Risk-standardised rate of residents who are discharged to the community following a skilled nursing facility stay, and do not have an unplanned readmission to an acute care hospital or long-term care hospital in the 31 days following discharge to community, and who remain alive during the 31 days following discharge to community. Community is defined as home or self care, with or without home health services, based on Patient Discharge Status Codes.

The risk-adjusted estimate of the number of patients/residents who are discharged to the community, do not have an unplanned readmission to an acute care hospital or long-term care hospital in the 31-day post-discharge observation window, and who remain alive during the post-discharge observation window. This estimate starts with the observed discharges to community, and is risk-adjusted for patient/resident characteristics and a statistical estimate of the facility effect beyond case mix.

The risk-adjusted expected number of discharges to community. This estimate includes risk adjustment for patient/resident characteristics with the facility effect removed.

1. Age under 18 years 2. No short-term acute care stay within the 30 days preceding an IRF, SNF, or LTCH admission 3. Discharges to psychiatric hospital 4. Discharges against medical advice 5. Discharges to disaster alternative care sites or federal hospitals 6. Discharges to court/law enforcement 7. Patients/residents discharged to hospice and those with a hospice benefit in the post-discharge observation window 8. Patients/residents not continuously enrolled in Part A fee-for-service Medicare for the 12 months prior to the post-acute admission date, and at least 31 days after post-acute discharge date 9. Patients/residents whose prior short-term acute care stay was for non-surgical treatment of cancer 10. Post-acute stays that end in transfer to the same level of care 11. Post-acute stays with Claims that are problematic (e.g., anomalous records for stays that overlap wholly or in part, or are otherwise erroneous or contradictory) 12. Planned discharges to an acute or LTCH setting 13. Baseline NF residents 13. Swing Bed Stays in Critical Access Hospitals (SNF setting only).

Risk-adjusted for patient/resident characteristics and a statistical estimate of the PAC provider's effect, beyond patient/resident case mix. Variables: Age, sex, end stage renal disease, principal diagnosis(Clinical Classifications Software groups), Surgical procedure categories if present based on the prior acute stay in the past 30 days, dialysis in prior acute stay, length of prior acute hospital stay in days, ventilator use in the post-acute stay, comorbidities (Hierarchical Condition Categories) based on prior acute stay) and number of prior acute hospital discharges in the past year.

Medicare claims data submitted for Medicare Fee-For-Service residents.

Skilled Nursing Facilities Quality Reporting Program (CMS and Providers CMS Care Compare - Nursing Homes and CMS Provider Compare (CMS, providers and publicly reported) Contributes to star ratings.

Terry S. Field, Hassan Fouayzi, Sybil Crawford, Alok Kapoor, Cassandra Saphirak, Steven M. Handler, Kimberly Fisher, Florence Johnson, Ann Spenard, Ning Zhang, Jerry H. Gurwitz, The Association of Nursing Home Characteristics and Quality with Adverse Events After a Hospitalization, Journal of the American Medical Directors Association, Volume 22, Issue 10, 2021, Pages 2196-2200, ISSN 1525-8610, doi.org/10.1016/j.jamda.2021.02.027.

www.cms.gov/medicare/quality/snf-quality-reporting-program/public-reporting www.cms.gov/medicare/quality/snf-quality-reporting-program/measures-and-technical-information www.cms.gov/medicare/provider-enrollment-and-certification/certificationandcomplianc/downloads/usersguide.pdf

cmit.cms.gov/cmit/#/MeasureView/?variantId=1985&sectionNumber=1 Technical details: www.cms.gov/files/document/snf-quality-measure-calculations-and-reporting-users-manual-v40.pdf www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/NursingHomeQualityInits/Downloads/Measure-Specifications-for-FY17-SNF-QRP-Final-Rule.pdf

www.cms.gov/medicare/quality/nursing-home-improvement/resident-assessment-instrument-manual