Timely Treatment of Severe Hypertension

  "Encounter With First Severe Hypertension Sustained Within 60 Minutes"

  ["Physical Exam, Performed": "Diastolic blood pressure"]

    "Encounter With First Severe Hypertension Sustained Within 60 Minutes" QualifyingEncounter
      let FirstHypertensionTime: "SevereHTNTimings"(QualifyingEncounter).HTNReadingTime[0]
        with ["Medication, Administered": "Maternal Antihypertensive"] Antihypertensive
       such that  Global."EarliestOf" ( Antihypertensive.relevantDatetime, Antihypertensive.relevantPeriod ) 60 minutes or less after FirstHypertensionTime

  PCMaternal."Encounter With Age Range" EncounterWithAge
    where "CalculatedGestationalAgeAtArrival" ( EncounterWithAge ) >= 20

  PCMaternal."Encounter With Age Range" EncounterWithAge
    where "CalculatedGestationalAgeAtArrival" ( EncounterWithAge ) is null
      and "EstimatedGestationalAgeAtArrival" ( EncounterWithAge ) >= 20 weeks

  "Pregnant Encounter 20 Plus Weeks Gestation Or Postpartum Encounter" PPEncounter
     let FirstHypertensionTime: "SevereHTNTimings"(PPEncounter).HTNReadingTime[0],
        LastBPIn15Mins: "LastBPReadingIn15Mins"(PPEncounter, FirstHypertensionTime),
        SystolicReading: singleton from ("Systolic BP" SystolicBP
                      where Global."EarliestOf"(SystolicBP.relevantDatetime, SystolicBP.relevantPeriod) same as LastBPIn15Mins.Timing),                    
        DiastolicReading: singleton from ("Diastolic BP" DiastolicBP
                      where Global."EarliestOf"(DiastolicBP.relevantDatetime, DiastolicBP.relevantPeriod) same as LastBPIn15Mins.Timing),
        AllBPExams: ("Systolic BP" union "Diastolic BP") AllBPs where Global."EarliestOf"(AllBPs.relevantDatetime, AllBPs.relevantPeriod) during PCMaternal."HospitalizationWithEDOBTriageObservation"(PPEncounter)
      where  FirstHypertensionTime is not null 
        and (
            (SystolicReading.result.value >= 160 or DiastolicReading.result.value >= 110 )
            or 
              (not (exists (AllBPExams) AnyBPExam
               let AnyBPExamTiming: Global."EarliestOf"(AnyBPExam.relevantDatetime, AnyBPExam.relevantPeriod) 
               where AnyBPExam.result is not null 
                   and AnyBPExamTiming 15 minutes or less after minute of FirstHypertensionTime
                )
              )
             or 
              (SystolicReading.result.value < 160 and DiastolicReading.result.value < 110 
                and (
                    exists ( ("SevereHTNTimings"(PPEncounter)) SevereBPReadingTime
                        where (difference in minutes between FirstHypertensionTime and SevereBPReadingTime.HTNReadingTime) in Interval [16,60]
                            )
                     or 
                      (not (exists (AllBPExams) AnyBPExam
                        let AnyBPExamTiming: Global."EarliestOf"(AnyBPExam.relevantDatetime, AnyBPExam.relevantPeriod)
                            where AnyBPExam.result is not null
                                  and ( difference in minutes between FirstHypertensionTime and AnyBPExamTiming ) in Interval [16,60]
                            )
                        )
                  
                  )
             )
            
        )

  PCMaternal."Encounter With Age Range" EncounterWithAge
    let CGA: "CalculatedGestationalAgeAtArrival" ( EncounterWithAge ),
    EGA: "EstimatedGestationalAgeAtArrival" ( EncounterWithAge )
    where CGA is null
      and EGA is null
      and exists ( EncounterWithAge.diagnoses EncounterDiagnoses
          where EncounterDiagnoses.code in "20 to 42 Plus Weeks Gestation"
      )

  ["Encounter, Performed": "Encounter Inpatient"] EncounterInpatient
    where EncounterInpatient.relevantPeriod ends during day of "Measurement Period"

  "Pregnant Encounter 20 Plus Weeks Gestation Or Postpartum Encounter"

    "Encounter With Antihypertensive Treatment 60 Minutes Or Less After First Severe Hypertension Blood Pressure Reading"

  "Encounter With Age Range" EncounterWithAge
    with ["Procedure, Performed": "Delivery Procedures"] DeliveryProcedure
      such that Global."NormalizeInterval" ( DeliveryProcedure.relevantDatetime, DeliveryProcedure.relevantPeriod ) starts during "HospitalizationWithEDOBTriageObservation"(EncounterWithAge)

  Global."Inpatient Encounter" InpatientEncounter
    where AgeInYearsAt(date from start of InpatientEncounter.relevantPeriod) >= 8
      and AgeInYearsAt(date from start of InpatientEncounter.relevantPeriod) < 65

  (PCMaternal."Encounter With Age Range" 
   except PCMaternal."Delivery Encounter With Age Range" ) EncounterWithoutDelivery
    let AssessedPostpartum: "IsInFirstPostpartum" (EncounterWithoutDelivery).result,
      CalculatedPostpartum: "CalculatedWeeksPostPartumAtArrival" (EncounterWithoutDelivery) 
          where ( (AssessedPostpartum ~ "Yes (qualifier value)"
              or CalculatedPostpartum between 0 and 6)
              or
                (AssessedPostpartum is null
                  and CalculatedPostpartum is null
                  and exists (EncounterWithoutDelivery.diagnoses EncounterDiagnoses
                     where EncounterDiagnoses.code in "Postpartum Hypertension")
                )
          )

  "Pregnant Encounter With Gestational Age Greater Than Or Equal To 20 Weeks"
      union "Postpartum Encounter"

  "Encounter With Calculated Gestational Age Greater Than Or Equal To 20 Weeks"
    union "Encounter With Estimated Gestational Age Greater Than Or Equal To 20 Weeks"
    union "Encounter With Gestational Age Greater Than Or Equal To 20 Weeks Based On Coding"

  ["Patient Characteristic Ethnicity": "Ethnicity"]

  ["Patient Characteristic Payer": "Payer Type"]

  ["Patient Characteristic Race": "Race"]

  ["Patient Characteristic Sex": "Federal Administrative Sex"]

  ["Physical Exam, Performed": "Systolic blood pressure"]

  (
    ["Physical Exam, Performed": "Systolic blood pressure"] S
      where S.result.unit = 'mm[Hg]'
        and Global."EarliestOf"(S.relevantDatetime, S.relevantPeriod) during PCMaternal."HospitalizationWithEDOBTriageObservation"(Encounter)
      return {
        Timing: Global."EarliestOf"(S.relevantDatetime, S.relevantPeriod)
      }
  )
  union
  (
    ["Physical Exam, Performed": "Diastolic blood pressure"] D
      where D.result.unit = 'mm[Hg]'
        and Global."EarliestOf"(D.relevantDatetime, D.relevantPeriod) during PCMaternal."HospitalizationWithEDOBTriageObservation"(Encounter)
      return {
        Timing: Global."EarliestOf"(D.relevantDatetime, D.relevantPeriod)
      }
  )

  Last(["Assessment, Performed": "Delivery date Estimated"] EstimatedDateOfDelivery
      where Global."EarliestOf"(EstimatedDateOfDelivery.relevantDatetime, EstimatedDateOfDelivery.relevantPeriod)during day of PCMaternal."HospitalizationWithEDOBTriageObservation" (Encounter)
        and EstimatedDateOfDelivery.result is not null
      sort by Global."EarliestOf"(relevantDatetime, relevantPeriod)
  ).result as DateTime

  ( 280 - ( difference in days between start of PCMaternal."HospitalizationWithEDOBTriageObservation" (Encounter) and "AssessedEstimatedDeliveryDate"(Encounter) ) ) div 7

( difference in days between "LastDateOfDelivery" (Encounter) and start of PCMaternal."HospitalizationWithEDOBTriageObservation" (Encounter)  ) div 7

  Last(["Assessment, Performed": "Estimated Gestational Age"] LastEGA 
      let EGATiming: Global."EarliestOf"(LastEGA.relevantDatetime, LastEGA.relevantPeriod) 
      where EGATiming on same day as start of PCMaternal."HospitalizationWithEDOBTriageObservation"(Encounter) 
                and LastEGA.result is not null
        sort by Global."EarliestOf"(relevantDatetime, relevantPeriod)     
        ).result as Quantity

  if ( HasStart(period)) then start of period 
    else 
  end of period

  Earliest(NormalizeInterval(pointInTime, period))

  not ( start of period is null
      or start of period = minimum DateTime
  )

  if pointInTime is not null then Interval[pointInTime, pointInTime]
    else if period is not null then period 
    else null as Interval<DateTime>

  First(["Assessment, Performed": "Patient is within 6 weeks postpartum"] Postpartum
        where Postpartum.result is not null
        and Global."EarliestOf"(Postpartum.relevantDatetime, Postpartum.relevantPeriod) during day of PCMaternal."HospitalizationWithEDOBTriageObservation"(Encounter)
        sort by Global."EarliestOf"(relevantDatetime, relevantPeriod) 
  )

  Last ( ("AllBloodPressureReadingsDuringEncounter"(Encounter)) AllBPReadings
    where AllBPReadings.Timing > FirstHypertensionTime
      and  (difference in minutes between FirstHypertensionTime and AllBPReadings.Timing ) <= 15
    sort by Timing
  )

   Last(["Assessment, Performed": "Date and time of obstetric delivery"] LastDelivery
      where Global."EarliestOf"(LastDelivery.relevantDatetime, LastDelivery.relevantPeriod)during day of PCMaternal."HospitalizationWithEDOBTriageObservation" (Encounter) 
        and LastDelivery.result is not null
      sort by Global."EarliestOf"(relevantDatetime, relevantPeriod)
  ).result as DateTime

  //HospitalizationWithEDOBTriageObservation returns the total interval from the start of any immediately prior emergency department visit or OB Triage visit through the observation visit to the discharge of the given encounter.
  
  Encounter Visit
    let ObsVisit: Last(["Encounter, Performed": "Observation Services"] LastObs
        where LastObs.relevantPeriod ends 1 hour or less on or before start of Visit.relevantPeriod
        sort by end of relevantPeriod
    ),
    VisitStart: Coalesce(start of ObsVisit.relevantPeriod, start of Visit.relevantPeriod),
    EDOBTriageVisit: Last(["Encounter, Performed": "ED Visit and OB Triage"] LastEDOBTriage
        where LastEDOBTriage.relevantPeriod ends 1 hour or less on or before VisitStart
        sort by end of relevantPeriod
    )
    return Interval[Coalesce(start of EDOBTriageVisit.relevantPeriod, VisitStart), 
        end of Visit.relevantPeriod]

 ( ( ["Physical Exam, Performed": "Systolic blood pressure"] SystolicBP
    where SystolicBP.result.unit = 'mm[Hg]'
      and SystolicBP.result.value >= 160
      return {
        HTNReadingTime: Global."EarliestOf" (SystolicBP.relevantDatetime, SystolicBP.relevantPeriod)
        }
 )    
union (
  ["Physical Exam, Performed": "Diastolic blood pressure"] DiastolicBP
    where DiastolicBP.result.unit = 'mm[Hg]'
      and DiastolicBP.result.value >= 110
      return {
        HTNReadingTime: Global."EarliestOf" (DiastolicBP.relevantDatetime, DiastolicBP.relevantPeriod)
        }
    ) ) SevereBPReadingTime
    where SevereBPReadingTime.HTNReadingTime during PCMaternal."HospitalizationWithEDOBTriageObservation"(Encounter)
      sort by HTNReadingTime