Home Health Within-Stay Potentially Preventable Hospitalisation
Identifying Attributes
Care Settings
Country
Publishing Organisation
Type of Quality Indicator
IOM Quality Dimension
Domain
Defining Attributes
Definition
Home health agency-level rate of risk-adjusted potentially preventable hospitalisation (PPH) or potentially preventable observation stays (PPOBS) that occur within a home health stay for all eligible stays..
Numerator
Number of patients with at least one potentially preventable hospitalisation (i.e., in an acute care hospital/ long-term care hospital) or observation stay during the home health stay.
Denominator
The risk-adjusted expected number of hospitalisations or observation stays. The "expected" number of observation stays or admissions is the projected number of risk-adjusted hospitalisations if the same patients were treated at the average home health agency appropriate to the measure.
Exclusions
Stays where the patients are less than 18 years old, stays where the patients were not continuously enrolled in Part A FFS Medicare for the 12 months prior to the home health admission date through the end of the home health stay, stays that begin with a Low Utilisation Payment Adjustment (LUPA) claim, stays where the patient receives service from multiple agencies during the home health stay, stays where the information required for risk adjustment is missing.
Use of Risk Adjustment
Risk Adjustments
A hierarchical regression method using a logistic regression to predict the probability of a countable (potentially preventable, unplanned) inpatient admission or observation stay is used. The patient characteristics related to each discharge and a marker for the specific discharging home health agency are included in the equation. The equation is hierarchical in that both individual patient characteristics are accounted for as well as the clustering of patients into home health agencies. The risk adjustment model uses potential risk factors that fall into three categories: 1) Demographics (e age and sex, enrolment status, and functional impairment scores); 2) Care received during a prior proximal hospitalisation if one occurred (beneficiaries' immediate prior care setting, principal diagnoses, and procedures); and 3) Other care received within one year of the home health stay (beneficiaries' number of prior acute discharges, number of outpatient emergency department visits, number of skilled nursing facility visits, number of inpatient rehabilitation facility visits, number of long-term care hospital visits, and Hierarchical Condition Categories (HCC) comorbidities).
Stratifications
None
Data Attributes
Type of Data Collection
Data Collection Methods
Data from Medicare's eligibility database as well as fee-for-service (FFS) claims from the home health, inpatient, outpatient, and physician office settings. Calculated using one year of data.
Frequency of Data Collection
Frequency of Data Collection in Days
Reporting Methods
Home Health Quality Reporting (CMS and providers) To be included in the CMS Care Compare - Home health services and CMS Provider Compare from October 2023.