Transfer of Health Information to the Provider

Identifying Attributes

Care Settings
Home Care
Country
United States of America
Publishing Organisation
Centers for Medicare & Medicaid Services (CMS): Home Health Quality Reporting Program
Type of Quality Indicator
Process
IOM Quality Dimension
Effectiveness
Domain
Service Delivery / Care Planning

Defining Attributes

Definition

The measure assesses the timeliness of the transfer of health information, specifically transfer of a reconciled medication list. This measure evaluates for the transfer of information when a patient is transferred or discharged to a subsequent provider. For this proposed measure, the subsequent provider is defined as a short-term general hospital, a skilled nursing facility, intermediate care, home under care of an organised home health service organisation or hospice, hospice in an institutional facility, an inpatient rehabilitation hospital, an long-term care hospital, a Medicaid nursing facility, an inpatient psychiatric facility, or a critical access hospital.

Numerator

Number of home health quality episodes ending in discharge or transfer for which the OASIS indicated that the following is true: At the time of discharge/transfer, the agency provided a current reconciled medication list to the subsequent provider.

Denominator

The denominator is the number quality episodes ending in discharge or/transfer to a short-term general hospital, a skilled nursing facility, intermediate care, home under care of another organised home health service organisation or hospice, hospice in an institutional facility, a swing bed, an inpatient rehabilitation hospital, a long-term care hospital, a Medicaid nursing facility, an inpatient psychiatric facility, or a critical access hospital.

Exclusions

Patients who die during the episode and patients discharged to a location not specified in denominator statement.

Use of Risk Adjustment
No
Risk Adjustments

None

Stratifications

None

Data Attributes

Type of Data Collection
Standardised clinical data
Data Collection Methods

Outcome and Assessment Information Set (OASIS). Entry of home health service and the last 5 days of every 60 day period beginning with the start of care date.

Frequency of Data Collection
60 days
Frequency of Data Collection in Days
60
Reporting Methods

Home Health Quality Reporting (CMS and providers) To be reported on CMS Care Compare - Home health services and CMS Provider Compare by January 2024.

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

Source and Reference Attributes

Evidence Source

Centers for Medicare and Medicaid Services (CMS). Home health quality measures 2020 [Available from: www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/HomeHealthQualityInits/Home-Health-Quality-Measures. Centers for Medicare and Medicaid Services (CMS). Home Health Quality Measures 2023 [Available from: www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/HomeHealthQualityInits/Home-Health-Quality-Measures

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