Emergency Department Use Without Hospitalisation During the First 60 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 used the emergency department but were not admitted to the hospital during the 60 days following the start of the home health stay.
Numerator
Number of home health stays for patients who have a Medicare claim for outpatient emergency department use and no claims for acute care Hospitalisation in the 60 days following the start of the home health stay.
Denominator
Number of home health stays that begin during the 12-month observation period.
Exclusions
Home health stays for patients who are not continuously enrolled in fee-for-service Medicare for the 6 months prior to and the 60 days following the start of home health stay or until death, home health stays that begin with a Low Utilisation Payment Adjustment (LUPA) claim, home health stays in which the patient receives service from multiple agencies during the first 60 days, and home health stays for patients who are not continuously enrolled in fee-for-service Medicare for the 6 months prior the start of the home health stay.
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.. Uses a 90-day lookback period
Frequency of Data Collection
Frequency of Data Collection in Days
Reporting Methods
Home Health Quality Reporting (CMS and providers) CMS Care Compare - Home health services and CMS Provider Compare (CMS, providers and publicly reported online).