Percent of short-stay residents who entered or re-entered the nursing home from a hospital and visited an emergency department within 30 days of the start of the nursing home stay, and this visit did not result in an inpatient or observation stay.

Nursing home stays for beneficiaries in the denominator who were admitted to an emergency department within 30 days of entry/re-entry to the nursing home (regardless of whether they were discharged from the nursing home prior to the emergency department visit) AND were not admitted to a hospital for an inpatient stay or observation stay immediately after the visit to the emergency department.

Stays for residents who: a) Entered or re-entered the nursing home within 1 day of discharge from an inpatient hospitalisation (inpatient rehabilitation facility and long-term care hospitalisations are not included) AND b) entered or re-entered the nursing home within the 12-month target period.

The resident was ever enrolled in hospice care during their nursing home stay; OR The resident was comatose or missing data on comatose on the first MDS assessment after the start of the stay; OR Data were missing for any of the claims or MDS items used to construct the numerator or denominator; OR The resident did not have an initial MDS assessment to use in constructing covariates for risk-adjustment.

Risk adjustment to account for differences across nursing homes in patient demographic and clinical characteristics. Covariates Constructed from Claims: age, sex, length of stay during the hospitalisation preceding the nursing home stay, any time spent in the intensive care unit during the hospitalisation preceding the nursing stay, Ever enrolled in Medicare under disability coverage, End-Stage Renal Disease, Number of acute care hospitalisations in the 365 days before the beginning of the nursing stay, Principal diagnosis as categorized using AHRQ's single-level Clinical Classification System, Outcome-Specific Comorbidity Index(based on the clinical conditions included in the Charlson Comorbidity Index and captures the complexity beyond the linear additivity of the individual comorbidities). Covariates Constructed from Minimum Dataset Items: functional status, clinical conditions, clinical treatments, clinical diagnoses and other.

The numerator and denominator include stays that started over a 12-month period. Outpatient emergency department visits are identified using Medicare Part B claims. Inpatient and observation stays are identified using Medicare Parts A and B claims.

Nursing Home Quality Reporting Program (CMS and Providers). CMS Care Compare - Nursing Homes including rehab services and CMS Provider Compare (CMS, providers and publicly reported).

cmit.cms.gov/cmit/#/MeasureView?variantId=3052&sectionNumber=1 www.cms.gov/medicare/quality/nursing-home-improvement/quality-measures - Nursing Home Compare Claims-Based Quality Measure Technical Specifications