Emergency Department Use Without Hospital Readmission During the First 30 Days of Home Health (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 who had an acute inpatient discharge within the 5 days before the start of their home health stay used an emergency department but were not admitted to an acute care hospital during the 30 days following the start of the home health stay.
Numerator
Number of home health stays for patients who have a Medicare FFS claim for outpatient emergency department use and no claims for acute care Hospitalisation in the 30 days following the start of the home health stay.
Denominator
Number of home health stays that begin during the 3-year observation period for patients who had an acute inpatient discharge within the 5 days prior to the start of the home health stay.
Exclusions
Home Health stays for patients who are not continuously enrolled in fee-for-service Medicare during the measure numerator window or until death; Home Health stays that begin with a Low-Utilisation Payment Adjustment (LUPA); Home Health stays in which the patient receives services from multiple home health agencies in the first 30 days; Home Health stays in which the patient receives treatment in another setting in the 5 days between hospital discharge and the start of home health; Home Health stays in which the hospitalisation occurring within 5 days of the start of home health care is not a qualifying inpatient stay. Hospitalisations that do not qualify as index hospitalisations include admissions for the medical treatment of cancer, primary psychiatric disease, or rehabilitation care, and admissions ending in patient discharge against medical advice.
Use of Risk Adjustment
Risk Adjustments
Prior care settings, health status as per the CMS Hierarchical Condition Categories framework, demographics (age and sex), end stage renal disease (ESRD) status and Disability Status.
Stratifications
None
Data Attributes
Type of Data Collection
Data Collection Methods
Medicare fee-for-service (FFS) claims data.
Frequency of Data Collection
Frequency of Data Collection in Days
Reporting Methods
Home Health Quality Reporting (CMS and providers). Not reported on CMS Care Compare or CMS Provider Data Catalogue.