langcare-quality-measures - SKILL.md Agent Skill

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.

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