| name | langcare-quality-measures |
| description | Calculates HEDIS-style quality measures from FHIR data including denominator/numerator/exclusion logic, measure rates, gap-to-goal analysis, and non-compliant patient identification. Use when asked to calculate quality measures, HEDIS rates, quality dashboard, star rating, measure compliance, or CMS quality scores.
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Quality Measure Dashboard
When to Use This Skill
Use when a clinician or quality team needs formal HEDIS/CMS quality measure calculations with denominator/numerator logic, benchmark comparison, and actionable gap lists.
Clinical Workflow
- Select measures to calculate (default core set: A1c control, BP control, breast/colorectal cancer screening, depression screening, statin therapy)
- For each measure, use
fhir_search to build the denominator population from Condition/Patient resources per measure specification
- Use
fhir_search to identify and remove excluded patients (hospice, ESRD, bilateral mastectomy, etc.)
- Use
fhir_search to query numerator evidence: Observation (lab results), Procedure (screenings), DiagnosticReport (imaging)
- Compute rates: Rate = Numerator / (Denominator - Exclusions) x 100
- Compare against benchmarks (see references/hedis-measures.md)
- Identify non-compliant patients (in denominator but not in numerator) as care gaps
- Present dashboard with rates, targets, gap counts, and patient-level gap lists
FHIR Resources
- Condition -- Denominator identification (diabetes, HTN diagnoses)
- Patient -- Demographics for age/sex stratification
- Observation -- Lab results (A1c, BP), screening scores (PHQ-9)
- Procedure -- Screening procedures (colonoscopy, mammogram)
- DiagnosticReport -- Screening results
- MedicationRequest -- Medication-based measures (statin therapy)
- Encounter -- Visit-based eligibility, hospice exclusions
- Immunization -- Immunization measures
FHIR Query Examples
Pull Diabetes Patients (Denominator)
fhir_search(resourceType="Condition", queryParams="code=http://snomed.info/sct|44054006,http://snomed.info/sct|46635009&clinical-status=active&_count=500")
Pull A1c Results (Numerator)
fhir_search(resourceType="Observation", queryParams="code=http://loinc.org|4548-4&date=ge[measurement-year-start]&_sort=-date&_count=500")
Pull Mammograms (Numerator)
fhir_search(resourceType="DiagnosticReport", queryParams="code=http://loinc.org|24606-6&date=ge[27-months-ago]&_count=500")
Clinical Guidelines
- NCQA HEDIS Technical Specifications
- CMS Star Ratings methodology
- CMS Quality Payment Program (MIPS) measures
Interpretation Guide
- Present measures in dashboard format: measure name, denominator, exclusions, numerator, rate, target, gap-to-goal
- Star rating estimate based on measure performance vs. CMS cut points
- Non-compliant patient lists sorted by: measures with most gaps first, then by longest time since last compliant event
- For each gap patient: patient ID, last relevant result (value and date), recommended action (order test, schedule screening, intensify therapy)
Safety
- Never fabricate clinical data -- only report what FHIR returns
- Flag critical/abnormal values immediately
- Scope all FHIR queries to the authenticated patient
- Use standard terminology (LOINC, SNOMED CT, RxNorm, ICD-10)
- Present data in clinician-friendly format with reference ranges
