Discharge to Community (Claims-Based)
Identifying Attributes
Care Settings
Country
Publishing Organisation
Type of Quality Indicator
IOM Quality Dimension
Domain
Defining Attributes
Definition
Percentage of home health stays in which patients were discharged to the community and do not have an unplanned admission to an acute care hospital or long-term care facility in 31 days and remain alive.
Numerator
Number of home health stays for patients who have a Medicare claim for patient discharge from home health and do not have an unplanned admission to and acute care hospital or long-term care facility and remained alive.
Denominator
Number of home health stays that begin during the 2 -year observation period.
Exclusions
Patients under 18 years of age, discharged to a psychiatric hospital; discharged against medical advice or to disaster alternative care sites or federal hospitals; discharged to court/law enforcement; to hospice; those who experienced a short-term acute care stay or psychiatric stay for non-surgical treatment of cancer in the 30 days prior to post-acute care admission; those discharged to another home health agency and baseline nursing facility residents that return to their nursing home as a place of residence.
Use of Risk Adjustment
Risk Adjustments
Uses a hierarchical logistic regression method to predict the probability of discharge to community. Risk adjustment variables: Age and sex groups, End stage renal disease or disability as original reason for entitlement, Principal diagnosis (Clinical Classifications Software groups) when from a prior hospitalisation, if that hospitalisation took place during the 30 days before the home health start or resumption of care, Surgical procedure categories from a prior hospitalisation, if that hospitalisation took place during the 30 days before home health start or resumption of care, Length of prior acute hospital stay in days, for patients whose prior acute stay was in a non-psychiatric hospital, Indicator for if a prior hospitalisation during the 30 days before home health start or resumption of care took place in the intensive/cardiac care units. Comorbidities (Hierarchical Condition Categories) recorded during the one year prior to home health start or resumption of care are clustered using the Hierarchical Condition Categories groups used by CMS, Number of prior acute hospital discharges during the one year prior to home health, not including those that took place during the 30 days prior to home health start or resumption of care, Indicator for whether or not the patient had an outpatient emergency room visit, or a post-acute care visit, or an inpatient dialysis session during the year prior to home health start or resumption of care and Activity of Daily Living Severity Score, as calculated using responses on the patient's OASIS assessment.
Stratifications
None
Data Attributes
Type of Data Collection
Data Collection Methods
Medicare fee-for-service claims, calculated using two years of data.
Frequency of Data Collection
Frequency of Data Collection in Days
Reporting Methods
Home Health Quality Reporting (CMS and providers) CMS Care Compare - Home health services and CMS Provider Compare (CMS, providers and publicly reported).