USCDI Export for the Public

This data element denotes whether an individual currently consumes alcohol or not

Most of the requested data elements are in LOINC, as per the codes below. We have requested the addition of the NIAAA Single-Item Screener and the diagnosis of Alcohol Use Disorder to LOINC. AUDIT-C : 72109-2 Ethanol in blood: 5640-8 Ever drink alcohol: 69721-9 Average daily alcohol intake: 74013-4 Alcohol binge episodes/month: 11286-2 Alcohol abuse or dependence: 74043-1 Alcohol help during pregnancy: 64718-0

This data element provides a measure of an individual’s average daily alcohol intake, i.e., how many drinks per day someone has

Most of the requested data elements are in LOINC, as per the codes below. We have requested the addition of the NIAAA Single-Item Screener and the diagnosis of Alcohol Use Disorder to LOINC. AUDIT-C : 72109-2 Ethanol in blood: 5640-8 Ever drink alcohol: 69721-9 Average daily alcohol intake: 74013-4 Alcohol binge episodes/month: 11286-2 Alcohol abuse or dependence: 74043-1 Alcohol help during pregnancy: 64718-0

This data element includes whether an individual has received a diagnosis of alcohol abuse or dependence, as per the DSM-IV nosology

Most of the requested data elements are in LOINC, as per the codes below. We have requested the addition of the NIAAA Single-Item Screener and the diagnosis of Alcohol Use Disorder to LOINC. AUDIT-C : 72109-2 Ethanol in blood: 5640-8 Ever drink alcohol: 69721-9 Average daily alcohol intake: 74013-4 Alcohol binge episodes/month: 11286-2 Alcohol abuse or dependence: 74043-1 Alcohol help during pregnancy: 64718-0

This data element captures the Alcohol Use Disorder (AUD) diagnosis, which reflects the current nosology for the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5).

Most of the requested data elements are in LOINC, as per the codes below. We have requested the addition of the NIAAA Single-Item Screener and the diagnosis of Alcohol Use Disorder to LOINC. AUDIT-C : 72109-2 Ethanol in blood: 5640-8 Ever drink alcohol: 69721-9 Average daily alcohol intake: 74013-4 Alcohol binge episodes/month: 11286-2 Alcohol abuse or dependence: 74043-1 Alcohol help during pregnancy: 64718-0

This data element describes whether an individual sought help for alcohol-related problems during pregnancy

Most of the requested data elements are in LOINC, as per the codes below. We have requested the addition of the NIAAA Single-Item Screener and the diagnosis of Alcohol Use Disorder to LOINC. AUDIT-C : 72109-2 Ethanol in blood: 5640-8 Ever drink alcohol: 69721-9 Average daily alcohol intake: 74013-4 Alcohol binge episodes/month: 11286-2 Alcohol abuse or dependence: 74043-1 Alcohol help during pregnancy: 64718-0

The AUDIT-C is a three-item measure to screen for alcohol-related problems. Questions and answers include: 1. How often do you have a drink containing alcohol? (Response choices: Never/Monthly or less/2-4 times per month/2-3 times per week/4 or more times per week) 2. How many standard drinks containing alcohol do you have on a typical day? (Response choices: 1-2/3-4/5-6/7-9/10 or more) 3. How often do you have six or more drinks on one occasion? (Response choices: Daily or almost daily/Weekly/Monthly/Less than monthly/Never)

Most of the requested data elements are in LOINC, as per the codes below. We have requested the addition of the NIAAA Single-Item Screener and the diagnosis of Alcohol Use Disorder to LOINC. AUDIT-C : 72109-2 Ethanol in blood: 5640-8 Ever drink alcohol: 69721-9 Average daily alcohol intake: 74013-4 Alcohol binge episodes/month: 11286-2 Alcohol abuse or dependence: 74043-1 Alcohol help during pregnancy: 64718-0

The NIAAA Single-Item Screener is a single question that may be used to screen men and women (separately) for unhealthy alcohol use. It has been validated in primary care settings; the specific language for men and women appears below. Men: How many times in the past year have you had five or more drinks in a day? Women: How many times in the past year have you had four or more drinks in a day?

Most of the requested data elements are in LOINC, as per the codes below. We have requested the addition of the NIAAA Single-Item Screener and the diagnosis of Alcohol Use Disorder to LOINC. AUDIT-C : 72109-2 Ethanol in blood: 5640-8 Ever drink alcohol: 69721-9 Average daily alcohol intake: 74013-4 Alcohol binge episodes/month: 11286-2 Alcohol abuse or dependence: 74043-1 Alcohol help during pregnancy: 64718-0

An identifier of the custodian organization.

Domain of the stated patient goal.
Examples of goal categories include housing, physical function, behavioral, and social & role functioning.

HL7 Terminology: Goal Category.

NCQA is also actively working with the HL7 Patient Goals work group to update the HL7 terminology for “goal category” to include additional patient goal categories aligned to our work.

Inability to pay for, threat of shutoff and lack of access to utilities. (LOINC) LA30124-4 : Synonyms: (ICD-10-CM) Z59.1 Inadequate housing (lack of heat, restriction of space, technical home defects, unsatisfactory surroundings) Z59.62 (Unable to pay for utilities)

LOINC 93031-3 In the past year, have you or any family members you live with been unable to get any of the following when it was really needed?

In the past year whether patient has been unable to afford or access a phone. (LOINC) LA30129-3 LA13918-0 (With little difficulty), 3; LA13920-6 (with some difficulty), 2; LA13919-8 (With much difficulty) Synonyms: (SNOMEDCT) 5501000175107 Lack of telephone in home environment (ICD-10-CM) Z59.65 (Unable to pay for phone)

LOINC 93031-3 In the past year, have you or any family members you live with been unable to get any of the following when it was really needed?

In the past year whether patient has been unable to afford or access medicine or or any health care (medical, dental, mental health, vision) services. (LOINC) LA30128-5 LA15832-1 (Very hard), 2; LA14745-6 (Hard), 3; LA22683-9 (Somewhat)" Synonyms: (SNOMEDCT) 423593006 Inadequate healthcare resources (ICD-10-CM) Z59.63 (Unable to pay for medical care) Z59.61 (Unable to pay for prescriptions)

LOINC 93031-3 In the past year, have you or any family members you live with been unable to get any of the following when it was really needed?

In the past year whether patient has been able to unable to find affordable or pay for childcare. (LOINC) LA30127-7 Synonyms: (ICD-10-CM) Z59.68 (Unable to pay for child care)

LOINC 93031-3 In the past year, have you or any family members you live with been unable to get any of the following when it was really needed?

The Karnofsky Performance Status (KPS) is a tool used to measure a patient's functional status. It can be used to compare the effectiveness of different therapies and to help assess the prognosis of certain patients, such as those with certain cancers. The KPS score ranges from 0 to 100 in intervals of 10. Higher scores are associated with better functional status, with 100 representing no symptoms or evidence of disease, and 0 representing death.

LOINC, SNOMED-CT, and FHIR see: https://search.loinc.org/searchLOINC/search.zul?query=functional+status http://hl7.org/fhir/us/mcode/ https://browser.ihtsdotools.org/?perspective=full&conceptId1=273472005&edition=MAIN/2020-07-31&release=&languages=en

A measure of the estimated average quantity of tobacco product used in a 24hr period. o Smoking Tobacco Use A general estimate of the number of cigarettes, cigars, or bowls (pipe) with Nicotine smoked in a 24hr period. Question Prompt: Average number of cigarettes, cigars, or bowls (pipe) smoked per day o E-Cigarettes Use Count of the number of disposable cigarettes, prefilled cartridges/pods, or refillable bottles with nicotine smoked in a 24hr period. Question Prompt: Average number of disposable e-cigarettes, prefilled cartridges/pods, or refillable bottles smoked per day o Smokeless Tobacco Use Amount of smokeless Tobacco consumed in a 24hr period. Question Prompt: Average number of pinches of smokeless tobacco consumed per day

There are SNOMED and LOINC Codes for most of the data elements but new codes will be requested for eCigarette use.

A question about how often an individual uses or used any tobacco product. An ordered reference standard related to the use of tobacco within a period of time. Element from the TAPS Tool: In the PAST 12 MONTHS, how often have you used any tobacco product (for example, cigarettes, e-cigarettes, cigars, pipes, or smokeless tobacco)? Value: 1. Daily or almost daily (displayed as "0"): a subjective response that something happens daily or almost daily 2. Weekly (displayed as "1"): Every week 3. Monthly (displayed as "2"): Every month 4. Less than Monthly (displayed as "3"): An event that occurs less frequently than once a month 5. Never (displayed as "4"): Not ever, at no time in the past (or future).

Elements were recently submitted for inclusion in LOINC.

Individual's self-identification as living in a rural area. Rurality is recognized in public health science as a significant indicator of adverse rates of morbidity and morality; this is sometimes called the 'rural health penalty'. Rurality is a complex phenomenon that researchers treat fluidly, with changing definition: https://www.sciencedirect.com/science/article/abs/pii/S0743016721000437 This failure of research to confirm a settled defintion should not constrain from asking the individual's self-identification, anymore than the failure of research to confirm a settled definition of sex or gender should constrain from asking the individual's self-identification of sex or gender.

A condition in which one is unable to regularly move from place to place in a safe and timely manner because one lacks the material, economic or social resources necessary for transportation. (Alix Gould-Werth, Jamie Griffin & Alexandra K. Murphy, “Developing a New Measure of Transportation Insecurity: An Exploratory Factor Analysis,” 11(2) Survey Practice , p. 1 (2018).) Currently under consideration by and in process with the Gravity community.

Yes, a vocabulary/terminology standard and/or technical specification exists for each proposed data element. The Gravity Project attaches a letter with an overview. For (1) Food Insecurity: LOINC, SNOMED-CT, ICD-10-CM, and CPT/HCPCS terminologies are specified by value set in NLM’s Value Set Authority Center (VSAC). For (2) Housing Instability and Homelessness, (3) Inadequate Housing, (4) Transportation Insecurity, (5), Financial Strain, (6) Social Isolation, (7) Stress, (8) Interpersonal Violence, (9) Education, (10) Employment, and (11) Veteran Status: • The corresponding value sets are under development by the Gravity Project; • The value sets will be complete prior to publishing of USCDI v2.0; • Even if a particular value set might be incomplete, the value set will be citable. The technical specifications for value sets under each data element are described below: • Assessments: LOINC • Health Concerns/Problems/Diagnoses: SNOMED-CT, ICD-10-CM • Goals: LOINC • Procedures/Interventions: SNOMED-CT (clinical), CPT/HCPCS (billing) • Outcomes: LOINC (NCQA measures) • Consent (where needed): based on existing HL7 code systems

Housing with moderate to severe physical problems. ( U.S. Department of Housing and Urban Development, American Housing Survey: Housing Adequacy and Quality As Measured by the AHS, p. 2 (Mar. 2013).) Currently under consideration by and in process with the Gravity community.

Yes, a vocabulary/terminology standard and/or technical specification exists for each proposed data element. The Gravity Project attaches a letter with an overview. For (1) Food Insecurity: LOINC, SNOMED-CT, ICD-10-CM, and CPT/HCPCS terminologies are specified by value set in NLM’s Value Set Authority Center (VSAC). For (2) Housing Instability and Homelessness, (3) Inadequate Housing, (4) Transportation Insecurity, (5), Financial Strain, (6) Social Isolation, (7) Stress, (8) Interpersonal Violence, (9) Education, (10) Employment, and (11) Veteran Status: • The corresponding value sets are under development by the Gravity Project; • The value sets will be complete prior to publishing of USCDI v2.0; • Even if a particular value set might be incomplete, the value set will be citable. The technical specifications for value sets under each data element are described below: • Assessments: LOINC • Health Concerns/Problems/Diagnoses: SNOMED-CT, ICD-10-CM • Goals: LOINC • Procedures/Interventions: SNOMED-CT (clinical), CPT/HCPCS (billing) • Outcomes: LOINC (NCQA measures) • Consent (where needed): based on existing HL7 code systems

Currently consistently housed, but experiencing any of the following circumstances in the past 12 months: being behind on rent or mortgage, multiple moves, homelessness; or currently living in a shelter, motel, temporary or transitional living situation, scattered site housing, or not having a consistent place to sleep at night; or lacking a fixed, regular, and adequate nighttime residence. (Richard Sheward, Allison Bovell-Ammon, Nayab Ahmad, Genevieve Preer, Stephanie Ettinger de Cuba & Megan Sandel, Promoting Caregiver and Child Health Through Housing Stability Screening in Clinical Settings, 39 Zero to Three J. 52, 52-53 (Mar. 2019); Megan Sandel, Richard Sheward, Stephanie Ettinger de Cuba, Sharon M. Coleman, Deborah A. Frank, Mariana Chilton, Maureen Black, Timothy Heeren, Justin Pasquariello, Patrick Casey, Eduardo Ochoa & Diana Cutts, Unstable Housing and Caregiver and Child Health in Renter Families, 141 Pediatrics e20172199, p. 3 (2018); McKinney-Vento Homeless Assistance Act of 1987, Pub. L. 100-77, § 103(a)(1), 101 Stat. 482, 485 (July 22, 1987).) Currently under consideration by and in process with the Gravity community.

Yes, a vocabulary/terminology standard and/or technical specification exists for each proposed data element. The Gravity Project attaches a letter with an overview. For (1) Food Insecurity: LOINC, SNOMED-CT, ICD-10-CM, and CPT/HCPCS terminologies are specified by value set in NLM’s Value Set Authority Center (VSAC). For (2) Housing Instability and Homelessness, (3) Inadequate Housing, (4) Transportation Insecurity, (5), Financial Strain, (6) Social Isolation, (7) Stress, (8) Interpersonal Violence, (9) Education, (10) Employment, and (11) Veteran Status: • The corresponding value sets are under development by the Gravity Project; • The value sets will be complete prior to publishing of USCDI v2.0; • Even if a particular value set might be incomplete, the value set will be citable. The technical specifications for value sets under each data element are described below: • Assessments: LOINC • Health Concerns/Problems/Diagnoses: SNOMED-CT, ICD-10-CM • Goals: LOINC • Procedures/Interventions: SNOMED-CT (clinical), CPT/HCPCS (billing) • Outcomes: LOINC (NCQA measures) • Consent (where needed): based on existing HL7 code systems