Emergency Department Use Without Hospital Readmission During the First 30 Days of Home Health (Claims-Based)

Identifying Attributes

Care Settings
Care Transitions
Country
United States of America
Publishing Organisation
Centers for Medicare & Medicaid Services (CMS): Home Health Quality Reporting Program
Type of Quality Indicator
Outcome
IOM Quality Dimension
Effectiveness
Domain
Hospitalisation

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
Yes
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
Administrative data
Data Collection Methods

Medicare fee-for-service (FFS) claims data.

Frequency of Data Collection
Uses a 90-day lookback period
Frequency of Data Collection in Days
91
Reporting Methods

Home Health Quality Reporting (CMS and providers). Not reported on CMS Care Compare or CMS Provider Data Catalogue.

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

Source and Reference Attributes

Link to Measurement Tools
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
Identified by PHARMA-Care Project
No
Upload Date
12 March 2025