{"actual":false,"author":[{"name":"Brian S. Alper"}],"characteristic":[{"definitionByTypeAndValue":{"type":{"coding":[{"code":"397669002","display":"Age","system":"http://snomed.info/sct"}]},"valueQuantity":{"code":"a","comparator":">=","system":"http://unitsofmeasure.org","unit":"years","value":18}},"description":"Adult.","exclude":false},{"definitionByTypeAndValue":{"type":{"coding":[{"code":"64572001","display":"Disease (disorder)","system":"http://snomed.info/sct"},{"code":"Condition","display":"Condition","system":"http://hl7.org/fhir/resource-types"}]},"valueCodeableConcept":{"coding":[{"code":"44054006","display":"Diabetes mellitus type 2 (disorder)","system":"http://snomed.info/sct"}]}},"description":"Diagnosed with type 2 diabetes.","exclude":false},{"definitionByCombination":{"characteristic":[{"definitionByTypeAndValue":{"type":{"coding":[{"code":"39156-5","display":"Body mass index (BMI) [Ratio]","system":"http://loinc.org"}]},"valueQuantity":{"code":"kg/m2","comparator":">=","system":"http://unitsofmeasure.org","unit":"kg/m2","value":40}},"description":"Body Mass Index (BMI) ≥ 40.0 kg/m2","exclude":false},{"definitionByCombination":{"characteristic":[{"definitionByTypeAndValue":{"type":{"coding":[{"code":"39156-5","display":"Body mass index (BMI) [Ratio]","system":"http://loinc.org"}]},"valueQuantity":{"code":"kg/m2","comparator":">=","system":"http://unitsofmeasure.org","unit":"kg/m2","value":37.5}},"description":"BMI ≥ 37.5 kg/m2","exclude":false},{"definitionByTypeAndValue":{"type":{"coding":[{"code":"103579009","display":"Race (observable entity)","system":"http://snomed.info/sct"}]},"valueCodeableConcept":{"coding":[{"code":"2028-9","display":"Asian","system":"urn:oid:2.16.840.1.113883.6.238"}],"text":"Asian American"}},"description":"Asian American","linkId":"AsianAmerican","note":[{"text":"The evidence and guideline panel decision to modify the BMI threshold for Asian Americans is based on data mostly from Asian Americans not generally including Native Hawaiians and other Pacific Islanders, so it is not explicit whether the modified thresholds apply to Native Hawaiians and other Pacific Islanders. See https://diabetesjournals.org/care/article/38/1/150/37769/BMI-Cut-Points-to-Identify-At-Risk-Asian-Americans for details"}]}],"code":"all-of"},"description":"BMI ≥ 37.5 kg/m2 in Asian Americans"},{"definitionByCombination":{"characteristic":[{"definitionByTypeAndValue":{"type":{"coding":[{"code":"39156-5","display":"Body mass index (BMI) [Ratio]","system":"http://loinc.org"}]},"valueRange":{"high":{"code":"kg/m2","system":"http://unitsofmeasure.org","unit":"kg/m2","value":39.9},"low":{"code":"kg/m2","system":"http://unitsofmeasure.org","unit":"kg/m2","value":35}}},"description":"BMI ≥ 35.0 kg/m2 and ≤ 39.9 kg/m2"},{"definitionCodeableConcept":{"text":"achieving durable weight loss and improvement in comorbidities (including hyperglycemia) with nonsurgical methods"},"description":"who do not achieve durable weight loss and improvement in comorbidities (including hyperglycemia) with nonsurgical methods.","exclude":true}],"code":"all-of"},"description":"BMI ≥ 35.0 kg/m2 and ≤ 39.9 kg/m2 who do not achieve durable weight loss and improvement in comorbidities (including hyperglycemia) with nonsurgical methods."},{"definitionByCombination":{"characteristic":[{"definitionByTypeAndValue":{"type":{"coding":[{"code":"39156-5","display":"Body mass index (BMI) [Ratio]","system":"http://loinc.org"}]},"valueRange":{"high":{"code":"kg/m2","system":"http://unitsofmeasure.org","unit":"kg/m2","value":37.4},"low":{"code":"kg/m2","system":"http://unitsofmeasure.org","unit":"kg/m2","value":32.5}}},"description":"BMI ≥ 32.5 kg/m2 and ≤ 37.4 kg/m2"},{"definitionId":"AsianAmerican","description":"Asian American"},{"definitionCodeableConcept":{"text":"achieving durable weight loss and improvement in comorbidities (including hyperglycemia) with nonsurgical methods"},"description":"who do not achieve durable weight loss and improvement in comorbidities (including hyperglycemia) with nonsurgical methods.","exclude":true}],"code":"all-of"},"description":"BMI ≥ 32.5 kg/m2 and ≤ 37.4 kg/m2 in Asian Americans who do not achieve durable weight loss and improvement in comorbidities (including hyperglycemia) with nonsurgical methods."}],"code":"any-of"},"description":"Body Mass Index (BMI) ≥ 40.0 kg/m2 (BMI ≥ 37.5 kg/m2 in Asian Americans), or BMI ≥ 35.0 kg/m2 and ≤ 39.9 kg/m2 (BMI 32.5-37.4 kg/m2 in Asian Americans) who do not achieve durable weight loss and improvement in comorbidities (including hyperglycemia) with nonsurgical methods."},{"definitionByCombination":{"characteristic":[{"definitionByTypeAndValue":{"type":{"coding":[{"code":"64572001","display":"Disease (disorder)","system":"http://snomed.info/sct"},{"code":"Condition","display":"Condition","system":"http://hl7.org/fhir/resource-types"}]},"valueReference":{"display":"Acute Coronary Heart Disease Value Set","reference":"ValueSet/32152","type":"ValueSet"}},"description":"acute coronary heart disease (a value set covering many forms)"},{"definitionByTypeAndValue":{"type":{"coding":[{"code":"71388002","display":"Procedure (procedure)","system":"http://snomed.info/sct"},{"code":"Procedure","display":"Procedure","system":"http://hl7.org/fhir/resource-types"}]},"valueCodeableConcept":{"coding":[{"code":"81266008","display":"Heart revascularization (procedure)","system":"http://snomed.info/sct"}]}},"description":"coronary artery angioplasty or bypass"},{"definitionByTypeAndValue":{"type":{"coding":[{"code":"64572001","display":"Disease (disorder)","system":"http://snomed.info/sct"},{"code":"Condition","display":"Condition","system":"http://hl7.org/fhir/resource-types"}]},"valueCodeableConcept":{"coding":[{"code":"230690007","display":"Cerebrovascular accident (disorder)","system":"http://snomed.info/sct"}]}},"description":"stroke"}],"code":"any-of"},"description":"Cardiovascular event (myocardial infarction, acute coronary syndrome, coronary artery angioplasty or bypass, stroke) in the past six months.","exclude":true,"note":[{"text":"placeholder for now to represent 'screened surgical candidate'"}],"timeFromEvent":[{"description":"in the past six months","note":[{"text":"occurrence within the range is equivalent to 'in the past six months'"}],"range":{"high":{"code":"mo","system":"http://unitsofmeasure.org","unit":"months","value":0},"low":{"code":"mo","system":"http://unitsofmeasure.org","unit":"months","value":-6}}}]},{"definitionCodeableConcept":{"text":"Current evidence of congestive heart failure, angina pectoris, or symptomatic peripheral vascular disease."},"description":"Current evidence of congestive heart failure, angina pectoris, or symptomatic peripheral vascular disease.","exclude":true,"note":[{"text":"This may be possible to encode as presence of Disease(disorder) without 'in remission'"},{"text":"placeholder for now to represent 'screened surgical candidate'"}]},{"definitionCodeableConcept":{"text":"Cardiac stress test indicating that surgery or IMM would not be safe."},"description":"Cardiac stress test indicating that surgery or IMM would not be safe.","exclude":true,"note":[{"text":"placeholder for now to represent 'screened surgical candidate'"}]},{"definitionByTypeAndValue":{"type":{"coding":[{"code":"64572001","display":"Disease (disorder)","system":"http://snomed.info/sct"},{"code":"Condition","display":"Condition","system":"http://hl7.org/fhir/resource-types"}]},"valueCodeableConcept":{"coding":[{"code":"59282003","display":"Pulmonary embolism (disorder)","system":"http://snomed.info/sct"}]}},"description":"Pulmonary embolus in the past six months.","exclude":true,"note":[{"text":"placeholder for now to represent 'screened surgical candidate'"}],"timeFromEvent":[{"description":"in the past six months","note":[{"text":"occurrence within the range is equivalent to 'in the past six months'"}],"range":{"high":{"code":"mo","system":"http://unitsofmeasure.org","unit":"months","value":0},"low":{"code":"mo","system":"http://unitsofmeasure.org","unit":"months","value":-6}}}]},{"definitionByTypeAndValue":{"type":{"coding":[{"code":"64572001","display":"Disease (disorder)","system":"http://snomed.info/sct"},{"code":"Condition","display":"Condition","system":"http://hl7.org/fhir/resource-types"}]},"valueCodeableConcept":{"coding":[{"code":"64156001","display":"Thrombophlebitis (disorder)","system":"http://snomed.info/sct"}]}},"description":"Thrombophlebitis in the past six months.","exclude":true,"note":[{"text":"placeholder for now to represent 'screened surgical candidate'"}],"timeFromEvent":[{"description":"in the past six months","note":[{"text":"occurrence within the range is equivalent to 'in the past six months'"}],"range":{"high":{"code":"mo","system":"http://unitsofmeasure.org","unit":"months","value":0},"low":{"code":"mo","system":"http://unitsofmeasure.org","unit":"months","value":-6}}}]},{"definitionByCombination":{"characteristic":[{"definitionByTypeAndValue":{"type":{"coding":[{"code":"64572001","display":"Disease (disorder)","system":"http://snomed.info/sct"},{"code":"Condition","display":"Condition","system":"http://hl7.org/fhir/resource-types"}]},"valueCodeableConcept":{"coding":[{"code":"363346000","display":"Malignant neoplastic disease (disorder)","system":"http://snomed.info/sct"}]}},"description":"Cancer of any kind","exclude":false},{"definitionByTypeAndValue":{"type":{"coding":[{"code":"64572001","display":"Disease (disorder)","system":"http://snomed.info/sct"},{"code":"Condition","display":"Condition","system":"http://hl7.org/fhir/resource-types"}]},"valueCodeableConcept":{"coding":[{"code":"254701007","display":"Basal cell carcinoma of skin (disorder)","system":"http://snomed.info/sct"}]}},"description":"(except basal cell skin cancer)","exclude":true},{"definitionByTypeAndValue":{"type":{"coding":[{"code":"64572001","display":"Disease (disorder)","system":"http://snomed.info/sct"},{"code":"Condition","display":"Condition","system":"http://hl7.org/fhir/resource-types"}]},"valueCodeableConcept":{"coding":[{"code":"109355002","display":"Carcinoma in situ (disorder)","system":"http://snomed.info/sct"}]}},"description":"(except cancer in situ)","exclude":true},{"definitionCodeableConcept":{"coding":[{"code":"395100000","display":"No evidence of cancer found (situation)","system":"http://snomed.info/sct"}]},"description":"unless documented to be disease-free for five years","exclude":true,"timeFromEvent":[{"description":"for five years","note":[{"text":"presence throughout the range is equivalent to 'for five 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[Mass/volume] in Blood","system":"http://loinc.org"}]},"valueQuantity":{"code":"g/dL","comparator":"<=","system":"http://unitsofmeasure.org","unit":"g/dL","value":-1}},"description":"Significant anemia (hemoglobin 1.0 g or more below normal range)","exclude":true,"note":[{"text":"placeholder for now to represent 'screened surgical candidate'"}]},{"definitionByTypeAndValue":{"type":{"coding":[{"code":"2160-0","display":"Creatinine [Mass/volume] in Serum or Plasma","system":"http://loinc.org"}]},"valueQuantity":{"code":"mg/dL","comparator":">=","system":"http://unitsofmeasure.org","unit":"mg/dl","value":1.5}},"description":"Serum creatinine ≥ 1.5 mg/dl","exclude":true,"note":[{"text":"placeholder for now to represent 'screened surgical candidate'"}]}],"contact":[{"telecom":[{"system":"email","value":"support@computablepublishing.com"}]}],"copyright":"https://creativecommons.org/licenses/by-nc-sa/4.0/","description":"Inclusion Criteria: [[1]] Adults. [[2]] Diagnosed with type 2 diabetes. [[3]] Body Mass Index (BMI) ≥ 40.0 kg/m2 (BMI ≥ 37.5 kg/m2 in Asian Americans), or BMI ≥ 35.0 kg/m2 and ≤ 39.9 kg/m2 (BMI 32.5-37.4 kg/m2 in Asian Americans) who do not achieve durable weight loss and improvement in comorbidities (including hyperglycemia) with nonsurgical methods. [[4]] Screened surgical candidates.","effectivePeriod":{"start":"2021-01"},"id":"example-eligibility-criteria-ada-rec-bariatric","identifier":[{"assigner":{"display":"Computable Publishing LLC"},"system":"https://fevir.net","type":{"text":"FEvIR Object Identifier"},"value":"32140"}],"name":"RecommendationEligibilityCriteriaEligibilityCriteriaForBariatricSurgeryADARecommendation816","publisher":"Computable Publishing LLC","resourceType":"EvidenceVariable","shortTitle":"Recommend bariatric surgery if BMI 35 or higher","status":"active","text":{"div":"

Generated Narrative: EvidenceVariable

Resource EvidenceVariable "example-eligibility-criteria-ada-rec-bariatric"

identifier: FEvIR Object Identifier:\u00a032140

name: RecommendationEligibilityCriteriaEligibilityCriteriaForBariatricSurgeryADARecommendation816

title: RecommendationEligibilityCriteria: Eligibility Criteria for Bariatric Surgery (ADA Recommendation 8.16)

shortTitle: Recommend bariatric surgery if BMI 35 or higher

status: active

publisher: Computable Publishing LLC

contact: support@computablepublishing.com

description: Inclusion Criteria: [[1]] Adults. [[2]] Diagnosed with type 2 diabetes. [[3]] Body Mass Index (BMI) ≥ 40.0 kg/m2 (BMI ≥ 37.5 kg/m2 in Asian Americans), or BMI ≥ 35.0 kg/m2 and ≤ 39.9 kg/m2 (BMI 32.5-37.4 kg/m2 in Asian Americans) who do not achieve durable weight loss and improvement in comorbidities (including hyperglycemia) with nonsurgical methods. [[4]] Screened surgical candidates.

copyright: https://creativecommons.org/licenses/by-nc-sa/4.0/

effectivePeriod: 2021-01 --> (ongoing)

author: Brian S. Alper:

actual: false

characteristic

description: Adult.

exclude: false

DefinitionByTypeAndValues

-TypeValue[x]
*Age (SNOMED CT#397669002)>=18 years (Details: UCUM code a = 'a')

characteristic

description: Diagnosed with type 2 diabetes.

exclude: false

DefinitionByTypeAndValues

-TypeValue[x]
*Disease (disorder) (SNOMED CT#64572001; resource-types#Condition "Condition")Diabetes mellitus type 2 (disorder) (SNOMED CT#44054006)

characteristic

description: Body Mass Index (BMI) ≥ 40.0 kg/m2 (BMI ≥ 37.5 kg/m2 in Asian Americans), or BMI ≥ 35.0 kg/m2 and ≤ 39.9 kg/m2 (BMI 32.5-37.4 kg/m2 in Asian Americans) who do not achieve durable weight loss and improvement in comorbidities (including hyperglycemia) with nonsurgical methods.

definitionByCombination

code: any-of

characteristic

description: Body Mass Index (BMI) ≥ 40.0 kg/m2

exclude: false

definitionByTypeAndValue

characteristic

description: BMI ≥ 37.5 kg/m2 in Asian Americans

definitionByCombination

characteristic

description: BMI ≥ 35.0 kg/m2 and ≤ 39.9 kg/m2 who do not achieve durable weight loss and improvement in comorbidities (including hyperglycemia) with nonsurgical methods.

definitionByCombination

characteristic

description: BMI ≥ 32.5 kg/m2 and ≤ 37.4 kg/m2 in Asian Americans who do not achieve durable weight loss and improvement in comorbidities (including hyperglycemia) with nonsurgical methods.

definitionByCombination

characteristic

description: Cardiovascular event (myocardial infarction, acute coronary syndrome, coronary artery angioplasty or bypass, stroke) in the past six months.

note: placeholder for now to represent 'screened surgical candidate'

exclude: true

definitionByCombination

code: any-of

characteristic

description: acute coronary heart disease (a value set covering many forms)

definitionByTypeAndValue

characteristic

description: coronary artery angioplasty or bypass

definitionByTypeAndValue

characteristic

description: stroke

definitionByTypeAndValue

TimeFromEvents

-DescriptionNoteRange
*in the past six monthsoccurrence within the range is equivalent to 'in the past six months'-6-0 months

characteristic

description: Current evidence of congestive heart failure, angina pectoris, or symptomatic peripheral vascular disease.

note: This may be possible to encode as presence of Disease(disorder) without 'in remission', placeholder for now to represent 'screened surgical candidate'

exclude: true

definitionCodeableConcept: Current evidence of congestive heart failure, angina pectoris, or symptomatic peripheral vascular disease. ()

characteristic

description: Cardiac stress test indicating that surgery or IMM would not be safe.

note: placeholder for now to represent 'screened surgical candidate'

exclude: true

definitionCodeableConcept: Cardiac stress test indicating that surgery or IMM would not be safe. ()

characteristic

description: Pulmonary embolus in the past six months.

note: placeholder for now to represent 'screened surgical candidate'

exclude: true

DefinitionByTypeAndValues

-TypeValue[x]
*Disease (disorder) (SNOMED CT#64572001; resource-types#Condition "Condition")Pulmonary embolism (disorder) (SNOMED CT#59282003)

TimeFromEvents

-DescriptionNoteRange
*in the past six monthsoccurrence within the range is equivalent to 'in the past six months'-6-0 months

characteristic

description: Thrombophlebitis in the past six months.

note: placeholder for now to represent 'screened surgical candidate'

exclude: true

DefinitionByTypeAndValues

-TypeValue[x]
*Disease (disorder) (SNOMED CT#64572001; resource-types#Condition "Condition")Thrombophlebitis (disorder) (SNOMED CT#64156001)

TimeFromEvents

-DescriptionNoteRange
*in the past six monthsoccurrence within the range is equivalent to 'in the past six months'-6-0 months

characteristic

description: Cancer of any kind (except basal cell skin cancer or cancer in situ) unless documented to be disease-free for five years.

note: This combination logic fails if the patient has both a basal cell skin cancer or cancer in situ and a cancer of another kind., placeholder for now to represent 'screened surgical candidate'

exclude: true

definitionByCombination

code: all-of

characteristic

description: Cancer of any kind

exclude: false

definitionByTypeAndValue

characteristic

description: (except basal cell skin cancer)

exclude: true

definitionByTypeAndValue

characteristic

description: (except cancer in situ)

exclude: true

definitionByTypeAndValue

characteristic

description: unless documented to be disease-free for five years

exclude: true

definitionCodeableConcept: No evidence of cancer found (situation) (SNOMED CT#395100000)

timeFromEvent

characteristic

description: History of coagulopathy

note: placeholder for now to represent 'screened surgical candidate'

exclude: true

definitionCodeableConcept: history of coagulopathy ()

characteristic

description: Significant anemia (hemoglobin 1.0 g or more below normal range)

note: placeholder for now to represent 'screened surgical candidate'

exclude: true

DefinitionByTypeAndValues

-TypeValue[x]Offset
*Hemoglobin [Mass/volume] in Blood (LOINC#718-7)<=-1 g/dL (Details: UCUM code g/dL = 'g/dL')Lower Normal Limit (Characteristic Offset#LNL)

characteristic

description: Serum creatinine ≥ 1.5 mg/dl

note: placeholder for now to represent 'screened surgical candidate'

exclude: true

DefinitionByTypeAndValues

-TypeValue[x]
*Creatinine [Mass/volume] in Serum or Plasma (LOINC#2160-0)>=1.5 mg/dl (Details: UCUM code mg/dL = 'mg/dL')
","status":"generated"},"title":"RecommendationEligibilityCriteria: Eligibility Criteria for Bariatric Surgery (ADA Recommendation 8.16)"}