, or ADHD.Demographics inclusionAge at time of pregnancy: ≥ 18 yearsSex: FemaleEncounter inclusionOutpatient encounter date: during 3rd trimester of pregnancyDiagnosis inclusionPregnancyDiagnosis exclusionSevere learning disability (ICD-9): 318.1, 319Bipolar I disorder (ICD-9): 296.0, 296.00, 296.01, 296.02, 296.03, 296.04, 296.05, 296.06, 296.4, 296.40, 296.41, 296.42, 296.43, 296.44, 296.45, 296.46, 296.5, 296.50, 296.51, 296.52, 296.53, 296.54, 296.55, 296.56, 296.6, 296.60, 296.61, 296.62, 296.63, 296.64, 296.65, 296.66, 296.6, 296.7, 296.8, 296.80, 296.89Manic disorder (ICD-9): 296.1, 296.10, 296.11, 296.12, 296.13, 296.14, 296.15, 296.16, 296.81Major depressive disorder (ICD-9): 296.2, 296.20, 296.21, 296.22, 296.23, 296.24, 296.25, 296.26, 296.3, 296.30, 296.31, 296.32, 296.33, 296.34, 296.35, 296.36, 296.82Schizophrenia (ICD-9): 295, 295.0, 295.00, 295.01, 295.02, 295.03, 295.04, 295.05, 295.1, 295.10, 295.11, 295.12, 295.13, 295.14, 295.15, 295.2, 295.20, 295.21, 295.22, 295.23, 295.24, 295.25, 295.3, 295.30, 295.31, 295.32, 295.33, 295.34, 295.35, 295.4, 295.40, 295.41, 295.42, 295.43, 295.44, 295.45, 295.4, 295.5, 295.50, 295.51, 295.52, 295.53, 295.54, 295.55, 295.5, 295.6, 295.60, 295.61, 295.62, 295.63, 295.64, 295.65, 295.7, 295.70, 295.71, 295.72, 295.73, 295.74, 295.75, 295.8, 295.80, 295.81, 295.82, 295.83, 295.84, 295.85, 295.9, 295.90, 295.91, 295.92, 295.93, 295.94, 295.95Autism spectrum disorder (ICD-9): 299.0, 299.00, 299.01Attention deficit hyperactivity disorder (ICD-9): 314.0, 314.00, 314.01, 799.51Tobacco use exclusionTobacco use during pregnancyTobacco use disorder (ICD-9): 305.1Tobacco use disorder complicating pregnancy (ICD-9): 649.0, 649.00, 649.01, 649.02, 649.03, 649.04Topic 2 (OHSU): Adults with IBD who haven’t had GI surgeryAdults with inflammatory bowel disease (ulcerative colitis or Crohn’s disease), who have not had surgery of the intestines, rectum, or anus entailing excision, ostomy creation, repair of rectal prolapse or anal fistula, or stricturoplasty.Adults with inflammatory bowel disease who haven’t had surgery involving the small intestine, colon, rectum, or anus.A 22-year-old woman with Crohn’s disease is seen for follow up. She began maintenance therapy 6 weeks ago and has no new signs or symptoms of relapse. Her Crohn’s disease involves both the distal ileus and colon, and she has never undergone gastrointestinal surgery.Adults with inflammatory bowel disease who haven’t had surgery involving the small intestine, colon, rectum, or anus.Demographics inclusionAge: ≥ 18 yearsDiagnosis inclusionInflammatory bowel diseaseUlcerative colitis (ICD-9): 556, 556.0, 556.1, 556.2, 556.3, 556.4, 556.5, 556.6, 556.7, 556.8, 556.9Crohn’s disease (regional enteritis) (ICD-9): 555, 555.0, 555.1, 555.2, 555.9Other noninfectious gastroenteritis and colitis (ICD-9): 558.9Surgery exclusionColectomy (CPT): 44140, 44141, 44143, 44144, 44145, 44146, 44147, 44160, 44204, 44205, 44206, 44207, 44208, 44150, 44151, 44155, 44156, 44157, 44158, 44210, 44212, 44211Enterectomy (CPT): 44120, 44121, 44125, 44202, 44203Intestinal ostomy creation (CPT): 44310, 44316, 44187, 44320, 44322, 44188Proctoplasty or proctopexy (CPT): 45500, 45505, 45540, 45541, 45550, 45400, 45402Stricturoplasty (CPT): 44615, 45150, 46700Anal fistula surgery (CPT): 46270, 46275, 46280, 46285, 46288Topic 3 (OHSU): Adults with a Vitamin D lab resultAdults who have a resulted lab for serum Vitamin D measured as the 25-hydroxy form, and which was drawn between May 15 and October 15 of any year.Adults with a lab result for 25-hydroxy Vitamin D collected between May 15 and October 15.A 47-year-old male presents following a Roux-en-Y gastric bypass surgery performed 3 months ago. He is following the post-surgery recommended diet, but admits he isn’t taking a multivitamin or other supplements as advised. Due to his high risk of deficiency, the physician checks his Vitamin D level through a serum 25(OH)D lab test, which measures the 25-hydroxy form of Vitamin D. The lab result shows a level of 18 ng/mL, confirming deficiency.Adults with a lab result for 25-hydroxy Vitamin D collected between May 15 and October 15.Demographics inclusionAge: ≥ 18 yearsLab inclusion25-hydroxy Vitamin D (CPT): 82306Date collected: May 15 through October 15Topic 4 (OHSU): Postherpetic neuralgia treated with topical and systemic medicationPatients 18-90 years old with postherpetic neuralgia who have been treated with concurrent use of both topical medication, lidocaine or capsaicin, and non-opioid systemic medication, gabapentin, pregabalin, amitriptyline, or nortriptyline.Adults with postherpetic neuralgia ever treated by concurrent use of topical and non-opioid systemic medications.An adult male presents with neuropathic pain after a recent herpes zoster outbreak, limited to the area previously affected by zoster rash. The physician prescribes both oral amitriptyline and topical capsaicin cream for treatment of postherpetic neuralgia.Adults with postherpetic neuralgia ever treated by concurrent use of topical and non-opioid systemic medications.Demographics inclusionAge: 18-90 yearsDiagnosis inclusionPostherpetic neuralgia (ICD-9): 053.10, 053.13, 053.19Medication inclusionConcurrent use of a topical medication and a non-opioid systemic medicationTopical medicationLidocaine patch (Lidoderm)Capsaicin cream or patch (Trixaicin, Zostrix, Qutenza)Systemic medication (non-opioid)AmitriptylineNortriptyline (Pamelor)Gabapentin (Neurontin, Gralise)Pregabalin (Lyrica)Topic 5 (OHSU): Children seen in ED with oral painChildren who have been seen in the emergency department for oropharyngeal pain due to herpetic gingivostomatitis, herpangina, hand, foot, and mouth disease, tonsillitis, gingivitis, or oral ulcers (oral aphthae, stomatitis, or mucositis) that isn’t due to chemotherapy or radiation, and who were 1 month to 8 years old as of that visit date.Children who were seen in the emergency department with herpetic gingivostomatitis, herpangina or hand, foot, and mouth disease, tonsillitis, gingivitis, or ulceration (aphthae, stomatitis, or mucositis) not due to chemotherapy or radiation.A 5-year-old boy is brought to the emergency department complaining of sore throat and headache for 2 days. His parents report he has severe pain with eating, but is drinking fluids, and deny any recent rashes. He has no other medical problems. On exam, he is febrile and several small vesicles and ulcers with an erythematous base are present on the tonsils and soft palate. He is diagnosed with herpangina and discharged home with instructions for supportive care.Children who were seen in the emergency department with herpetic gingivostomatitis, coxsackie infection, tonsillitis, gingivitis, or ulceration (aphthae, stomatitis, or mucositis) not due to chemotherapy or radiation.Demographics inclusionAge on date of visit: 1 month to 8 yearsEncounter inclusionVisit type: emergency departmentDiagnosis inclusionHerpetic gingivostomatitis (ICD-9): 054.2Hand, foot, and mouth disease (ICD-9): 074.3Herpangina (ICD-9): 074.0Acute tonsillitis (ICD-9): 463Acute gingivitis (ICD-9): 523.0, 523.00, 523.01Stomatitis or mucositis, not due to chemotherapy or radiation (ICD-9): 528.00, 528.02Oral aphthae (ICD-9): 528.2Topic 6 (OHSU): 3rd trimester prenatal visit with midwife or Ob/GynAdult women who have had a pregnancy during which they had an outpatient prenatal visit with an obstetrician and gynecologist or nurse midwife during their 3rd trimester (pregnancy at 27 weeks or greater).Women who had a pregnancy with a 3rd trimester outpatient prenatal visit with an obstetrician and gynecologist or midwife.A 29-year-old female G2P2 is 2 weeks post-partum following NSVD. Her last clinic visit was for prenatal care at 37w6d of pregnancy with a certified nurse midwife.Women who had a pregnancy with a 3rd trimester outpatient prenatal visit with an obstetrician and gynecologist or midwife.Demographics inclusionSex: FemaleAge: ≥ 18 yearsEncounter inclusionOutpatientVisit type: prenatalVisit date: during patient’s 3rd trimester of pregnancyVisit providerNurse midwifeObstetrician and gynecologistDiagnosis inclusionPregnancy in 3rd trimester (week 27 or greater)Topic 7 (OHSU): Hereditary hemorrhagic telangiectasiaAdults 18-100 years old who have a diagnosis of hereditary hemorrhagic telangiectasia (HHT), which is also called Osler-Weber-Rendu syndrome.Adults 18-100 years old with hereditary hemorrhagic telangiectasia (HHT).A 23-year-old male presents with fatigue and frequent nosebleeds, which began in childhood. Exam shows pale skin and conjunctiva, and scattered telangiectasias on his trunk, extremities, and buccal mucosa. He has a family history of recurrent epistaxis and deaths due to stroke. Further tests show iron-deficient anemia and pulmonary arteriovenous malformations, confirming a diagnosis of hereditary hemorrhagic telangiectasia.Adults 18-100 years old with hereditary hemorrhagic telangiectasia (HHT).Demographics inclusionAge: 18-100 yearsDiagnosis inclusionHereditary hemorrhagic telangiectasia (ICD-9): 448.0Topic 8 (OHSU): Breast cancer and high risk of BRCA mutationWomen who were ever considered at high risk of having a BRCA gene mutation based on diagnosis of any breast cancer before age 50, or triple-negative (estrogen receptor negative, progesterone receptor negative, HER2/neu negative) breast cancer before age 60.Women who have been diagnosed with breast cancer before age 50 or with triple-negative breast cancer before age 60.A 55-year-old female with breast cancer presents to discuss her pathology results. The report identifies the tumor as ER-, PR-, and HER2 normal. Based on her age and triple-negative biomarkers, she has a high risk of harboring a BRCA mutation and decides to proceed with genetic counseling.Women who have been diagnosed with breast cancer before age 50 or with triple-negative breast cancer before age 60.Demographics inclusionSex: FemaleAge: ≥ 18 yearsAge at time of breast cancer diagnosis: < 50 years Age at time of triple-negative breast cancer diagnosis: < 60 yearsDiagnosis inclusionBreast cancer (ICD-9): 174, 174.0, 174.1, 174.2, 174.3, 174.4, 174.5, 174.6, 174.8, 174.9Early-onset breast cancerTriple-negative breast cancer (estrogen receptor negative, progesterone receptor negative, HER2/neu negative)Topic 9 (OHSU): Children with focal epilepsy with partial seizuresChildren with localization-related (focal) epilepsy with simple or complex partial seizures diagnosed before 4 years old who have had an outpatient neurology visit.Children seen by outpatient neurology who had focal epilepsy with partial seizures diagnosed before age 4.A 3-year-old girl presents to neurology clinic for evaluation of seizures. She had her 2nd seizure 5 days ago, which resolved spontaneously. Her previous seizure was 6 months ago. The episodes involved loss of consciousness and lip smacking, followed by period of confusion, indicating complex partial seizures. She had no provoking factors such as fever, illness, or trauma. An interictal EEG was consistent with localization-related epilepsy and she is started on antiepileptic treatment. Children seen by outpatient neurology who had focal epilepsy with partial seizures diagnosed before age 4.Demographics inclusionAge: < 18 yearsAge at epilepsy diagnosis: < 4 yearsEncounter inclusionOutpatientSpecialty: neurologyDiagnosis inclusionLocalization-related (focal) epilepsy with partial seizures (ICD9): 345.40, 345.41, 345.50, 345.51, 780.3910-19 [OHSU]Topic 10 (OHSU): Non-smokers with CAD and no DMPatients 50-70 years old with coronary artery disease (CAD), who don’t have Diabetes Mellitus Type 1 or Type 2, are not current smokers, and have had an outpatient cardiology visit.Patients ages 50-70 with coronary artery disease who don’t have diabetes or currently smoke, and have had an outpatient cardiology visit.A 59-year-old obese male is seen in cardiology clinic due to a recent diagnosis of stable angina. He confirms diagnoses of hypertension and hyperlipidemia, but denies diabetes. He quit smoking 5 years ago. Initial presentation to primary care doctor was for chest pain provoked with exertion and relieved with rest, and he underwent an exercise EKG stress test. Review of those results confirms myocardial ischemia and coronary artery disease. Patients ages 50-70 with coronary artery disease who don’t have diabetes or currently smoke, and have had an outpatient cardiology visit.Demographics inclusionAge: 50-70 yearsEncounter inclusionOutpatientSpecialty: cardiologyDiagnosis inclusionCoronary artery diseaseAcute myocardial infarction (ICD-9): 410, 410.0, 410.00, 410.01, 410.02, 410.2, 410.20, 410.21, 410.22, 410.3, 410.30, 410.31, 410.32, 410.4, 410.40, 410.41, 410.42, 410.5, 410.50, 410.51, 410.52, 410.6, 410.60, 410.61, 410.62, 410.7, 410.70, 410.71, 410.72, 410.8, 410.80, 410.81, 410.82, 410.9, 410.90, 410.91, 410.92Other acute ischemic heart disease (ICD-9): 411, 411.0, 411.1, 411.8, 411.81, 411.89Old myocardial infarction (ICD-9): 412Angina pectoris (ICD-9): 413, 413.0, 413.1, 413.9Coronary atherosclerosis (ICD-9): 414.0, 414.00, 414.01, 414.02, 414.03, 414.04, 414.05, 414.06, 414.07, 414.3, 414.4Coronary aneurysm or dissection (ICD-9): 414.1, 414.10, 414.11, 414.12, 414.19Other chronic ischemic heart disease (ICD-9): 414.2, 414.8, 414.9Tobacco use exclusionCurrent smokerDiagnosis exclusionDiabetes mellitus, type I or type II (ICD-9): 250, 250.0, 250.00, 250.01, 250.02, 250.03, 250.1, 250.10, 250.11, 250.12, 250.13, 250.2, 250.20, 250.21, 250.22, 250.23, 250.3, 250.30, 250.31, 250.32, 250.33, 250.4, 250.40, 250.41, 250.42, 250.43, 250.5, 250.50, 250.51, 250.52, 250.53, 250.6, 250.60, 250.61, 250.62, 250.63, 250.7, 250.70, 250.71, 250.72, 250.73, 250.8, 250.80, 250.81, 250.82, 250.83, 250.9, 250.90, 250.91, 250.92, 250.93Topic 11 (OHSU): Pregnancy with preterm deliveryWomen 18-55 years old who have had a singleton pregnancy with preterm delivery (delivery before 37 weeks gestational age), and in which there were no major fetal anomalies.Women who had a singleton pregnancy without major fetal anomalies ending in preterm delivery.A 33-year-old G1P1 female is discharged from labor and delivery following preterm delivery at 36w3d of a healthy baby girl. Her pregnancy had been an uncomplicated singleton pregnancy without any suspected fetal anomalies.Women who had a singleton pregnancy without major fetal anomalies ending in preterm delivery.Demographics inclusionSex: FemaleAge: 18-55 yearsDiagnosis inclusionPregnancy (ICD-9): V22, V22.0, V22.1, V22.2, V23, V23.0, V23.1, V23.2, V23.3, V23.4, V23.41, V23.42, V23.49, V23.5, V23.7, V23.8, V23.81, V23.82, V23.83, V23.84, V23.85, V23.86, V23.87, V23.89, V23.9Preterm delivery (GA < 37 weeks) (ICD-9): 644.2, 644.20, 644.21Diagnosis exclusionMultiples pregnancyTwin (ICD-9): V91.0, V91.00, V91.01, V91.02, V91.03, V91.09, 651.0, 651.00, 651.01, 651.03, 651.3, 651.30, 651.31, 651.33Triplet (ICD-9): V91.1, V91.10, V91.11, V91.12, V91.19, 651.1, 651.10, 651.11, 651.13, 651.4, 651.40, 651.41, 651.43Quadruplet (ICD-9): V91.2, V91.20, V91.21, V91.22, V91.29, 651.2, 651.20, 651.21, 651.23, 651.5, 651.50, 651.51, 651.53Other (ICD-9): V91.9, V91.90, V91.91, V91.92, V91.99, 651.6, 651.60, 651.61, 651.63, 651.7, 651.70, 651.71, 651.73, 651.8, 651.80, 651.81, 651.83, 651.9, 651.90, 651.91, 651.93Major fetal anomalyCNS malformation (ICD-9): 655.0, 655.00, 655.01, 655.03Chromosomal (ICD-9): 655.1, 655.10, 655.11, 655.13Suspected damage due to disease in mother (ICD-9): 655.3, 655.30, 655.31, 655.33, 655.4, 655.40, 655.41, 655.43Suspected damage from drugs or radiation (ICD-9): 655.5, 655.50, 655.51, 655.53, 655.6, 655.60, 655.61, 655.63Topic 12 (OHSU): Children with autismChildren 6-11 years old with autism who don’t have any of these neurodevelopmental disorders: cerebral palsy, Down’s syndrome, Smith-Lemli-Opitz syndrome, Neurofibromatosis, Tuberous sclerosis, or Rett syndrome.Children 6-11 years old with autism and not cerebral palsy, Down’s syndrome, Smith-Lemli-Opitz syndrome, Neurofibromatosis, Tuberous sclerosis, or Rett syndrome.A 7-year-old female with autism presents for continuing care at an autism clinic. She continues to have difficulty understanding social cues, doesn’t display emotion, and avoids loud music, and experiences difficulty with any changes in her environment or schedule. Therapy at the autism clinic incorporates behavioral interventions and includes the involvement of her parents.Children 6-11 years old with autism and not cerebral palsy, Down’s syndrome, Smith-Lemli-Opitz syndrome, Neurofibromatosis, Tuberous sclerosis, or Rett syndrome.Demographics inclusionAge: 6-11 yearsDiagnosis inclusionAutism (ICD-9): 299.0, 299.00, 299.01, 299.8, 299.80, 299.81, 299.9, 299.90, 299.91Diagnosis exclusionCerebral palsy (ICD-9): 343, 343.0, 343.1, 343.2, 343.3, 343.4, 343.8, 343.9Down’s syndrome (ICD-9): 758.0Smith-Lemli-Opitz syndrome (ICD-9): 758.89Neurofibromatosis (ICD-9): 237.7, 237.70, 237.71, 237.72, 237.73, 237.79Tuberous sclerosis (ICD-9): 759.5Rett syndrome (ICD-9): 330.8Topic 13 (OHSU): Renal impairment and daptomycinAdults who have had a hospitalization during which they were treated with daptomycin for at least 3 days and had renal impairment with a serum creatinine of ≥ 1.7 mg/dL.Adults who had a creatinine ≥ 1.7 mg/dL and at least 3 days of daptomycin treatment during the same hospitalization.A 62-year-old woman admitted 9 days ago for endocarditis due to MRSA is on day 7 of IV daptomycin treatment. Review of an a.m. CMP shows a creatinine of 2.6 mg/dL, up from 1.4 mg/dL on admission labs.Adults who had a creatinine ≥ 1.7 mg/dL and at least 3 days of daptomycin treatment during the same hospitalization.Demographics inclusionAge: ≥ 18 yearsEncounter inclusionInpatientDaptomycin use and elevated creatinine in same hospitalizationMedication inclusionDaptomycin (Cubicin)Duration of use: ≥ 3 daysLab inclusionSerum creatinine ≥ 1.7 mg/dLTopic 14 (OHSU): Adults with cardiac arrest and CPR who died in ICUDeceased adults who expired while in the intensive care unit and had cardiac arrest with cardiopulmonary resuscitation during the same hospitalization.Adults who expired in the ICU and had cardiac arrest and CPR during that hospitalization.A 79-year-old woman is being treated in the intensive care unit for pulmonary embolism. She becomes hemodynamically unstable and goes into cardiac arrest. After prolonged cardiopulmonary resuscitation following the ACLS protocol, there is still no return of spontaneous circulation. Resuscitative attempts are stopped and the patient is pronounced dead.Adults who expired in the ICU and had cardiac arrest and CPR during that hospitalization.Demographics inclusionAge at death: ≥ 18 yearsVital status: DeceasedEncounter inclusionDeath, cardiac arrest, and CPR during the same hospitalizationDischarged from intensive care unit (ICU)Discharge disposition: ExpiredDiagnosis inclusionCardiac arrest (ICD-9): 427.5Procedure inclusionCardiopulmonary resuscitation (CPR)Topic 15 (OHSU): Rheumatoid arthritis and positive anti-CCPAdults 18-64 years old with rheumatoid arthritis who have had a lab test for cyclic citrullinated peptide IgG antibody with a result greater than 40 units.Adults 18-64 years old with rheumatoid arthritis and lab result for positive anti-CCP IgG > 40 units.A 58-year-old female presents with morning stiffness and joint pain in her hands, especially her fingers, which improves after about 30 minutes, but doesn’t remit fully. On examination she is found to have ulnar deviation, decreased grip strength, and joint tenderness over the MCP and PIP joints. She has a positive rheumatoid factor and is positive for anti-CCP Ab at 45 units.Adults 18-64 years old with rheumatoid arthritis and lab result for positive anti-CCP IgG > 40 units.Demographics inclusionAge: 18-64 yearsDiagnosis inclusionRheumatoid arthritis (ICD-9): 714.0Lab inclusionCyclic citrullinated peptide IgG antibody (anti-CCP IgG): > 40 unitsTopic 16 (OHSU): Gestational anemia and postpartum hemorrhageWomen who have had a pregnancy complicated by gestational anemia and immediate or delayed postpartum hemorrhage.Women who have had a pregnancy with gestational anemia and postpartum hemorrhage.A 26-year-old G2P1 female at 38w1d with pregnancy complicated by gestational anemia presents in labor. After a prolonged labor, she delivers a baby girl vaginally but continues to bleed despite uterine massage. Additional uterotonics and brief tamponade of the uterus stops the hemorrhage, with an estimated blood loss of 850 mL.Women who have had a pregnancy with gestational anemia and postpartum hemorrhage.Demographics inclusionSex: FemaleAge: ≥ 18 yearsDiagnosis inclusionPregnancyGestational anemia (ICD-9): 648.2, 648.20, 648.21, 648.22, 648.23, 648.24Postpartum hemorrhage, immediate or delayed (ICD-9): 666.0, 666.00, 666.02, 666.04, 666.1, 666.10, 666.12, 666.14, 666.2, 666.20, 666.22, 666.24Topic 17 (OHSU): RA on MTX w/o biologic DMARDAdults 18-70 years old with rheumatoid arthritis currently treated with methotrexate who have never used a biologic disease-modifying antirheumatic drug (DMARD).Adults ages 18-70 with rheumatoid arthritis taking methotrexate who have never been on a biologic DMARD.A 65-year-old male with rheumatoid arthritis is followed at the rheumatology clinic. He was diagnosed with RA 2 years ago, and is responding to ongoing treatment with methotrexate without requiring any biologic DMARD therapy.Adults ages 18-70 with rheumatoid arthritis taking methotrexate who have never been on a biologic DMARD.Demographics inclusionAge: 18-70 yearsDiagnosis inclusionRheumatoid arthritis (ICD-9): 714.0Medication inclusionMethotrexate (Rheumatrex, Otrexup, Rasuvo, Trexall)Medication exclusionBiologic disease-modifying antirheumatic drugTNFi biologic DMARDAdalimumab (Humira)Certolizumab (Cimzia)Etanercept (Enbrel)Golimumab (Simponi)Infliximab (Remicade)Non-TNF biologic DMARDAbatacept (Orencia)Rituximab (Rituxan)Anakinra (Kineret)Topic 18 (OHSU): RA on conventional DMARD w/o hepatitisAdults 18-80 years old with rheumatoid arthritis diagnosed at least 6 months ago, who have never had hepatitis B or C, and are currently on conventional disease-modifying antirheumatic drug monotherapy with methotrexate, sulfasalazine, hydroxychloroquine, or leflunomide.Adults ages 18-80 with rheumatoid arthritis, who have never had hepatitis B or C, and are on monotherapy with a conventional DMARD.A 72-year-old male with a 3-year history of rheumatoid arthritis is currently on monotherapy with methotrexate. Prior to DMARD treatment he was tested for HBV and HCV, which were negative.Adults ages 18-80 with rheumatoid arthritis, who have never had hepatitis B or C, and are on monotherapy with a conventional DMARD.Demographics inclusionAge: 18-80 yearsDiagnosis inclusionRheumatoid arthritis (ICD-9): 714.0Diagnosis date: ≥ 6 months agoMedication inclusionCurrent treatment with one conventional DMARD:Methotrexate (Rheumatrex, Otrexup, Rasuvo, Trexall)Sulfasalazine (Azulfidine)Hydroxychloroquine (Plaquenil)Leflunomide (Arava)Diagnosis exclusionHepatitis B (HBV)Hepatitis C (HCV)Topic 19 (OHSU): Children taking an understudied drugPatients younger than 20 years old taking at least one of these understudied drugs: clonidine, doxycycline, granisetron, griseofulvin, hydrochlorothiazide, metoclopramide, ondansetron, pravastatin, or simvastatin; which was ordered as outpatient treatment in an oral form.Patients under age 20 on outpatient treatment with clonidine, doxycycline, granisetron, griseofulvin, hydrochlorothiazide, metoclopramide, ondansetron, pravastatin, or simvastatin, taken orally.A 16-year-old male with nephrogenic diabetes insipidus is seen for routine follow-up in nephrology. He has no new problems, and is continued on his current regimen with 25mg hydrochlorothiazide daily by mouth, frequent voiding, and a low-sodium diet.Patients under 20 on outpatient treatment with clonidine, doxycycline, granisetron, griseofulvin, hydrochlorothiazide, metoclopramide, ondansetron, pravastatin, or simvastatin, taken orally.Demographics inclusionAge: < 20 yearsMedication inclusionRoute of administration: oral, buccal, sublingualOutpatient medicationCurrent use of medicationUnderstudied drugsClonidine (Catapres, Duraclon, Jenloga, Kapvay)Doxycycline (Acticlate, Doryx, Doxteric, Doxychel, Monodox, Oracea, Vibramycin)Granisetron (Granisol, Kytril, Sancuso)Griseofulvin (Grifulvin, Gris-PEG)Hydrochlorothiazide (Esidrex, Microzide, Oretic)Metoclopramide (Metozolv, Reglan)Ondansetron (Zofran, Zuplenz)Pravastatin (Pravachol)Simvastatin (Zocor)20-29 [OHSU]Topic 20 (OHSU): Osteoarthritis w/o rheumatoid or psoriatic arthritisAdults 18-99 years old with osteoarthritis who do not have rheumatoid arthritis or psoriatic arthritis.Adults with osteoarthritis who do not have rheumatoid or psoriatic arthritis.A 55-year-old female with osteoarthritis of bilateral knees presents for follow-up. She continues to have pain in her knees. Examination reveals crepitus and decreased range of motion of both knees. Prior knee radiographs have shown joint space narrowing and osteophytes. Prior synovial fluid analysis was non-inflammatory, and ESR was 20.Adults with osteoarthritis who do not have rheumatoid or psoriatic arthritis.Demographics inclusionAge: 18-99 yearsDiagnosis inclusionOsteoarthritis (ICD-9): 715, 715.0, 715.00, 715.04, 715.09, 715.1, 715.10, 715.11, 715.12, 715.13, 715.14, 715.15, 715.16, 715.17, 715.18, 715.2, 715.20, 715.21, 715.22, 715.23, 715.24, 715.25, 715.26, 715.27, 715.28, 715.3, 715.30, 715.31, 715.32, 715.33, 715.34, 715.35, 715.36, 715.37, 715.38, 715.8, 715.80, 715.89, 715.9, 715.90, 715.91, 715.92, 715.93, 715.94, 715.95, 715.96, 715.97, 715.98Diagnosis exclusionPsoriatic arthritis (ICD-9): 696.0Rheumatoid arthritis (ICD-9): 714, 714.0Topic 21 (OHSU): Premature infants with ALT or AST labChildren 5 years old or younger who were born prematurely (less than 37 weeks completed gestation) and had an ALT (alanine transaminase) or AST (aspartate transaminase) lab result within 6 months after birth.Children born prematurely who had ALT or AST lab within 6 months after birth.A 5-day-old boy born at 35 weeks gestational age is in the NICU. A CMP lab test taken this morning show an elevated ALT and AST.Children born prematurely who had ALT or AST lab within 6 months after birth.Demographics inclusionAge: ≤ 5 yearsAge at time of lab test: ≤ 6 monthsDiagnosis inclusionPremature infantLab inclusionAlanine transaminase (ALT)Aspartate transaminase (AST)Topic 22 (OHSU): Pediatric stroke with endovascular procedurePediatric patients under 18 years old who have had a stroke and underwent an endovascular procedure involving blood vessels of the head and neck.Pediatric patients who have had a stroke with an endovascular procedure of the head and neck.A 16-year-old boy presents with acute onset of focal neurologic deficits. Brain MRI reveals cerebral ischemia with occlusion of the internal carotid artery. After initiation of r-tPA, treatment proceeds with endovascular mechanical thrombectomy.Pediatric patients who have had a stroke with an endovascular procedure of the head and neck.Demographics inclusionAge: < 18 yearsDiagnosis inclusionCerebrovascular stroke (ICD-9): V17.1, 436Procedure inclusionEndovascular procedure of the head and neck vessels (ICD-9 procedure): 39.72, 39.74Topic 23 (OHSU): Adults with quadriplegiaAdults 18-65 years old who have quadriplegia.Adults ages 18-65 with quadriplegia.A 31-year-old female has quadriplegia at C1-C2 due to traumatic atlantoaxial dislocation sustained in a motor vehicle accident.Adults ages 18-65 with quadriplegia.Demographics inclusionAge: 18-65 yearsDiagnosis inclusionQuadriplegia (ICD-9): 344.0, 344.00, 344.01, 344.02, 344.03, 344.04, 344.09Topic 24 (OHSU): Children w/anemia and height and weight measurements.Pediatric patients under 18 years old who have had anemia and who, on or after the date of diagnosis, had height and weight measurements at an outpatient visit.Pediatric patients who have had anemia and had height and weight measured at an outpatient visit.An 11-month-old girl is seen in the pediatric outpatient clinic for a well-child visit. Her height is 73 cm (approximately 50th percentile) and she weighs 9.0 kg (approximately 35th percentile). Routine screening reveals iron-deficiency anemia.Pediatric patients who have had anemia and had height and weight measured at an outpatient visit.Demographics inclusionAge: < 18 yearsEncounter inclusionOutpatientDate of visit: on or after date of anemia diagnosisDiagnosis inclusionAnemiaVitals inclusionHeight measurementWeight measurementTopic 25 (OHSU): LASIK w/acuity and corneal sensitivity measured pre- and post-opAdults who have undergone laser-assisted in situ keratomileusis (LASIK) or photorefractive keratectomy (PRK) eye surgery in which visual acuity and corneal sensitivity measurements were recorded both pre-operatively and post-operatively.Adults who have had LASIK or PRK eye surgery with pre-op and post-op visual acuity and corneal sensitivity measurements.A 44-year-old female presents for a 6-month post-operative examination after undergoing LASIK surgery to correct her myopia. At each visit, visual acuity has been measured and a slit-lamp exam performed with measurement of corneal sensitivity with an esthesiometer, including at the pre-operative evaluation.Adults who have had LASIK or PRK eye surgery with pre-op and post-op visual acuity and corneal sensitivity measurements.Demographics inclusionAge: ≥ 18 yearsProcedure inclusionLaser-assisted in situ keratomileusis (LASIK) or photorefractive keratectomy (PRK)CPT: 66999HCPCS: S0800Encounter inclusionPre-op visitPost-op visitDocumentation inclusionMeasurements recorded at pre-op and post-op visitsVisual acuityCorneal sensitivityTopic 26 (OHSU): Adults with lab result for anti-tTG Ab or antigliadin AbAdults who have a lab test resulted for IgA or IgG tissue transglutaminase antibody (IgA tTG or IgG tTG), or antigliadin antibody IgA or IgG (AGA).Adults who have had a lab test for anti-tTG IgA or IgG, or anti-gliadin antibody IgA or IgG.A 24-year-old male of Swedish descent presents with chronic foul-smelling bulky loose stools, fatigue, and pruritic rash over the elbows, knees, and back, which seem worse after consuming wheat products. Physical examination is significant for dermatitis herpetiformis. Lab testing is positive for anti-tTG IgA.Adults who have had a lab test for anti-tTG IgA or IgG, or anti-gliadin antibody IgA or IgG.Demographics inclusionAge: ≥ 18 yearsLab inclusionAnti-tissue transglutaminase antibody IgA (IgA tTG)Anti-tissue transglutaminase antibody IgG (IgG tTG)IgA anti-gliadin antibody (AGA)IgG anti-gliadin antibody (AGA) Topic 27 (OHSU): Young adults with high A1cPatients 16-26 years old who have had at least two lab results for glycated hemoglobin (hemoglobin A1c) at 7.5% or higher.Patients ages 16-26 with at least 2 labs with HbA1c of ≥ 7.5%.A 21-year-old with DM Type 1, first diagnosed by pediatrician 7 years ago, is seen by endocrinology for ongoing treatment. Chart review reveals his most recent hemoglobin A1c values are 8.2% and 7.7%.Patients ages 16-26 with at least 2 labs with HbA1c of ≥ 7.5%.Demographics inclusionAge: 16-26 yearsLab inclusionHigh HbA1c on ≥ 2 lab testsHemoglobin A1c (HbA1c) ≥ 7.5%Topic 28 (OHSU): Pregnancy complication with lab results and no HIV or hepatitisWomen 16-45 years old who have had a pregnancy during which they had a complication of hypertension, pre-eclampsia, eclampsia, renal disease, edema, excessive weight gain, cardiovascular disorder, or fetal growth retardation, and also had a lab test for aspartate transaminase (AST) (SGOT), alanine transaminase (ALT) (SGPT), blood urea nitrogen (BUN), creatinine (Cr), uric acid, or urine protein, and did not have viral hepatitis or human immunodeficiency virus.Women ages 16-45 who have had a pregnancy with complication, during which they did not have viral hepatitis or HIV, and had a lab test for AST, ALT, BUN, creatinine, uric acid, or urine protein.A 36-year-old G1P1 female presents for a postpartum outpatient visit. Her pregnancy was complicated by pre-eclampsia, evidenced by elevated creatinine, urine protein, and high blood pressure. This has resolved since giving birth. She is otherwise healthy and has no history of hepatitis or HIV.Women ages 16-45 who have had a pregnancy with complication, during which they did not have viral hepatitis or HIV, and had a lab test for AST, ALT, BUN, creatinine, uric acid, or urine protein.Demographics inclusionSex: FemaleAge: 16-45 yearsLab inclusionAspartate transaminase (AST, SGOT)Alanine transaminase (ALT, SGPT)Blood urea nitrogen (BUN)Creatinine (Cr)Uric acidUrine proteinDiagnosis inclusionPregnancy complicationHypertension (ICD-9): 642, 642.0, 642.00, 642.01, 642.02, 642.03, 642.04, 642.1, 642.10, 642.11, 642.12, 642.13, 642.14, 642.2, 642.20, 642.21, 642.22, 642.23, 642.24, 642.3, 642.30, 642.31, 642.32, 642.33, 642.34, 760.0Pre-eclampsia or eclampsia (ICD-9): 642.4, 642.40, 642.41, 642.42, 642.43, 642.44, 642.5, 642.50, 642.51, 642.52, 642.53, 642.54, 642.6, 642.60, 642.61, 642.62, 642.63, 642.64, 642.7, 642.70, 642.71, 642.72, 642.73, 642.74, 642.9, 642.90, 642.91, 642.92, 642.93, 642.94Edema or excessive weight gain (ICD-9): 646.1, 646.10, 646.11, 646.12, 646.13, 646.14Renal disease (ICD-9) 646.2, 646.20, 646.21, 646.22, 646.23, 646.24Antepartum drug dependence (ICD-9): 648.33Cardiovascular disorder (ICD-9): 648.5, 648.50, 648.51, 648.52, 648.53, 648.54, 648.6, 648.60, 648.61, 648.62, 648.63, 648.64Fetal growth retardation (ICD-9): 764.9, 764.90, 764.91, 764.92, 764.93, 764.94, 764.95, 764.96, 764.97, 764.98, 764.99Diagnosis exclusionHuman immunodeficiency virus (HIV) (ICD-9): 042, 647.6, 647.60, 647.61, 647.62, 647.63, 647.64Viral hepatitis (ICD-9): 070, 070.0, 070.1, 070.2, 070.20, 070.21, 070.22, 070.23, 070.3, 070.30, 070.31, 070.32, 070.33, 070.4, 070.41, 070.42, 070.43, 070.44, 070.49, 070.5, 070.51, 070.52, 070.53, 070.54, 070.59, 070.6, 070.7, 070.70, 070.71, 070.9Topic 29 (OHSU): Adults with thyroid surgery or ablation w/o CVD or ischemic heart diseaseAdults 20-73 years old who have had radioiodine thyroid ablation, thyroid lobectomy, or thyroidectomy, and who have never had ischemic heart disease, including myocardial infarction or coronary atherosclerosis, and have never had cerebrovascular disease, including stroke or transient ischemic attack.Adults ages 20-73 who have had thyroid excision or ablation, and have never had ischemic heart disease or cerebrovascular disease.A 35-year-old female presents for management of secondary hypothyroidism following radioiodine ablation for treatment of Grave’s disease. She is otherwise healthy, and has no history of cerebrovascular disease or cardiovascular disease.Adults ages 20-73 who have had thyroid excision or ablation, and have never had ischemic heart disease or cerebrovascular disease. Demographics inclusionAge: 20-73 yearsProcedure inclusionRadioiodine (131-I) thyroid ablation (CPT): 79005, 79999Surgery inclusionThyroid lobectomy, total or partial (CPT): 60210, 60212, 60220, 60225Thyroidectomy, total or subtotal (CPT): 60240, 60252, 60254, 60260, 60270, 60271Diagnosis exclusionIschemic heart diseaseAcute myocardial infarction (ICD-9): 410, 410.0, 410.00, 410.01, 410.02, 410.1, 410.10, 410.11, 410.12, 410.2, 410.20, 410.21, 410.22, 410.3, 410.30, 410.31, 410.32, 410.4, 410.40, 410.41, 410.42, 410.5, 410.50, 410.51, 410.52, 410.6, 410.60, 410.61, 410.62, 410.7, 410.70, 410.71, 410.72, 410.8, 410.80, 410.81, 410.82, 410.9, 410.90, 410.91, 410.92Other acute or subacute, non-MI (ICD-9): 411, 411.0, 411.1, 411.8, 411.81, 411.89Old MI (ICD-9): 412Angina (ICD-9): 413, 413.0, 413.1, 413.9Coronary atherosclerosis (ICD-9): 414, 414.0, 414.00, 414.01, 414.02, 414.03, 414.04, 414.05, 414.06, 414.07, 414.3, 414.4Aneurysm or dissection of heart (ICD-9): 414.1, 414.10, 414.11, 414.12, 414.19Other chronic ischemic heart disease (ICD-9): 414.2, 414.8, 414.9History of aortocoronary bypass (ICD-9): V45.81History of percutaneous coronary intervention (PCI) (ICD-9): V45.82Cerebrovascular diseaseHemorrhage (ICD-9): 430, 431, 432, 432.0, 432.1, 432.9Occlusion, stenosis, thrombosis, or embolism, w/ or w/o infarction (ICD-9): 433, 433.0, 433.00, 433.01, 433.1, 433.10, 433.11, 433.2, 433.20, 433.21, 433.3, 433.30, 433.31, 433.8, 433.80, 433.81, 433.9, 433.90, 433.91, 434, 434.0, 434.00, 434.01, 434.1, 434.10, 434.11, 434.9, 434.90, 434.91Transient ischemic attack (TIA) or posterior circulation ischemia (ICD-9): 435, 435.0, 435.1, 435.2, 435.3, 435.8, 435.9, V12.54Acute or other ill-defined CVD (ICD-9): 436, 437, 437.0, 437.1, 437.2, 437.3, 437.4, 437.5, 437.6, 437.7, 437.8, 437.9Late effects of CVD (ICD-9): 438, 438.0, 438.1, 438.10, 438.11, 438.12, 438.13, 438.14, 438.19, 438.2, 438.20, 438.21, 438.22, 438.3, 438.30, 438.31, 438.32, 438.4, 438.40, 438.41, 438.42, 438.5, 438.50, 438.51, 438.52, 438.53, 438.6, 438.7, 438.8, 438.81, 438.82, 438.83, 438.84, 438.85, 438.89, 438.930-34 [PheKB]Topic 30 (PheKB): Possible acute drug-induced liver injuryAdults who may have had acute drug-induced liver injury in the past 3 years; defined as those who have no history of chronic liver disease or viral hepatitis, who had acute liver injury in the past 3 years, and who had also taken amoxicillin, amoxicillin/clavulanate, nitrofurantoin, trimethoprim, trimethoprim/sulfamethoxazole, isoniazid, or rifampin at any time during the past 3 years.Adults who may have had acute liver injury in the past 3 years, defined as acute liver injury with an elevated ALP, AST, or bilirubin, and use of amoxicillin, nitrofurantoin, TMP or TMP-SMZ, INH, or rifampin, in those without a history of viral hepatitis or chronic liver disease.A 45-year-old male is hospitalized with acute liver injury after developing malaise, severe nausea and vomiting, jaundice, and dark urine. He is currently on day 3 of a 7-day course of amoxicillin for treatment of sinusitis. Labs reveal elevated ALT of 520 U/L and ALP 142 U/L. He has no chronic disease, and previous routine lab tests have been normal. He has no underlying liver disease and has never had these symptoms before. Physicians suspect drug-induced liver injury secondary to amoxicillin.Adults who may have had acute liver injury in the past 3 years, defined as acute liver injury with an elevated ALP, AST, or bilirubin, and use of amoxicillin, nitrofurantoin, TMP or TMP-SMZ, INH, or rifampin, in those without a history of viral hepatitis or chronic liver disease.Demographics inclusionAge: ≥ 18 yearsDiagnosis inclusionDate of diagnosis: within past 3 yearsAcute liver injuryAcute or subacute liver necrosis (ICD-9): 570Hepatic encephalopathy (ICD-9): 572.2Hepatorenal syndrome (ICD-9): 572.4Hepatic infarction (ICD-9): 573.4Hepatopulmonary syndrome (ICD-9); 573.5Other disorders of liver (ICD-9): 573, 573.0, 573.3, 573.8, 573.9Unspecified jaundice (ICD-9): 782.4Abnormal liver labs (ICD-9): 790.4, 794.8Medication inclusionDate of medication use: within past 3 yearsAmoxicillin (Amoxil, Larotid, Moxatag)Amoxicillin/clavulanate (Augmentin, amoxicillin/clavulanic acid)Nitrofurantoin (Furadantin, Macrobid, Macrodantin)Trimethoprim (Primsol, TMP)Trimethoprim/Sulfamethoxazole (Bactrim, Septra, TMP-SMX)Isoniazid (INH, Laniazid)Rifampin (Rifadin, Rimactane)Isoniazid/Rifampin (Rifamate, Rifater)Lab inclusionDate of lab result: within past 3 yearsAlkaline phosphatase (ALP) ≥ 90 U/LAlanine transaminase (ALT) ≥ 600 U/LBilirubin (Bili) ≥ 4.68 mg/dLDiagnosis exclusionChronic liver diseaseAlcoholic liver damage (ICD-9): 571.0, 571.1, 571.2, 571.3Chronic hepatitis (ICD-9): 571.4, 571.40 571.41, 571.42, 571.49Liver or biliary cirrhosis (ICD-9): 571.5, 571.6Other chronic liver disease (ICD-9): 571, 571.8, 571.9Viral hepatitisHepatitis A (ICD-9): 070.0, 070.1Hepatitis B, w/ or w/o delta (ICD-9): 070.2, 070.20, 070.21, 070.22, 070.23, 070.3, 070.30, 070.31, 070.32, 070.33Hepatitis C (ICD-9): 070.41, 070.44, 070.51, 070.54, 070.7, 070.70, 070.71Hepatitis E or delta w/o B (ICD-9): 070.42, 070.43, 070.52, 070.53Other/unspecified viral hepatitis (ICD-9): 070, 070.4, 070.49, 070.5, 070.59, 070.6, 070.9, 573.1Topic 31 (PheKB): Peripheral arterial disease (PAD)Adults diagnosed with lower extremity peripheral arterial disease (PAD), or who meet diagnostic criteria of PAD with an ankle-brachial index (ABI) < 0.9 or > 1.4 or vascular imaging showing lower extremity artery occlusion or severe stenosis (≥50%), and who don’t have vasculitis, thrombotic microangiopathy, neurofibromatosis, or systemic sclerosis.Adults with peripheral arterial disease, or who have a diagnostic ABI or lower extremity artery stenosis on imaging, and don’t have neurofibromatosis, vasculitis, thrombotic microangiopathy, or systemic sclerosis.A 65-year-old male presents for evaluation of bilateral leg pain. His other medical problems include hypertension and GERD. Further evaluation of his symptoms and exam are consistent with lower extremity claudication. An ankle-brachial index is measured at 0.76, confirming a diagnosis of peripheral arterial disease.Adults with peripheral arterial disease, or who have a diagnostic ABI or lower extremity artery stenosis on imaging, and don’t have neurofibromatosis, vasculitis, thrombotic microangiopathy, or systemic sclerosis.Demographics inclusionAge: ≥ 18 yearsDiagnosis inclusionPeripheral arterial disease (ICD-9): 440.2, 440.20, 440.21, 440.22, 440.23, 440.24, 440.29, 440.3, 440.30, 440.31, 440.32, 440.8, 443.9Procedure inclusionAnkle-brachial index (ABI) of < 0.9 or > 1.4Imaging inclusionRadiologic finding of lower extremity artery occlusion or severe stenosis (≥ 50%) on vascular imagingDuplex ultrasoundComputed tomography angiography (CTA)Magnetic resonance angiography (MRA)Contrast arteriogram (conventional angiogram)Diagnosis exclusionVasculitis (ICD-9): 443.1, 446.0, 446.4, 446.5, 446.7, 447.6Thrombotic microangiopathy (ICD-9): 446.6Neurofibromatosis (ICD-9): 237.7, 237.70, 237.71, 237.72, 237.73, 237.79Systemic sclerosis (ICD-9): 710.1Topic 32 (PheKB): ACE inhibitor-induced coughAdults who have been treated with an angiotensin-converting-enzyme (ACE) inhibitor and developed an associated cough, consistent with ACE inhibitor-induced cough as an adverse effect of the medication.Adults who have used an ACE inhibitor and experienced ACE inhibitor-induced cough.A 48-year-old woman with hypertension begins treatment with Lisinopril. One month later she complains of persistent dry cough, but has no other respiratory or infectious symptoms. Suspecting ACE inhibitor-induced cough, she is switched from Lisinopril to Valsartan and reports resolution of her cough on follow up.Adults who have used an ACE inhibitor and experienced ACE inhibitor-induced cough as an adverse effect.Demographics inclusionAge: ≥ 18 yearsMedication inclusionAngiotensin-converting-enzyme (ACE) inhibitorQuinapril (Accupril)Benazepril (Lotensin)Lisinopril (Prinivil, Zestril)Captopril (Capoten)Enalapril (Vasotec)Fosinopril (Monopril)Ramipril (Altace)Perindopril (Aceon)Trandolapril (Mavik)Moexipril (Univasc)Medication adverse effect: ACE inhibitor-induced coughTopic 33 (PheKB): Children with ADHD on CNS stimulantChildren 4-18 years old who have attention deficit hyperactivity disorder or hyperkinetic syndrome treated with a central nervous system stimulant of methylphenidate, dexmethylphenidate, amphetamine, or lisdexamfetamine, and who don’t have comorbid somatoform disorder, stereotypic movement disorder, mental retardation, central nervous system malignancy, or neurofibromatosis.Children ages 4-18 with ADHD treated with a CNS stimulant, and who don’t have somatoform disorder, stereotypic movement disorder, mental retardation, CNS malignancy, or neurofibromatosis.A 6-year-old girl is brought for evaluation for symptoms of inattention, forgetfulness, difficulty with organizing tasks and following long conversations. She has no marked hyperactivity symptoms, and is otherwise healthy and has no signs of other CNS disorders. After further discussion, exam, and follow up, she is diagnosed with attention deficit disorder without hyperactivity.Children ages 4-18 with ADHD treated with a CNS stimulant, and who don’t have somatoform disorder, stereotypic movement disorder, mental retardation, CNS malignancy, or neurofibromatosis.Demographics inclusionAge: 4-18 yearsDiagnosis inclusionAttention deficit disorder or hyperkinetic syndrome (ICD-9): 314, 314.0, 314.00, 314.01, 314.1, 314.2, 314.8, 314.9Medication inclusionCentral nervous system stimulantMethylphenidate (Concerta, Daytrana, Dexosyn, Metadate, Methylin, Ritalin, Quillichew, Quillivant)Dexmethylphenidate (Focalin)Amphetamine (Adderall, Dexedrine, DextroStat)Lisdexamfetamine (Vyvanse)Diagnosis exclusionSomatoform disorder (ICD-9): 300.81, 300.82, 300.89Stereotypic movement disorder (ICD-9): 307.3Mental retardation (ICD-9): 317, 318, 318.0, 318.1, 318.2, 319Malignancy of central nervous system (ICD-9): 191, 191.0, 191.1, 191.2, 191.3, 191.4, 191.5, 191.6, 191.7, 191.8, 191.9, 192, 192.0, 192.1, 192.2, 192.3, 192.8, 192.9Neurofibromatosis (ICD-9): 237.7, 237.70, 237.71, 237.72, 237.73, 237.79Topic 34 (PheKB): WBC differential and no h/o splenectomy, dialysis, or HIVAdults who have never had a splenectomy, undergone dialysis, or been diagnosed with human immunodeficiency virus (HIV), and who have lab results for at least 2 components of a differential white blood cell count (neutrophils, band cells, lymphocytes, monocytes, eosinophils, basophils) which was not drawn during an inpatient, emergency department, or urgent care encounter.Adults who don’t have HIV, splenectomy, or a history of dialysis, and have results for ≥ 2 cell types of a WBC differential which wasn’t drawn in an inpatient, ED, or urgent care visit.A 39-year-old male presents to the family medicine clinic for evaluation of fatigue. His past medical history and surgical history are negative. The physician orders a complete blood count with differential. The results include normal hemoglobin, hematocrit, and platelets, but an elevated WBC count, with lymphocytosis present on the differential count.Adults who don’t have HIV, splenectomy, or a history of dialysis, and have results for ≥ 2 cell types of a WBC differential which wasn’t drawn in an inpatient, ED, or urgent care visit.Demographics inclusionAge: ≥ 18 yearsLab inclusion≥ 2 leukocyte cell types, differential %NeutrophilsBandsLymphocytesMonocytesEosinophilsBasophilsEncounter exclusionLab specimen collected during an inpatient, ED, or urgent care encounter InpatientEmergency departmentUrgent careDiagnosis exclusionHuman immunodeficiency (HIV) (ICD-9): 042, V08Procedure exclusionPeritoneal dialysis or hemodialysisCPT: 90921, 90924, 90925, 90935, 90937, 90940, 90941, 90942, 90945, 90947, 90953, 90976, 90980, 90988, 90989, 90990, 90991, 90992, 90993, 90999ICD-9 procedure code: 39.95, 54.98Surgery exclusionPartial or total splenectomyCPT: 38120, 38100, 38101, 38102ICD-9 procedure code: 41.43, 41.535-46 [NQF]Topic 35 (NQF): Breast cancer screening mammogramWomen who were 50-74 years old and had a mammogram to screen for breast cancer between October 1, 2010 and December 31, 2012, and at that time had not had a mastectomy involving both breasts. Women who had a screening mammogram at ages 50-74 between 10/1/2010 and 12/31/2012, and hadn’t undergone mastectomy of both breasts.A 63-year-old woman presents for a routine health maintenance visit on February 4, 2012. She has never had breast cancer or any previous surgeries. Her last mammogram was in 2009, and she is due for another bilateral screening mammogram, which is performed two weeks later.Women who had a screening mammogram at ages 50-74 between 10/1/2010 and 12/31/2012, and hadn’t undergone mastectomy of both breasts.Demographics inclusionSex: FemaleAge on 12/31/2012: 52-74 yearsEncounter inclusionImaging date: 10/1/2010 - 12/31/2012Imaging inclusionScreening mammogramCPT: 77055, 77056, 77057ICD-9 procedure codes: 87.37, 87.36HCPCS code: G0202Surgery exclusionMastectomy of both breastsBilateral mastectomy (ICD-9 procedure codes): 85.42, 85.44, 85.46, 85.48Unilateral mastectomyCPT: 19307, 19306, 19305, 19304, 19303ICD-9 procedure codes: 85.41, 85.43, 85.45, 85.47Topic 36 (NQF): Children with dental decayChildren 1-17 years old who have had an outpatient office visit in which they were diagnosed with dental caries.Children 1-17 years old who were diagnosed with dental caries during an office visit.A 4-year-old girl is seen in outpatient pediatrician office complaining of toothache. She is afebrile, and physical exam reveals dental decay, but no surrounding erythema, induration, or lymphadenopathy. She is referred to a dentist for further evaluation and treatment.Children 1-17 years old who were diagnosed with dental caries during an office visit.Demographics inclusionAge: 1-17 yearsEncounter inclusionOutpatient office visit (CPT): 99391, 99392, 99393, 99394, 99381, 99382, 99383, 99384, 99201, 99202, 99203, 99204, 99205, 99212, 99213, 99214, 99215Diagnosis inclusionDental caries (ICD-9): 521.0, 521.00, 521.01, 521.02, 521.03, 521.04, 521.05, 521.06, 521.07, 521.08, 521.09Topic 37 (NQF): Inpatient falls with injuryAdults who have had a fall with injury while hospitalized, who were not pregnant or admitted for psychiatric illness at that time, and had an injury level of minor, moderate, major, or resulting in death.Adults who have had an injury fall during an inpatient encounter in which they were not pregnant or admitted for psychiatric illness.A 76-year-old female who was admitted for inpatient treatment of complicated UTI, suffers a fall and sustains lacerations to bilateral elbows requiring steri-strips for wound management, which is reported as a fall with moderate injury level.Adults who have had an injury fall during an inpatient encounter in which they were not pregnant or admitted for psychiatric illness.Demographics inclusionAge: ≥ 18 yearsEncounter inclusionInpatientAdverse event inclusionFall with injuryInjury level: minor, moderate, major, or resulting in deathDiagnosis exclusionAdmitting diagnosis: psychiatric disorderPregnancyTopic 38 (NQF): Adolescent immunization w/ meningococcal and Tdap/TdChildren 11-13 years old who have had one dose of meningococcal conjugate or polysaccharide vaccine at ages 11-13, and either the Tdap (tetanus and diphtheria toxoids, and acellular pertussis) vaccine or the Td (tetanus and diphtheria toxoids) vaccine at ages 10-13.Children 11-13 years old who had meningococcal vaccination at ages 11-13 and Tdap or Td at ages 10-13.A 13-year-old male presents for his school sports physical. He was last seen 2 months ago, at which time he had meningococcal vaccination (MCV4). Records indicate that he received the Tdap (tetanus, diphtheria, pertussis) vaccine 14 months ago.Children 11-13 years old who had meningococcal vaccination at ages 11-13 and Tdap or Td at ages 10-13.Demographics inclusionAge: 11-13 yearsProcedure inclusionMeningococcal vaccination (one dose) at 11-13 years oldQuadrivalent meningococcal conjugate vaccine (MCV4) (Menactra, Menveo) (CPT): 90734Meningococcal polysaccharide vaccine (MPSV4) (Menomune) (CPT): 90733Tetanus and diphtheria toxoids vaccination at 10-13 years oldTetanus and diphtheria toxoids, and acellular pertussis vaccine (Tdap) (Adacel, Boostrix)CPT: 90715ICD-9 procedure code: 99.39Tetanus and diphtheria toxoids vaccine (Td) (Tenivac, Decavac) (CPT): 90714, 90718Tetanus toxoidCPT: 90703ICD-9 procedure code: 99.38Diphtheria toxoidCPT: 90719ICD-9 procedure code: 99.36Topic 39 (NQF): ED admission for appendix perforation or abscessAdults who have ever had an admission from the emergency department for inpatient treatment of appendicitis with abscess or perforation of the appendix, and who were not pregnant or postpartum at that time.Adults who have ever been admitted from the ED with appendiceal perforation or abscess, and weren’t pregnant or postpartum.A 21-year-old female presents to the emergency department with fever, chills, right lower quadrant pain, nausea, and vomiting. She has peritoneal signs on physical exam and a negative pregnancy test. Imaging reveals a perforated appendix and she is admitted for further treatment.Adults who have ever been admitted from the ED with appendiceal perforation or abscess, and weren’t pregnant or postpartum.Demographics inclusionAge: ≥ 18 yearsEncounter inclusionEmergency department visitAdmission to inpatient from emergency departmentDiagnosis inclusionAppendicitis with appendiceal perforation or abscess (ICD-9): 540.0, 540.1Diagnosis exclusionPregnancyLabor and deliveryPostpartumTopic 40 (NQF): Death from acute MI while inpatientAdults who suffered death as an inpatient and had a principal diagnosis of acute myocardial infarction (MI) at discharge.Adults who expired while hospitalized and have a discharge diagnosis of acute MI.A 75-year-old male is hospitalized for treatment of a severe diabetic foot infection. On day 2 of treatment, he suffers a massive acute myocardial infarction and expires.Adults who expired while hospitalized and have a discharge diagnosis of acute MI.Demographics inclusionAge: ≥ 18 yearsVital status: DeceasedEncounter inclusionInpatientDischarge status: ExpiredDiagnosis inclusionPrincipal discharge diagnosis: acute myocardial infarctionAcute myocardial infarction (ICD-9): 410, 410.0, 410.00, 410.01, 410.02, 410.1, 410.10, 410.11, 410.12, 410.2, 410.20, 410.21, 410.22, 410.3, 410.30, 410.31, 410.32, 410.4, 410.40, 410.41, 410.42, 410.5, 410.50, 410.51, 410.52, 410.6, 410.60, 410.61, 410.62, 410.7, 410.70, 410.71, 410.72, 410.8, 410.80, 410.81, 410.82, 410.9, 410.90, 410.91, 410.92Topic 41 (NQF): Prostate cancer and external beam radiation tx w/adjuvant GnRH agonist/antagonistMales with prostate cancer with high or very high risk of recurrence, who are undergoing external beam radiation therapy and receiving adjuvant hormonal therapy with a gonadotropin-releasing hormone (GnRH) agonist (leuprolide, triptorelin, goserelin, histrelin) or antagonist (degarelix).Males with prostate cancer with high risk of recurrence receiving external beam radiotherapy and adjuvant hormonal therapy with a GnRH agonist or antagonist.A 76-year-old male with prostate cancer is found to be at high risk of recurrence. He is currently receiving external beam radiotherapy using proton beam therapy, and is prescribed leuprolide as adjuvant androgen deprivation therapy.Males with prostate cancer with high risk of recurrence receiving external beam radiotherapy and adjuvant hormonal therapy with a GnRH agonist or antagonist.Demographics inclusionSex: MaleDiagnosis inclusionProstate cancer with high or very high risk of recurrenceProstate cancer (ICD-9): 185High or very high risk of recurrence diagnosisHCPCS: G8465CPT: 3274FHigh or very high risk of recurrence definition, one or more of:Lab: prostate specific antigen (PSA) > 20 ng/mLGleason score: 8-10Clinical stage: T3a, T3b, or T4Procedure inclusionExternal beam radiation therapy (CPT): 77427, 774353D conformal radiation therapyIntensity modulated radiation therapyStereotactic body radiotherapyProton beam therapyMedication inclusionAdjuvant gonadotropin-releasing hormone (GnRH) agonist or antagonist prescribed (CPT): 4164FGnRH agonistLeuprolide (Eligard, Lupron)Triptorelin (Trelstar)Goserelin (Zoladex)Histrelin (Vantas, Supprelin)GnRH antagonistDegarelix (Firmagon)Topic 42 (NQF): Elderly patients with dementia on antipsychotic medicationPatients ages 65 or older with dementia who are taking an antipsychotic medication, and don’t have schizophrenia, bipolar disorder, Huntington’s disease, or Tourette’s Syndrome.Elderly patients with dementia taking an antipsychotic and don’t have schizophrenia, bipolar disorder, Huntington’s disease, or Tourette’s Syndrome.An 81-year-old female with Alzheimer’s dementia develops agitation and behavioral disturbances. She is subsequently prescribed Haldol for these symptoms. The patient and caretakers deny any hallucinations or other evidence of psychosis, and the patient has no history of schizophrenia or other neurological disease.Elderly patients with dementia taking an antipsychotic and don’t have schizophrenia, bipolar disorder, Huntington’s disease, or Tourette’s Syndrome.Demographics inclusionAge: ≥ 65 yearsDiagnosis inclusionSenile or presenile dementia (ICD-9): 290.0, 290.1, 290.10, 290.11, 290.12, 290.13, 290.2, 290.20, 290.21, 290.3Vascular dementia (ICD-9): 290.4, 290.40, 290.41, 290.42, 290.43Other/unspecified dementia (ICD-9): 294.10, 294.20Alzheimer’s disease (ICD-9): 331.0Dementia with Lewy bodies (ICD-9): 331.82Medication inclusionAtypical antipsychoticAripiprazole (Abilify, Aristada)Asenapine (Saphris)Clozapine (Clozaril, Fazaclo, Versacloz)Iloperidone (Fanapt)Lurasidone (Latuda)Olanzapine (Zyprexa)Olanzapine/Fluoxetine (Symbyax)Paliperidone (Invega)Quetiapine (Seroquel)Risperidone (Risperdal)Ziprasidone (Geodon)Typical antipsychoticChlorpromazine (Thorazine)FluphenazineHaloperidol (Haldol)Loxapine (Adasuve)PerphenazinePimozide (Orap)ThioridazineThiothixene (Navane)TrifluoperazineDiagnosis exclusionSchizophrenia (ICD-9): 295, 295.0, 295.00, 295.01, 295.02, 295.03, 295.04, 295.05, 295.1, 295.10, 295.11, 295.12, 295.13, 295.14, 295.15, 295.2, 295.20, 295.21, 295.22, 295.23, 295.24, 295.25, 295.3, 295.30, 295.31, 295.32, 295.33, 295.34, 295.35, 294.4, 295.40, 295.41, 295.42, 295.43, 295.44, 295.45, 295.5, 295.50, 295.51, 295.52, 295.53, 295.54, 295.55, 295.6, 295.60, 295.61, 295.62, 295.63, 295.64, 295.65, 295.7, 295.70, 295.71, 295.72, 295.73, 295.74, 295.75, 295.8, 295.80, 295.81, 295.82, 295.83, 295.84, 295.85, 295.9, 295.90, 295.91, 295.92, 295.93, 295.94, 295.95Bipolar disorder (ICD-9): 296.0, 296.00, 296.01, 296.02, 296.03, 296.04, 296.05, 296.06, 296.1, 296.10, 296.11, 296.12, 296.13, 296.14, 296.15, 296.16, 296.4, 296.40, 296.41, 296.42, 296.43, 296.44, 296.45, 296.46, 296.5, 296.50, 296.51, 296.52, 296.53, 296.54, 296.55, 296.56, 296.6, 296.60, 296.61, 296.62, 296.63, 296.64, 296.65, 296.66, 296.7, 296.8, 296.80, 296.81, 296.82, 296.89, 296.9, 296.90, 296.99Huntington’s disease (ICD-9): 333.4Tourette’s disorder (ICD-9): 307.23Topic 43 (NQF): Chronic steroid therapy and osteoporosis preventionWomen ages 55 or older, or men ages 50 or older, who are on chronic glucocorticoid treatment of at least 3 months, and who are also taking a bisphosphonate for the prevention of glucocorticoid-induced osteoporosis.Women ages 55 or older or men ages 50 or older who are on chronic glucocorticoid therapy and taking a bisphosphonate for osteoporosis prevention.A 54-year-old male with rheumatoid arthritis treated with methotrexate and sulfasalazine started adjunctive therapy 6 months ago with daily prednisone. His physician prescribes alendronate in order to mitigate the risk of developing glucocorticoid-induced osteoporosis.Women ages 55 or older or men ages 50 or older who are on chronic glucocorticoid therapy and taking a bisphosphonate for osteoporosis prevention.Demographics inclusionAge if female: ≥ 55 yearsAge if male: ≥ 50 yearsMedication inclusionBisphosphonateAlendronate (Binosto, Fosamax)Risendronate (Actanel, Atelvia)Zoledronic acid (Reclast, Zometa)Pamidronate (Aredia)Ibandronate (Boniva)Chronic glucocorticoid therapyDuration of use: ≥ 3 monthsBetamethasone (Celestone soluspan)Dexamethasone (DoubleDex, DexPak)Methylprednisolone (A-Methapred, Depo-medrol, Solu-medrol, Medrol)Triamcinolone (Kenalog, Pro-C-Dure)Prednisone (Deltasone, Rayos)Prednisolone (Flo-Pred, Millipred, Orapred, Pediapred, Prelone, Veripred)Hydrocortisone (A-Hydrocort, Cortef, Solu-Cortef)CortisoneTopic 44 (NQF): COPD with potentially avoidable complicationAdults ages 18-65 with chronic obstructive pulmonary disease (COPD), who have had a hospitalization for a potentially avoidable complication with an acute exacerbation, respiratory failure or insufficiency, or requiring intubation, mechanical ventilation, or tracheostomy.Adults with COPD who have been hospitalized with an acute exacerbation or respiratory failure, or required a tracheostomy, intubation or mechanical ventilation.A 58-year-old woman with chronic bronchitis is treated with albuterol as needed. She has had 2 ED visits in the last 10 months for acute exacerbation, each treated with a course of prednisone. Her past medical history is negative for malignancy, renal disease, or organ transplantation. She presents for symptoms of a mild increase in frequency of cough and sputum production. She is started on daily tiotropium and continued on prn albuterol.Adults with COPD who have been hospitalized with an acute exacerbation or respiratory failure, or required a tracheostomy, intubation or mechanical ventilation.Demographics inclusionAge: 18-65 yearsEncounter inclusionInpatientDiagnosis inclusionChronic obstructive pulmonary disease (COPD) (ICD-9): 490, 491.0, 491.1, 491.20, 491.8, 491.9, 492, 492.0, 492.8, 493.20, 496Potentially avoidable complicationRespiratory failure or insufficiency (ICD-9): 518.8, 518.81, 518.82, 518.83, 518.84, 518.5, 518.51, 518.52, 518.53, 799.1Acute exacerbation of COPD (ICD-9): 491.21, 491.22, 493.21, 493.22Procedure inclusionPotentially avoidable complicationTracheostomy placementCPT: 31600, 31601, 31603, 31605, 31610, 31613, 31614ICD-9 procedure code: 31.1, 31.2, 31.21, 31.29Intubation, Mechanical ventilationCPT: 31500, 64660, 64662ICD-9 procedure code: 96.01, 96.02, 96.03, 96.04, 96.05Topic 45 (NQF): Patients w/coronary stent and 12 mo. antiplatelet txPatients with a coronary artery stent (bare-metal or drug-eluting) who were on antiplatelet therapy with clopidogrel, prasugrel, or ticagrelor for the 12 months following stenting, or taking currently if the stent was placed less than 12 months ago.Patients with a coronary artery stent and were treated with clopidogrel, prasugel, or tricagrelor for 12 months.A 76-year-old male presents for follow up of his heart disease. He has had coronary artery disease (CAD) for 7 years, and underwent coronary artery stenting of the left anterior descending artery (LAD) using a drug-eluting stent (DES) 5 months ago. He has no known contraindication to antiplatelet therapy. He is doing well and continued on dual antiplatelet therapy with aspirin and clopidogrel.Patients with a coronary artery stent and were treated with clopidogrel, prasugel, or tricagrelor for 12 months.Procedure inclusionCoronary artery stent placementICD-9 procedure code: 36.06, 36.07HCPCS: C1874, C1875, C1876, C1877, C9600, C9603, C9604, C9605, C9606, C9607, C9608, G0290, G0291Diagnosis inclusionHistory of percutaneous coronary intervention (ICD-9): V45.82Medication inclusionClopidogrel (Plavix)Crasugrel (Effient)Ticagrelor (Brilinta)Duration of use:12 months after stent placementCurrent use if stent placed < 12 months agoTopic 46 (NQF): Children with sickle cell anemia and transcranial doppler U/SChildren 2-15 years old with sickle cell anemia (hemoglobin SS) who have had at least 3 sickle cell anemia-related healthcare encounters and have had a transcranial doppler ultrasound to screen for increased ischemic stroke risk.Children ages 2-15 with sickle cell anemia, at least 3 related visits, and stroke risk screening with transcranial doppler ultrasound.A 5-year-old boy with sickle cell anemia presents for continuing care. His growth chart and vital signs are reviewed, and routine blood count ordered. His last transcranial doppler ultrasound, performed 6 months ago was normal, with a flow velocity < 170 cm/s, which is unchanged from previous screenings at ages 2 and 3.Children ages 2-15 with sickle cell anemia, at least 3 related visits, and stroke risk screening with transcranial doppler ultrasound.Demographics inclusionAge: 2-15 yearsDiagnosis inclusionSickle cell anemia (Hb-SS) (ICD-9): 282.61, 282.62Encounter inclusion≥ 3 healthcare visits for sickle cell anemiaImaging inclusionTranscranial doppler ultrasound study of intracranial arteries (CPT): 93886, 93888, 93890, 93892, 9389347-54 [REP]Topic 47 (REP): Prostate cancer on biopsy with Gleason scoreMen who have prostate cancer which was confirmed or diagnosed by prostate biopsy in which the Gleason score was documented in the pathology report.Men with prostate cancer who had a biopsy in which the Gleason score was reported.A 61-year-old male undergoes radical prostatectomy with pelvic lymph node dissection following prostate biopsy diagnosing prostate cancer, which is characterized as stage T2b, Gleason score of 7, and last PSA of 17 mg/dL.Men with prostate cancer who had a biopsy in which the Gleason score was reported.Demographics inclusionSex: MaleDiagnosis inclusionMalignant neoplasm of the prostate (ICD-9): 185Procedure inclusionProstate biopsy (CPT): 55700, 55705, 55706Documentation inclusionPathology report for prostate biopsy includes Gleason scoreTopic 48 (REP): Stroke after first MIAdults who have had an incident acute myocardial infarction within the last 3 years and who subsequently suffered hemorrhagic or ischemic stroke.Adults with an incident myocardial infarction in the last 3 years who have a subsequent stroke.A 59-year-old male presents with acute onset of confusion, headache, vomiting, with focal neurologic deficits on exam. He is hypertensive to an SBP of 220 mmHg, and medical history is significant for an MI 2 years ago. CT scan shows intracerebral hemorrhage, and he’s admitted to the ICU. Adults with an incident myocardial infarction in the last 3 years who have a subsequent stroke.Demographics inclusionAge: ≥ 18 yearsDiagnosis inclusionDate of first diagnosis of AMI: ≤ 3 years agoAcute myocardial infarction (ICD-9): 410, 410.0, 410.00, 410.01, 410.02, 410.1, 410.10, 410.11, 410.12, 410.2, 410.20, 410.21, 410.22, 410.3, 410.30, 410.31, 410.32, 410.4, 410.40, 410.41, 410.42, 410.5, 410.50, 410.51, 410.52, 410.6, 410.60, 410.61, 410.62, 410.7, 410.70, 410.71, 410.72, 410.8, 410.80, 410.81, 410.82, 410.9, 410.90, 410.91, 410.92Date of stroke diagnosis: after the date of incident AMI diagnosisStroke:Hemorrhagic stroke (ICD-9): 430, 431, 432, 432.0, 432.1, 432.9Ischemic stroke (ICD-9): 433, 433.0, 433.00, 433.01, 433.1, 433.10, 433.11, 433.2, 433.20, 433.21, 433.3, 433.30, 433.31, 433.8, 433.80, 433.81, 433.9, 433.90, 433.91, 434, 434.0, 434.00, 434.01, 434.1, 434.10, 434.11, 434.9, 434.90, 434.91Other acute cerebrovascular disease (ICD-9): 436Topic 49 (REP): Nephrolithiasis prophylaxis with thiazide diureticPatients who had a first episode of nephrolithiasis in the past 5 years not due to uric acid stones, who didn’t have diabetes mellitus at that time, and who are taking a thiazide or thiazide-like diuretic of hydrochlorothiazide, chlorthalidone, or indapamide, initiated subsequent to nephrolithiasis diagnosis for prophylaxis. Patients with onset of kidney stones in the past 5 years, taking a thiazide diuretic prescribed subsequently, and who didn’t have DM at the time of nephrolithiasis diagnosis.A 46-year-old female presents with cramping flank pain and dysuria. She doesn’t have a history of nephrolithiasis or DM. Imaging shows a left kidney stone, subsequently passed and analyzed as calcium oxalate type. After recurrent episodes and hypercalciuria on 24-hour urine testing, she is started on prophylactic hydrochlorothiazide.Patients with onset of kidney stones in the past 5 years, taking a thiazide diuretic prescribed subsequently, and who didn’t have DM at the time of nephrolithiasis diagnosis.Diagnosis inclusionNephrolithiasis (ICD-9): 592, 592.0, 592.1, 592.9, 594, 594.0, 594.1, 594.2, 594.8, 594.9First diagnosis date: ≤ 5 years agoMedication inclusionThiazide or thiazide-like diureticHydrochlorothiazide (HCTZ, Microzide)ChlorthalidoneIndapamideCurrent use of thiazide or thiazide-like diureticThiazide start date: after date of nephrolithiasis diagnosisDiagnosis exclusionUric acid nephrolithiasis (ICD-9): 274.11Diabetes mellitus diagnosis date: prior to date of nephrolithiasis diagnosisDiabetes mellitus (ICD-9): 250, 250.0, 250.00, 250.01, 250.02, 250.03, 250.1, 250.10, 250.11, 250.12, 250.13, 250.2, 250.20, 250.21, 250.22, 250.23, 250.3, 250.30, 250.31, 250.32, 250.33, 250.4, 250.40, 250.41, 250.42, 250.43, 250.5, 250.50, 250.51, 250.52, 250.53, 250.6, 250.60, 250.61, 250.62, 250.63, 250.7, 250.70, 250.71, 250.72, 250.73, 250.8, 250.80, 250.81, 250.82, 250.83, 250.9, 250.90, 250.91, 250.92, 250.93Topic 50 (REP): Bicuspid aortic valve on echocardiographyPatients with bicuspid aortic valve confirmed with transthoracic or transesophageal echocardiography with finding documented in radiology report. Patients with bicuspid aortic valve confirmed on echocardiography.A 30-year-old woman is found to have a systolic murmur and ejection click on cardiac auscultation. Further evaluation with a transthoracic echocardiogram reveals a bicuspid aortic valve.Patients with bicuspid aortic valve confirmed on echocardiography.Diagnosis inclusionBicuspid aortic valve (ICD-9): 746.4Imaging inclusionEchocardiographyTransthoracic echocardiography (TTE)Transesophageal echocardiography (TEE)Radiologic finding of bicuspid aortic valveTopic 51 (REP): Adults with HCV on lab testingAdults who have had lab tests showing a current hepatitis C infection with a reactive Hepatitis C antibody test and detection of Hepatitis C RNA.Adults who have had lab tests showing current HCV infection, with HCV Ab reactive and HCV RNA detected.A 44-year-old male presents after labs revealed elevated liver transaminases. Testing for viral hepatitis infection came back as HCV Ab reactive and qualitative HCV RNA detected, confirming a current infection with hepatitis C. Adults who have had lab tests showing current HCV infection, with HCV Ab reactive and HCV RNA detected.Demographics inclusionAge: ≥ 18 yearsDiagnosis inclusionViral hepatitis C (ICD-9): 070.41, 070.44, 070.51, 070.54, V02.62Lab inclusionHepatitis C antibody: positiveHepatitis C virus RNA: detectedTopic 52 (REP): Cataract surgery and prior SSRI useAdults 50 years old or more who underwent cataract surgery and had taken a selective serotonin reuptake inhibitor (SSRI) in the 12 months prior to surgery.Adults at least 50 years old who had cataract surgery and had used an SSRI in the preceding 12 months.A 72-year-old female is seen for a post-op evaluation following cataract surgery on the left eye. She initially presented with decreasing visual acuity with clouding, and was found to have bilateral senile cataracts. Her medical and surgical history reviewed at a pre-op visit is significant for depression and anxiety, treated with escitalopram.Adults at least 50 years old who had cataract surgery and had used an SSRI in the preceding 12 months.Demographics inclusionAge: ≥ 50 years Surgery inclusionCataract removalICD-9 procedure code: 13.1, 13.11, 13.2, 13.3, 13.4, 13.41, 13.42, 13.43, 13.5, 13.51, 13.59, 13.69, 13.71CPT: 66982, 66983, 66984Medication inclusionDate of SSRI use: ≤ 12 months before cataract surgerySelective serotonin reuptake inhibitor (SSRI)Citalopram (Celexa)Escitalopram (Lexapro)Fluoxetine (Prozac, Sarafem, Selfemra)Fluvoxamine (Luvox)Paroxetine (Paxil, Brisdelle, Pexeva)Sertraline (Zoloft)Topic 53 (REP): Vitamin D-deficiency ricketsChildren who have had Vitamin D-deficiency rickets diagnosed by characteristic findings on x-ray, an elevated parathyroid hormone (PTH), normal or low serum phosphorus concentration (Pi), and 25-hydroxyvitamin D (25-OHD) less than 30 ng/mL.Children who have had Vitamin D-deficiency rickets diagnosed by x-ray findings, elevated PTH, normal or low phosphorus, and 25-OHD < 30 ng/mL.A 2-year-old male is seen for difficulty walking and bow legs. On exam, he displays genu varum and craniotabes. Work-up is significant for frayed metaphyses on x-ray, low phosphate, high PTH, and 25-OHD of 12 ng/mL, and he is diagnosed with rickets due to Vitamin D deficiency.Children who have had Vitamin D-deficiency rickets diagnosed by x-ray findings, elevated PTH, normal or low phosphorus, and 25-OHD < 30 ng/mL.Demographics inclusionAge: < 18 yearsImaging inclusionX-rayRadiologic report of x-ray with findings consistent with ricketsLab inclusionParathyroid hormone (PTH): elevatedSerum phosphorus concentration (Pi): low25-hydroxyvitamin D (25-OHD): < 30 ng/mLTopic 54 (REP): Colonic diverticular disease w/o IBD or colon cancerAdults with diverticular disease of the colon evident on colonoscopy, flexible sigmoidoscopy, abdomen computed tomography (CT), CT colonography, or barium enema, and who don’t have ulcerative colitis, Crohn’s disease, or malignancy of the colon.Adults with diverticula of the colon on endoscopy, CT imaging, or barium enema radiography, and who don’t have colon cancer, Crohn’s disease, or ulcerative colitis.A 63-year-old male underwent screening colonoscopy 1 week ago. Results were significant for diverticulosis of the colon, without evidence of inflammation or infection. Findings were otherwise unremarkable.Adults with diverticula of the colon on endoscopy, CT imaging, or barium enema radiography, and who don’t have colon cancer, Crohn’s disease, or ulcerative colitis. Demographics inclusionAge: ≥ 18 yearsDiagnosis inclusionDiverticular disease of the colon (ICD-9): 562.1, 562.10, 562.11, 562.12, 562.13Imaging inclusionColonoscopyFlexible sigmoidoscopyCT of abdomenCT colonographyBarium enemaDiagnosis exclusionColon cancerUlcerative colitisCrohn’s disease55-56 [Mayo]Topic 55 (Mayo): Functional status in knee-related PT Adults who have had a knee injury, deformity, or inflammation for which they were seen by physical therapy, and who had at least one physical therapy visit with a documented assessment of functional status or outcome.Adults with knee inflammation, injury, or deformity, who had a physical therapy visit with documented functional status or outcome assessment. A 62-year-old female with right knee medial meniscal tear limiting her activities was referred for evaluation and treatment with a physical therapist. At her initial PT visit, the functional status related to knee impairment is documented, such as range of motion and ability to perform various activities of daily living.Adults with knee inflammation, injury, or deformity, who had a physical therapy visit with documented functional status or outcome assessment.Demographics inclusionAge: ≥ 18 yearsEncounter inclusionVisit provider: physical therapistDocumentation inclusionPhysical therapist documentation of functional status or outcome assessmentDiagnosis inclusionMeniscal injury, knee ligament injury (ICD-9): 717.0, 717.1, 717.2, 717.3, 717.4, 717.40, 717.41, 717.42, 717.43, 717.49, 717.5, 717.6, 717.7, 717.8, 717.81, 717.82, 717.83, 717.84, 717.85, 717.89, 717.9, 836.0, 836.1, 836.2, 844, 844.0, 844.1, 844.2, 844.3, 844.8, 844.9Dislocation, contracture, ankyloses, or other derangement of knee (ICD-9): 718.26, 718.36, 718.46, 718.56, 718.76, 718.86, 836.3, 836.4, 836.5, 836.51, 836.52, 836.53, 836.54, 836.59, 836.6, 836.60, 836.61, 836.62, 836.63, 836.64, 836.69Enthesopathy, tendinitis or bursitis, of knee (ICD-9): 726.6, 726.60, 726.61, 726.62, 726.63, 726.64, 726.65, 726.69Tendon rupture of quadriceps or patellar (ICD-9): 727.65, 727.66Genu varum, genu valgum, genu recurvatum, knee deformity (ICD-9): 736.41, 736.42, 736.5, 736.6, 755.64, 822, 822.0, 822.1Topic 56 (Mayo): Fall risk screening in elderly patientsPatients 65 years old or older who have had an outpatient visit with future fall risk screening, in which they were asked about the number of falls, with and without injury, occurring in the past 12 months.Elderly patients who have had an outpatient visit with screening for future fall risk.An 89-year-old male presents for review of his blood pressure and medications for hypertension. In addition, his caregiver reports that he has fallen 3 times in the past year, none of which resulted in injury.Elderly patients who have had an outpatient visit with screening for future fall risk.Demographics inclusionAge: ≥ 65 yearsEncounter inclusionOutpatient visitDocumentation inclusionPatient screened for future fall risk (CPT): 1100F, 1101F ................
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