table 1. percentage of short-stay residents who …...table 1. percentage of short-stay residents...

Table 1. Percentage of Short-Stay Residents who were Re-hospitalized after a Nursing Home Admission

Measure Description The percent of short-stay residents who entered or reentered the nursing home from a hospital and were re-admitted to a hospital for an unplanned inpatient stay or observation stay within 30 days of the start of the nursing home stay.

Numerator and Denominator Window

The numerator and denominator include stays that started over a 12-month period. The data are updated every six months (in April and October of each year), with a lag time of nine months (i.e., the data posted in April will include stays that started 9-21 months ago).

Numerator The numerator includes nursing home stays for beneficiaries who: a) Met the inclusion and exclusion criteria for the denominator; ANDb) Were admitted to a hospital for or an inpatient stay or outpatient observation stay within 30

days of entry/reentry to the nursing home, regardless of whether they were dischargedfrom the nursing home prior to the hospital readmission. Note that inpatient hospitalizationsand observation stays are identified using Medicare claims; AND

c) The hospital readmission did not meet the definition of a planned hospital readmission(identified using principal discharge diagnosis and procedure codes on Medicare claims forthe inpatient stay)

Denominator Included in the measure are stays for residents who: a) Entered or reentered the nursing home within 1 day of discharge from an inpatient

hospitalization (Note that inpatient rehabilitation facility and long-term care hospitalizationsare not included). These hospitalizations are identified using Medicare Part A claims; AND

b) Entered or reentered the nursing home within the target 12-month period

Denominator Exclusions

Short-stay residents are excluded if: a) The resident did not have Fee-for-Service Parts A and B Medicare enrollment for the entire

risk period (measured as the month of the index hospitalization and the month after themonth of discharge from the nursing home); OR

b) The resident was ever enrolled in hospice care during their stay; ORc) The resident was comatose (B0100 =[01]) or missing data on comatose on the first MDS

assessment after the start of the stay; ORd) Data were missing for any of the claims or MDS items used to construct the numerator or

denominator; ORe) The resident did not have an initial MDS assessment to use in constructing covariates for

risk-adjustment.

Covariates See Tables 2 and 3 for the list of claims-based and MDS-based covariates included in the logistic regression for calculating the facilities' expected rates and the Appendix tables for the risk-adjustment model covariates.

1Nursing Home Compare Draft Technical Specifications (April 2016)

Table 2. Covariates constructed from claims and used in the risk-adjustment model for Short-Stay Residents who were Re-hospitalized after a Nursing Home Admission

Variable Rationale

Age Demographic characteristic that is often important for outcomes of nursing home residents and associated with higher frailty and increasing number of comorbidities.

Sex Demographic characteristic that is important for predicting hospital readmission for the nursing home population.

Length of stay during the hospitalization preceding the nursing home stay

Patients who are hospitalized for longer periods of time may require more complex care because they are often sicker. In addition, bed rest from prolonged hospitalizations often leads to deconditioning and functional impairment.

Any time spent in the intensive care unit (ICU) during the hospitalization preceding the nursing stay

ICU stays are an important indicator of medical severity and a predictor of PAC resource use.

Ever enrolled in Medicare under Disability coverage This is an indicator of overall patient complexity, as qualification for Medicare because of disability requires the presence of serious chronic medical conditions that limit the ability to work.

ESRD This factor has been identified as a risk factor in prior studies of outcomes among nursing home residents.

Number of acute care hospitalizations in the 365 days before the beginning of the nursing stay

More hospitalizations in the previous year may be associated with declining health and increased complexity of care

Principal diagnosis as categorized using AHRQ's single-level CCS

First diagnosis from the Medicare claim corresponding to the prior proximal hospitalization as coded by AHRQ's CCS

Outcome-specific Comorbidity Index Patients with multiple or more severe comorbidities will tend to be frailer, putting them at increased risk for being readmitted to a hospital. This Index is based on the clinical conditions included in the Charlson Comorbidity Index and captures the complexity beyond the linear additivity of the individual comorbidities. See the sub-section below for more details.


Table 3. Covariates constructed from the MDS items and used in the final risk-adjustment model for Short-Stay Residents who were Re-hospitalized after a Nursing Home Admission

Category MDS Item

Functional status

Dependence in eating (G0110H) Walks in room independently or with supervision or limited assistance (G0110C) Wandering once or more in the past week (E0900) Walks in corridor independently or with supervision or limited assistance (G0110D) Wanders and walks in room or corridor independently or with supervision or limited assistance (E0900 and G0110D) Two-person support needed with one or more ADLs (G0110A – G0110J) Cognitive status not completely intact (C0100 – C1000) Cognitive assessment missing (C0100 and C0600) Acute change in mental status (C1600) Rarely makes self-understood by others (B0700) Fell in the last month (J1700A) Fell in the past two to six months (J1700B) Rejected care for past four to seven days (E0800) Coughing or choking during meals or when swallowing medications (K0100C)

Clinical conditions

End-stage prognosis (J1400) Venous/Arterial ulcer present (M1030) Infection of the foot (M1040A) Diabetic foot ulcer (M1040B) Internal bleeding (J1550D) Dehydrated (J1550C) Daily pain (J0400) Surgical wound (M1040E) Total bowel incontinence (H0400) Shortness of breath with exertion (J1100) Shortness of breath when sitting at rest (J1100) Shortness of breath when lying flat (J1100)

Clinical treatments

Parenteral/IV feeding (K0500A) Feeding tube (K0500B) Insulin (N0350A) Dialysis (O0100J) Ostomy care (H0100C) Oxygen therapy (O0100C) Chemotherapy for cancer (O0100A) Radiation for cancer (O0100B) Tracheostomy (O0100E) IV medications (O0100H) Ventilator or respirator (O0100F) Transfusions (O0100I) Antibiotic received (N0400F)


Category MDS Item

Clinical diagnoses

Anemia (I0200) Septicemia (I2100) Diabetes mellitus (I2900) Respiratory failure (I6300) Viral hepatitis (I2400) Heart failure (I0600) Alzheimer's disease (I4200) Non-Alzheimer's dementia (I4800) Cancer (I0100) Pneumonia (I2000) Urinary tract infection (I2300) Seizure disorder or epilepsy (I5400) Ulcerative Colitis/Crohn’s disease/inflammatory bowel disease (I1300) Wound infection other that foot (I0250)

Other Returned to the nursing home following hospitalization (A1700 and A1800) First assessment was for significant change in status (A0310A)


Table 4. Percentage of Short-Stay Residents who have had an Outpatient Emergency Department Visit

Measure Description The percent of short-stay residents who entered or reentered the facility from a hospital, visited an emergency department within 30 days of the start of the stay, and this visit did not result in an inpatient or observation stay.


The numerator and denominator include stays that started over a 12-month period. The data are updated every six months (in April and October of each year), with a lag time of nine months (i.e., the data posted in April will include stays that started 9-21 months ago).

Numerator The numerator includes nursing home stays for beneficiaries who: a) Met the inclusion and exclusion criteria for the denominator; ANDb) Was admitted to an emergency department within 30 days of entry/reentry to the nursing

home, regardless of whether they were discharged from the nursing home prior to theemergency department visit. These emergency department visits are identified usingMedicare Part B claims; AND

c) Were not admitted to a hospital for an inpatient stay or observation stay immediately afterthe visit to the emergency department inpatient and observation stays are determinedusing Medicare Parts A and B claims.

Denominator Included in the measure are stays for residents who: a) Entered or reentered the nursing home within 1 day of discharge from an inpatient

hospitalization (Note that inpatient rehabilitation facility and long-term care hospitalizationsare not included). These hospitalizations are identified using Medicare Part A claims; AND

b) Entered or reentered the nursing home within the target 12-month period



risk period (measured as the month of the index hospitalization and the month after themonth of discharge from the nursing home); OR

b) The resident was ever enrolled in hospice care during their nursing home stay; ORc) The resident was comatose (B0100 =[01]) or missing data on comatose on the first MDS

assessment after the start of the stay; ORd) Data were missing for any of the claims or MDS items used to construct the numerator or


risk-adjustment.



Table 5. Covariates constructed from claims and used in the risk-adjustment model for Short-Stay Residents who have had an Outpatient Emergency Department Visit

Variable Rationale


Sex Demographic characteristic that is important for predicting ED visits and hospital readmissions for the nursing home population.



Any time spent in the intensive care unit (ICU) during the hospitalization preceding the nursing home stay




Number of acute care hospitalizations in the 365 days before the beginning of the nursing home stay






Table 6. Covariates constructed from the MDS items and used in the final risk-adjustment model for Short-Stay Residents who have had an Outpatient Emergency Department Visit

Category MDS Item

Functional status

Walks in room independently or with supervision or limited assistance (G0110C) Walks in corridor independently or with supervision or limited assistance (G0110D) Wandering once or more in the past week (E0900) Two-person support needed with one or more ADLs (G0110A – G0110J) Cognitive status not completely intact (C0100 – C1000) Cognitive assessment missing (C0100 and C0600) Acute change in mental status (C1600) Rarely makes self-understood by others (B0700) Rarely understands others (B0800) Fell in the last month (J1700A) Fell in the past two to six months (J1700B) Rejected care for past four to seven days (E0800)

Clinical conditions

End-stage prognosis (J1400) Venous/Arterial ulcer present (M1030) Internal bleeding (J1550D) Dehydrated (J1550C) Daily pain (J0400) Surgical wound (M1040E) Shortness of breath with exertion (J1100) Shortness of breath when sitting at rest (J1100)

Clinical treatments

Parenteral/IV feeding (K0500A) Feeding tube (K0500B) Insulin (N0350A) Dialysis (O0100J) Ostomy care (H0100C) Radiation for cancer (O0100B) Oxygen therapy (O0100C) Tracheostomy (O0100E) Ventilator or respirator (O0100F) Transfusions (O0100I) Isolation or quarantine for active infectious disease (00100M) Anticoagulant received (N0400E) Antibiotic received (N0400F) Speech therapy (O0400A4) Respiratory therapy (O0400D2)

Clinical diagnoses

Anemia (I0200) Asthma, COPD, chronic lung disease (I6200) Cancer (I0100) Respiratory failure (I6300) Viral hepatitis (I2400) Heart failure (I0600) Orthostatic hypotension (I0800) Pneumonia (I2000) Urinary tract infection (I2300) Seizure disorder or epilepsy (I5400)

Other First assessment was for significant change in status (A0310A)


Table 7. Percentage of Short-Stay Residents who were Successfully Discharged to the Community

Measure Description The percent of short-stay residents admitted to the nursing home from a hospital who were discharged to the community with 100 calendar days of the start of the episode, and who remained in the community for 30 consecutive days following discharge to the community.


The numerator and denominator include episodes that started over a 12-month period. The data are updated every six months (in April and October of each year), with a lag time of nine months (i.e., the data posted in April will include episodes that started 9-21 months ago).

Numerator The numerator includes nursing home episodes for beneficiaries who: a) Met the inclusion and exclusion criteria for the denominator; ANDb) Had a discharge assessment indicating discharge to the ‘community’ (A2100 = [01]) within

100 calendar days of the start of the episode; ANDc) Was not admitted to a nursing home within 30 days of the community discharge, as

determined from Medicare claims; ANDd) Did not have an unplanned inpatient hospital stay within 30 days of the community

discharge, as determined from the principal diagnosis and procedure codes on Medicareclaims; AND

e) Did not die within 30 days of the community discharge, as determined from the MedicareEnrollment DataBase.

Denominator Included in the measure are episodes for residents who: a) Entered the nursing home within 1 day of discharge from an inpatient hospitalization (Note

that inpatient rehabilitation facility and long-term care hospitalizations are not included).These hospitalizations are identified using Medicare Part A claims; AND

b) Entered the nursing home within the target 12-month period



risk period (measured as the month of the index hospitalization and the month after the month of discharge from the nursing home); OR

b) The resident was ever enrolled in hospice care during their nursing home episode; ORc) The resident was comatose (B0100 =[01]) or missing data on comatose on the first MDS

assessment after the start of the episode; ORd) Data were missing for any of the claims or MDS items used to construct the numerator or


risk-adjustment.



Table 8 Covariates constructed from claims and used in the risk-adjustment model for Short-Stay Residents who were Successfully Discharged to the Community

Variable Rationale


Sex Demographic characteristic that is important for predicting outcomes for the nursing home population.



Any time spent in the intensive care unit (ICU) during the hospitalization preceding the nursing home stay




Number of acute care hospitalizations in the 365 days before the beginning of the nursing home stay






Table 9. Covariates constructed from the MDS items and used in the final risk-adjustment model for Short-Stay Residents who were Successfully Discharged to the Community

Category MDS Item

Functional status

Medicare RUG IV Hierarchical Group (Z0100A) Vision Impairment (B1000) Makes self-understood by others (B0700) Ability to understand others (B0800) Cognitive impairment based on the BIMS scale (C0500 and C0600) Cognitive assessment missing (C0500 and C0600) Any signs or symptoms of delirium (C1300) Major Depression (CMS quality measure) Major Depression not assessed (CMS quality measure) Any potential indicators of psychosis or behavioral symptoms (E0100 and E0200) Rejected care in the past seven days (E0800) Dependence in bed mobility (G0110A) Dependence in transfer (G0110B) Dependence in walking in room (G0110C) Dependence in walking in corridor (G0110D) Dependence in locomotion on unit (G0110E) Locomotion on unit missing (G0110E) Dependence in dressing (G0110G) Dependence in eating (G0110H) Dependence in toilet use (G0110I) Toilet use missing (G0110I) Dependence in personal hygiene (G0110J) ADL Summary score interacted with cognitive impairment based on BIMS scale ADL Summary score missing Depending in bathing (G0120) Balance moving from standing to seated position (G0300A) Balance walking (G0300B) Balance turning around (B0300C) Balance moving on and off toilet (B0300D) Fell in the last month (J1700A) Fell in the past two to six months (J1700B) Acute change in mental status (C1600) Wandering once or more in the past week (E0900)

Clinical conditions

Urinary Incontinence (H0300) Bowel Incontinence (H0400) Weight loss (K0300) Shortness of breath with exertion (J01100A) Shortness of breath when sitting at rest (J01100B) Shortness of breath when lying flat (J01100C) Any swallowing disorder (K0100) Wound infection (I2500) Hemiplegia (I4900) Paraplegia (I5000) Quadriplegia (I5100) Multiple Sclerosis (I5200) Huntington’s disease (I5250) Parkinson’s disease (I5300) Seizure disorder or epilepsy (I5400) Surgical wound (M1040E) Infection of the foot (M1040A) Diabetic foot ulcer (M1040B) Any condition related to ID/DD status (A1550)


Category MDS Item

Clinical treatments

Maximum number of injections (N0300 and N0350A) Chemotherapy for cancer (O0100A) Radiation for cancer (O0100B) Oxygen therapy (O0100C) Suctioning (O0100D) Ventilator or respirator (O0100F) IV medications (O0100H) Transfusions (O0100I) Dialysis (O0100J) Parenteral/IV feeding, feeding tube, or mechanically altered diet (K0500A–C) Antipsychotics received (N0400A)

Clinical diagnoses

Cancer (I0100) Anemia (I0200) Asthma, COPD, chronic lung disease (I6200) Heart failure (I0600) Hypertension (I0700) Pneumonia (I2000) Septicemia (I2100) Urinary tract infection (I2300) Viral hepatitis (I2400) Diabetes mellitus (I2900) Hyperkalemia (I3200) Hip fracture (I3900) Other fracture (I4000) Alzheimer's disease (I4200) Non-Alzheimer's dementia (I4800) CVA, TIA, or stroke (I4500) Malnutrition (I5600) Anxiety disorder (I5700) Manic depression (I5900) Psychotic disorder (I5950) Schizophrenia (I6000)

Other Married (A1200) Interpreter needed (A1100) Resident expects to remain in the facility or to be discharged to another facility or institution (Q300A) Entered facility from a psychiatric hospital (A1800)


Table 10. Percentage of Short-stay Residents Who Made Improvements in Function

Measure Description The percent of short-stay nursing home residents who made functional improvements on mid-loss ADLs during their complete episode of care.


The numerator and denominator include all short-stay residents who have resided in the nursing home for an episode of 100 days or fewer as of the end of the target period (e.g., calendar quarter). The data are updated every quarter.

Numerator The numerator includes nursing home episodes for beneficiaries who: a) Met the inclusion and exclusion criteria for the denominator; ANDb) Have a change in performance score that is negative ([Discharge] – [5-day or admission

assessment < 0), using the earlier assessment if resident has both a 5-day (A0310B) andadmission (A0310A) assessment. Note that performance is calculated as the sum ofG0110B1 (transfer: self-performance), G0110E1 (locomotion on unit: self-performance,and G0110D1 (walk in corridor: self-performance), with 7s (activity occurred only one ortwice) and 8s (activity did not occur) recoded to 4s (total dependence).

Denominator Included in the measure are episodes for residents who: a) Have a valid discharge assessment (A0310F); ANDb) Have a valid preceding 5-day assessment (A0310B) OR admission assessment (A0310B)


Long-stay residents are excluded if: a) The resident was comatose (B0100 =[01]) on the 5-day assessment; ORb) Had life expectancy of less than 6 months on the 5-day or admission assessment; ORc) Was in Hospice (O0100K2=[1]) on the 5-day or admission assessment; ORd) Had no impairment (sum of G0110B1, G0110D1 and G0110E1 = 0) on the 5-day or

admission assessment; ORe) Had an unplanned discharge during the care episode (A0310G=[02]); ORf) Data were missing for any of the MDS items used to construct the numerator or

denominator

Covariates From the 5-day or admission assessment: • Age (<=54, 55-84, or >84) (A0900)• Gender (A0800)• Severe cognitive impairment (C0500, C0700, and C1000)• Long-form ADL Scale (G0110A1 + G0110B1 + G0110E1 + G0110G1 + G0110H1 +

G0110I1 + G0110J1) (categorized by tercile in the quarter)• Heart failure (I0600)• CVA, TIA, or stroke (I4500)• Hip fracture (I3900)• Other fracture (I4000)


Table 11. Percentage of Long-stay Residents Whose Ability to Move Independently Worsened

Measure Description The percent of long-stay nursing home residents who experienced a decline in independence in locomotion


The numerator and denominator include all long-stay residents who have resided in the nursing home for longer than 100 days as of the end of the target period (e.g., calendar quarter). The data are updated every quarter.

Numerator The numerator includes long-stay nursing home residents who: a) Met the inclusion and exclusion criteria for the denominator; ANDb) Have a decline in locomotion when comparing their target assessment with the prior

assessment. A decline is identified by an increase of one or more points on the “locomotionon unit: self-performance” item (G0110E1) between the target assessment and the priorassessment, with 7s (activity occurred only one or twice) and 8s (activity did not occur)recoded to 4s (total dependence)

Denominator Included in this measure are long-stay residents who: a) Have a qualifying MDS 3.0 assessment during the target period. Qualifying MDS 3.0

assessments include annual, quarterly, significant change, or significant correction(A0310A = [02, 03, 04, 05, 06]), PPS 14-, 30-, 60-, or 90-day assessment (A0310B = [02,03, 04, 05]), or discharge assessment with or without return anticipated (A0310F = [10,11])

b) Have at least one qualifying prior assessment which include admission, annual, quarterly,significant change, or significant correction (A0310A = [01, 02, 03, 04, 05, 06]), or PPS 5-,14-, 30-, 60-, or 90-day assessment (A0310B = [01, 02, 03, 04, 05])


Long-stay residents are excluded if: a) The resident was comatose (B0100 = [01]) on the prior assessment; ORb) Had prognosis of less than 6 months (J1400 = [1]) on the prior assessment; ORc) Was in hospice (O0100K2 = [1]) on the prior assessment; ORd) Did not have prognosis of less than 6 months and did not have hospice on prior

assessment (J1400 ≠ [1] and O0100K2 ≠ [1] ) and had a missing value on either indicator(J1400 = [-] or O0100K2 = [-] )

e) Was totally dependent in locomotion on prior assessment (G0110E1 = [4, 7, 8]; ORf) Was missing data on locomotion on target or prior assessment (G0110E1 = [-])

Covariates From the prior assessment: Eating (self-performance): Needs help (G0110H1) Eating (self-performance): Dependence (G0110H1) Toileting (self-performance): Needs help (G0110I1) Toileting (self-performance): Dependence (G0110I1) Transfer (self-performance): Needs help (G0110B1) Transfer (self-performance): Dependence (G0110B1) Walking in corridor (self-performance): Independence (G0110D1) Walking in corridor (self-performance): Needs some help (G0110D1) Walking in corridor (self-performance): Needs more help (G0110D1) Severe cognitive impairment (C0500, C0700, and C1000) Linear age (A0900) Gender (A0800)

Positive vision change score calculated from prior assessment to latest assessment with non-missing value after prior assessment (B1000) No oxygen use on prior assessment (O0100C2 = [0]) and oxygen use on latest assessment with non-missing value after prior assessment (O0100C2 = [1])


Table 12. Percentage of Long-stay Residents Who Received an Antianxiety or Hypnotic Medication

Measure Description The percent of long-stay nursing home residents who receive antianxiety or hypnotic medications.


The numerator and denominator include all long-stay residents who have resided in the nursing home for longer than 100 days as of the end of the target period (e.g., calendar quarter). The data are updated every quarter.

Numerator The numerator includes long-stay nursing home residents with a target assessment where: a) Antianxiety medications are received (N0410B = [1, 2, 3, 4, 5, 6, 7])b) Hypnotic medications are received (N0410D = [1, 2, 3, 4, 5, 6, 7])

Denominator All long-stay residents with a target assessment are included in the measure.


Long-stay residents are excluded if: a) The resident was comatose (B0100 =[01]) on the prior assessment; ORb) Had life expectancy of less than 6 months (J1400 = [1]) on the target assessment: ORc) Was in Hospice (O0100K2=[1]) on the target assessment; ORd) Antianxiety medications received item was missing on target assessment (N0410B =

[-]); ORe) Hypnotic medications received item was missing on target assessment (N0410D = [-])

Covariates None


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nxie

ty/H

ypno

tic U

seDe

nom

inat

orAl

l sho

rt-s

tay

resid

ents

who

hav

e a

valid

Di

scha

rge

(ret

urn

not a

ntic

ipat

ed) a

sses

smen

t an

d a

valid

pre

cedi

ng 5

-day

ass

essm

ent

All l

ong-

stay

resid

ents

who

hav

e a

qua

lifyi

ng M

DS ta

rget

as

sess

men

t tha

t is n

ot a

n Ad

miss

ion

or 5

-day

ass

essm

ent

(i.e.

, Ann

ual,

Qua

rter

ly, S

igni

fican

t Cha

nge,

Sig

nific

ant

Corr

ectio

n, 1

4-, 3

0-, 6

0-, o

r 90-

day

or a

Disc

harg

e as

sess

men

t with

or w

ithou

t ret

urn

antic

ipat

ed d

urin

g th

e qu

arte

r) a

ccom

pani

ed b

y at

leas

t one

qua

lifyi

ng p

rior

asse

ssm

ent

All l

ong-

stay

resid

ents

with

a

sele

cted

targ

et a

sses

smen

t

Deno

min

ator

Ex

clus

ions

Com

atos

e on

the

5-da

y as

sess

men

tCo

mat

ose

or m

issin

g da

ta o

n co

mat

ose

at p

rior

asse

ssm

ent

Miss

ing

data

on

num

ber o

f an

tianx

iety

or h

ypno

tic m

eds

Prog

nosis

of <

6 m

onth

s on

the

5-da

y as

sess

men

tPr

ogno

sis o

f <6

mon

ths a

t prio

r ass

essm

ent

Prog

nosis

of <

6 m

onth

s

No

MLA

DL im

pairm

ent (

MLA

DL=0

) on

the

5-da

y as

sess

men

tRe

siden

t tot

ally

dep

ende

nt d

urin

g lo

com

otio

n on

prio

r as

sess

men

tHo

spic

e ca

re w

hile

a re

siden

t

Miss

ing

data

on

any

of th

e th

ree

MDA

DL it

ems

on th

e di

scha

rge

or 5

-day

ass

essm

ents

Miss

ing

data

on

loco

mot

ion

on ta

rget

or p

rior

asse

ssm

ent,

or n

o pr

ior a

sses

smen

t ava

ilabl

e to

ass

ess

prio

r fun

ctio

n

Hosp

ice

on th

e 5-

day

asse

ssm

ent

Prio

r ass

essm

ent i

s disc

harg

e as

sess

men

t with

or w

ithou

t re

turn

ant

icip

ated

Risk

Ad

just

men

tRi

sk a

djus

ted

base

d on

5-d

ay a

sses

smen

t: ag

e,

gend

er, c

ogni

tive

impa

irmen

t, lo

ng-fo

rm A

DL

scor

e, h

eart

failu

re, s

trok

e, h

ip fr

actu

re, o

ther

fr

actu

re, f

eedi

ng/I

V

Risk

adj

uste

d ba

sed

on A

DLs f

rom

prio

r ass

essm

ent

(eat

ing,

toile

ting,

tran

sfer

, and

wal

king

in c

orrid

or)

Non

e


Mea

sure

Spe

cific

atio

ns: C

laim

s-Ba

sed

Mea

sure

s

30-D

ay A

ll-Ca

use

Read

mis

sion

s

100-

day

Com

mun

ity

Dis

char

ge W

ithou

t Re

adm

issi

on30

-Day

Out

patie

nt

ED V

isits

Data

Sou

rce

Part

A c

laim

s to

iden

tify

inpa

tient

read

miss

ions

and

Pa

rt B

cla

ims f

or

obse

rvat

ion

stay

s. C

laim

s an

d M

DS a

re u

sed

for r

isk-

adju

stm

ent.

MDS

to id

entif

y co

mm

unity

di

scha

rges

; cla

ims t

o id

entif

y su

cces

sful

com

mun

ity

disc

harg

es.

Clai

ms a

nd M

DS

for r

isk-a

djus

tmen

t.

Part

B C

laim

s to

iden

tify

outp

atie

nt E

D vi

sits.

Cla

ims

and

MDS

for r

isk-

adju

stm

ent.

Num

erat

or

Win

dow

30

day

s aft

er a

dmiss

ion

to a

SN

F fo

llow

ing

an in

patie

nt

hosp

italiz

atio

n.

100

days

aft

er a

dmiss

ion

to a

SN

F fo

llow

ing

an in

patie

nt

hosp

italiz

atio

n an

d 30

day

s fo

llow

ing

disc

harg

e.

30 d

ays a

fter

adm

issio

n to

a

SNF

follo

win

g an

inpa

tient

ho

spita

lizat

ion.

Deno

min

ator

W

indo

w

Patie

nts m

ust h

ave

been

adm

itted

to th

e nu

rsin

g ho

me

follo

win

g an

inpa

tient

ho

spita

lizat

ion.


Mea

sure

Spe

cific

atio

ns:

Cla

ims-

Bas

ed M

easu

res

30-D

ay A

ll-Ca

use

Read

mis

sion

s

100-

day

Com

mun

ity

Disc

harg

e W

ithou

t Re

adm

issi

on30

-Day

Out

patie

nt

ED V

isits

Mea

sure

men

t Pe

riod

Rolli

ng 1

2 m

onth

s; u

pdat

ed e

very

six

mon

ths

Num

erat

or

The

num

ber o

f SN

F st

ays

whe

re th

ere

was

a a

dmitt

ed

to a

n ac

ute

care

hos

pita

l w

ithin

30

days

of S

NF

adm

issio

n. O

bser

vatio

n st

ays

are

incl

uded

Pl

anne

d re

adm

issio

ns a

re e

xclu

ded.

The

num

ber o

f SN

F st

ays

whe

re th

ere

was

a d

ischa

rge

to th

e co

mm

unity

(ide

ntifi

ed

usin

g th

e di

scha

rge

stat

us

info

rmat

ion

on th

e M

DS)

with

in 1

00 d

ays o

f adm

issio

n w

ho a

re n

ot a

dmitt

ed to

a

hosp

ital (

inpa

tient

or

obse

rvat

ion

stay

), a

nurs

ing

hom

e, o

r who

die

with

in 3

0 da

ys o

f disc

harg

e.

The

num

ber o

f SN

F st

ays

whe

re th

ere

was

an

outp

atie

nt

ER v

isit n

ot re

sulti

ng in

an

inpa

tient

stay

or o

bser

vatio

n st

ay w

ithin

30

days

of S

NF

adm

issio

n.

Num

erat

or

Excl

usio

ns

Plan

ned

read

miss

ions

Non

eN

one


Mea

sure

Spe

cific

atio

ns:

Cla

ims-

Bas

ed M

easu

res

30-D

ay A

ll-Ca

use

Read

mis

sion

s

100-

day

Com

mun

ity

Dis

char

ge W

ithou

t Re

adm

issi

on30

-Day

Out

patie

nt

ED V

isits

Deno

min

ator

The

deno

min

ator

is th

e nu

mbe

r of S

NF

stay

s tha

t beg

an w

ithin

1 d

ay o

f disc

harg

e fr

om a

prio

r hos

pita

lizat

ion

at a

n ac

ute

care

, CAH

, or p

sych

iatr

ic h

ospi

tal.

Prio

r ho

spita

lizat

ions

are

iden

tifie

d us

ing

clai

ms d

ata.

Deno

min

ator

Ex

clus

ions

•M

edic

are

Adva

ntag

een

rolle

es

•M

edic

are

Adva

ntag

e en

rolle

es•

Thos

e w

ho w

ere

in a

nur

sing

hom

e pr

ior t

o th

e st

art o

f the

st

ay•

Thos

e w

ho e

nrol

l in

hosp

ice

durin

g th

e ob

serv

atio

n pe

riod

•M

edic

are

Adva

ntag

een

rolle

es

Risk

Ad

just

men

tLo

gist

ic re

gres

sion

base

d on

cla

ims (

prim

ary

diag

nosis

and

leng

th o

f sta

y fr

om th

e ho

spita

lizat

ion

that

pre

cede

d th

e SN

F st

ay) a

nd M

DS it

ems f

ound

to b

e as

soci

ated

w

ith re

adm

issio

n ra

tes.

Not

e th

at th

ere

are

som

e di

ffere

nces

in th

e M

DS it

ems

used

acr

oss t

he th

ree

mea

sure

s. T

he ri

sk-a

djus

ted

rate

is c

alcu

late

d as

the

(act

ual r

ate/

expe

cted

rate

) x n

atio

nal a

vera

ge


RTI International Appendix F (April 2016, v10.0) F-1

Specifications for Facility Characteristics Report Record Selection

The Facility Characteristic Report is populated using data from records selected using the standard QM episode and record selection logic as given in the QM User’s Manual. The Facility Characteristics measures can be processed with the QM measures. Each Facility Characteristic measure is computed using all residents (both short-stay and long-stay residents). Most of the Facility Characteristic measures are populated using data from a look-back scan of the assessment records selected for each resident. For each resident, the look-back scan begins with the target assessment selected for QM processing. The resident’s records are scanned in reverse chronological order (by ARD) and all data items required for the Facility Characteristics report are populated from data that are available from each assessment. As assessments are scanned, each required item is initially populated with the item value from the target assessment. If the value from the target assessment is a valid (non-missing) value, then the scan for that item stops. If the value for the target assessment is not a valid value (a missing value), then the scan continues with the earlier assessments in reverse chronological order. Once a valid value is found for an item, that value is used for the report (i.e., the value is not changed if additional values are present in earlier records). A “valid value” is any value that is one of the “normal” responses to an item. Missing non-valid values are:

1. A dash (“-“) indicating that the item was not assessed. 2. A caret (“^”) indicating that the item was skipped. 3. A null (.) indicating that the item is inactive.

Note that the diagnosis code items (I8000A through I8000J) are not used in the measure specifications below and are therefore not included in the look-back scan. For each resident, the look-back scan continues until any of the following conditions is satisfied:

• All required items have been populated with valid values, as defined above, or • All selected records for a resident have been scanned.

Note that scanning stops for a resident as soon as either of these conditions is satisfied. Measure Specifications The definitions in the following table are applied to a look-back scan of the records selected for a resident as described in the prior section on Record Selection. Counts of the number of residents within each facility that meet the numerator criteria for each measure below are used as the numerator to produce facility percentages for the report. The denominator used to produce the facility percentages in the report will vary for different measures, depending on missing data. If missing data precludes determination of the status for a


measure as indicated in the “Exclusions” section, then the resident is excluded from both the numerator and denominator in the facility percentage.

Table F1: Facility Characteristics Report Measure Definitions Measure Description and Definition Gender Male Description: Resident is included if Item A0800 (Gender) is equal to 1

(Male). Records with dashes (not assessed) in A0800 are excluded from the male/female counts.

Numerator: A0800 = 1 (Male). Exclusions: A0800 missing

Female Description: Resident is included if Item A0800 (Gender) is equal to 2 (Female). Records with dashes (not assessed) in A0800 are excluded from the male/female counts.

Numerator: A0800 = 2 (Female). Exclusions: A0800 missing

Age Calculation of Age, based on Items A0900 (Birth Date) and A2300

(Assessment Reference Date ARD): IF (MONTH(A2300) > MONTH(A0900)) OR (MONTH(A2300) = MONTH(A0900) AND DAY(A2300) >= DAY(A0900)) THEN Age = YEAR(A2300)-YEAR(A0900) ELSE Age = YEAR(A2300)-YEAR(A0900)-1

<25 years old Description: Age less than 25 years old. Numerator: Record triggers if age < 25.

25-54 years old Description: Age of 25 through 54 years old. Numerator: Record triggers if age >= 25 and <= 54.


65-74 years old Description: Age of 65 to 74 years old. Numerator: Record triggers if age >= 65 and <= 74.


(continued)


Table F1: Facility Characteristics Report Measure Definitions (continued) Measure Description and Definition 85+ years old Description: Age of 85 years of age or older.

Numerator: Record triggers if age >= 85.

Diagnostic Characteristics Psychiatric Diagnosis

Description: Resident is included as having a psychiatric diagnosis if any of the following is true:

• Any psychiatric mood disorders are checked (=1) in items

I5700 through I6100, or • Item I5350 (Tourette’s Syndrome) is checked (=1), or • Item I5250 (Huntington’s Disease) is checked (=1).

Numerator:

• Any of the following items are checked (-1): I5250,

I5350, I5700 through I6100. Exclusions: No value I5250, I5350, I5700 through I6100 = 1 and any

value I5250, I5350, I5700 through I6100 is missing Intellectual Disability (ID) (Mental retardation as defined at 483.45(a)) or Developmental Disability (DD)

Description: Resident is counted as having ID/DD if any of the following items are checked:

• A1550A (Down syndrome). • A1550B (Autism). • A1550C (Epilepsy). • A1550D (Other organic condition related to ID/DD). • A1550E (ID/DD with no organic condition).

Numerator:

A1550A, B, C, D, or E is checked (=1). Exclusions: No value A1550A, B, C, D, or E = 1 and any value A1550A, B, C, D, or E missing

Hospice Description: Resident is included if Item O0100K2 (Hospice care) is checked.

Numerator: O0100K2 is checked (=1). Exclusions: O0100K2 missing

(continued)


Table F1: Facility Characteristics Report Measure Definitions (continued) Measure Description and Definition Prognosis Life expectancy of less than 6 months

Description: Resident is included if item J1400 (Prognosis) is coded 1 (Yes).

Numerator: J1400 = 1 (Yes). Exclusions: J1400 missing

Discharge Plan Discharge planning IS NOT already occurring for the resident to return to the community.

Description: Resident is included if Item Q0400A (Discharge Plan) is coded 0 (No). Numerator: Q0400A = 0 (No). Exclusions: Q0400A missing

Discharge planning IS already occurring for the resident to return to the community.

Description: Resident is included if Item Q0400A (Discharge Plan) is coded 1 (Yes). Numerator: Q0400A = 1 (Yes). Exclusions: Q0400A missing

Referral Referral not needed. Description: Resident is included if Item Q0600 (Referral) is coded 0 (No

- Referral not needed). Numerator: Q0600 = 0 (No - Referral not needed). Exclusions: Q0600 missing

Referral is or may be needed, but has not been made.

Description: Resident is included if Item Q0600 (Referral) is coded 1 (Yes – Referral is or may be needed). Numerator: Q0600 = 1 (No - Referral is or may be needed). Exclusions: Q0600 missing

Referral has been made. Description: Resident is included if Item Q0600 (Referral) is coded 2 (Yes - Referral made). Numerator: Q0600 = 2 (Yes - Referral made). Exclusions: Q0600 missing

(continued)


Table F1: Facility Characteristics Report Measure Definitions (continued) Measure Description and Definition Type of Entry Admission Description: Resident is included if Item A1700 (Type of Entry) is coded

1, (Admission). Numerator: A1700 = 1 (Admission). Exclusions: A1700 missing

Reentry Description: Resident is included if Item A1700 (Type of Entry) is coded 2, (Reentry). Numerator: A1700 = 2 (Reentry). Exclusions: A1700 missing

Entered Facility From Community (private home/apartment board/care, assisted living, group home)

Description: Resident is included if Item A1800 (Entered From) is coded 01 (Community). Numerator: A1800 = 01 (Community). Exclusions: A1800 missing

Another nursing home or swing bed

Description: Resident is included if Item A1800 (Entered From) is coded 02 (Another nursing home or swing bed). Numerator: A1800 = 02 (Another nursing home or swing bed). Exclusions: A1800 missing

Acute hospital Description: Resident is included if Item A1800 (Entered From) is coded 03 (Acute hospital). Numerator: A1800 = 03 (Acute hospital). Exclusions: A1800 missing

Psychiatric hospital Description: Resident is included if Item A1800 (Entered From) is coded 04 (Psychiatric hospital). Numerator: A1800 = 04 (Psychiatric hospital). Exclusions: A1800 missing

Inpatient rehabilitation facility

Description: Resident is included if Item A1800 (Entered From) is coded 05 (Inpatient rehabilitation facility). Numerator: A1800 = 05 (Inpatient rehabilitation facility). Exclusions: A1800 missing

(continued)


Table F1: Facility Characteristics Report Measure Definitions (continued) Measure Description and Definition ID/DD facility Description: Resident is included if Item A1800 (Entered From) is coded

06 (ID/DD facility). Numerator: A1800 = 06 (ID/DD facility). Exclusions: A1800 missing

Hospice Description: Resident is included if Item A1800 (Entered From) is coded 07 (Hospice). Numerator: A1800 = 07 (Hospice). Exclusions: A1800 missing

Long Term Care Hospital (LTCH)

Description: Resident is included if Item A1800 (Entered From) is coded 09 (Long Term Care Hospital (LTCH)). Numerator: A1800 = 09 (Long Term Care Hospital (LTCH)). Exclusions: A1800 missing

Other Description: Resident is included if Item A1800 (Entered From) is coded 99 (Other). Numerator: A1800 = 99 (Other). Exclusions: A1800 missing

table 1. percentage of short-stay residents who …...table 1. percentage of short-stay residents...

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