Discharged to the Community With Behavioural Problems

Identifying Attributes

Care Settings

Care Transitions

Country

United States of America

Publishing Organisation

Centers for Medicare & Medicaid Services (CMS): Home Health Quality Measures - Potentially Avoidable Events

Type of Quality Indicator

Outcome

IOM Quality Dimension

Effectiveness

Setting-Specific Domain

Appropriate Care

Defining Attributes

Definition

Percentage of home health quality episodes at the end of which the patient was discharged, with no formal assistance available, demonstrating behaviour problems

Numerator

Number of home health quality episodes where the discharge assessment indicated the patient remained in community without formal assistive services, and demonstrated at least two behaviour problems

Denominator

Number of home health quality episodes ending with a discharge during the reporting period, other than those covered by generic or measure-specific exclusions.

Exclusions

Home health quality episodes that end with inpatient facility transfer or death.

Use of Risk Adjustment

Risk Adjustments

Not risk adjusted since 2019. Previously adjusted for variation in patient characteristics

Stratifications

Collection and Reporting Attributes

Type of Data Collection

Standardised clinical data

Data Collection Methods

Standardised Patient Assessments created using the OASIS assessment tool data. OASIS-based measures are created using counts of HH quality episodes.

Frequency of Data Collection

Entry of home health service and the last 5 days of every 60 day period beginning with the start of care date.

Frequency of Data Collection in Days

Reporting Methods

Reporting Frequency

Potentially Avoidable Event (PAE) measures are a subset of outcome measures that are derived from OASIS data but are not a part of the home healthQRP. PAE measures were developed as part of the Outcome-Based Quality Improvement (OBQI) initiative that preceded the home healthQRP. PAE measures are not reported on Care Compare but are available to home health agencies via internet Quality Improvement and Evaluation System (iQIES) reports.

Reporting Frequency in Days

Indicator Has Recommended Targets

Source and Reference Attributes

Evidence Source

www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/HomeHealthQualityInits/Home-Health-Quality-Measures Home Health Quality Measures – Potentially Avoidable Events www.cms.gov/files/document/home-health-pae-measures-table-oasis-d112-2019.pdf

Technical Specifications

Link to Measurement Tools

Domain

Not Assigned

Quality Indicator Confirmed to be Part of a Program Used to Monitor Quality and Safety of Care Among Older People at a Population-Level between 2012-2022

Assessed by the Australian Consortium for Aged Care Collaborators as Generally Containing Good Properties (Importance and Scientific Acceptability)

Australian Consortium for Aged Care Endorsed

Can the Quality Indicator be Readily Implemented at a Population Level in Australia Given its Current Data Landscape?

Implementation of this quality indicator was not assessed.

Identified by PHARMA-Care Project

Upload Date

23 July 2025