Transfer of Health Information to the Provider Post-Acute Care (PAC)

Identifying Attributes

Care Settings
Care Transitions
Country
United States of America
Publishing Organisation
Centers for Medicare & Medicaid Services (CMS): Skilled Nursing Facility Quality Reporting Program
Type of Quality Indicator
Process
IOM Quality Dimension
Timeliness
Setting-Specific Domain
Communication

Defining Attributes

Definition

The percentage of long-term care home (LTCH) patient stays with a LTCH CARE Data Set discharge assessment indicating that a current reconciled medication list was provided to the subsequent provider at the time of discharge. A process-based measure that assesses whether or not a current reconciled medication list was provided to the subsequent provider when the patient was discharged from a Post-Acute Care setting to a subsequent provider.

Numerator

The number of LTCH patient stays with a LTCH CARE Data Set discharge assessment indicating that a current reconciled medication list was provided to the subsequent provider at the time of discharge.

Denominator

The total number of LTCH patient stays, regardless of payer, ending in discharge to the following settings only: a short-term general hospital, a SNF, intermediate care, home under care of an organised home health service organisation or hospice, hospice in an institutional facility, a swing bed, an IRF, another LTCH, a Medicaid nursing facility, an inpatient psychiatric facility, or a critical access hospital.

Exclusions

Patients/residents who died are not included in this measure

Use of Risk Adjustment
No
Risk Adjustments

None

Stratifications

None

Collection and Reporting Attributes

Type of Data Collection
Standardised clinical data
Data Collection Methods

Collected using the Minimum Data Set (MDS) 3.0 Resident Assessment Instrument (RAI).

Frequency of Data Collection
Data collection for this measure will begin on October 1, 2023. Data are collected on admission, on discharge (planned and unplanned), and for expired patients. Measures are updated monthly, at the facility and resident level, as data become available. MDS is transmitted to the CMS quarterly via the Internet Quality Improvement Evaluation System (iQIES).
Frequency of Data Collection in Days
30
Reporting Methods

Skilled Nursing Facilities Quality Reporting Program (CMS and Providers). Certification and Survey Provider Enhanced Reports (CASPER) Review and Correct Reports contain facility-level and resident-level measure information Will be reported on CMS Care Compare - delayed due to COVID-19

Reporting Frequency
Quarterly
Reporting Frequency in Days
91
Indicator Has Recommended Targets
No

Source and Reference Attributes

Domain
Medication-Related
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
Yes
Assessed by the Australian Consortium for Aged Care Collaborators as Generally Containing Good Properties (Importance and Scientific Acceptability)
No
Australian Consortium for Aged Care Endorsed
No
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
No
Upload Date
12 March 2025