Risk-adjusted change in mobility score between admission and discharge among long-term care hospital (LTCH) patients requiring ventilator support at admission.

The measure does not have a simple form for the numerator and denominator. This measure estimates the risk-adjusted change in mobility score between admission and discharge among LTCH patients requiring ventilator support at admission. The change in mobility score is calculated as the difference between the discharge mobility score and the admission mobility score.

The target population (denominator) for this quality measure is the number of LTCH patients requiring ventilator support at the time of admission to the LTCH.

This quality measure has following patient-level exclusion criteria: 1) Patients with incomplete stays: Rationale: When a patient has an incomplete stay, for example, the patients leave urgently due to a medical emergency, it can be challenging to gather accurate discharge functional status data. Patients with incomplete stays include patients who are unexpectedly discharged to an acute-care setting (Inpatient Prospective Payment System or Inpatient Psychiatric Hospital or unit) because of a medical emergency or psychiatric condition; patients transferred to another LTCH; patients who leave the LTCH against medical advice; patients who die; and patients with a length of stay less than 3 days. 2) Patients discharged to hospice: Rationale: Patients discharged to hospice are excluded because functional improvement may not be a goal for these patients. 3) Patients with progressive neurological conditions, including amyotrophic lateral sclerosis, multiple sclerosis, Parkinson's disease, and Huntington's chorea: Rationale: These patients are excluded because they may have functional decline or less predictable function trajectories. 4) Patients in coma, persistent vegetative state, complete tetraplegia, and locked-in syndrome: Rationale: The patients are excluded because they may have limited or less predictable mobility recovery. 5) Patients younger than age 21: Rationale: There is only limited evidence published about functional outcomes for individuals younger than 21. 6) Patients who are coded as independent on all the mobility items at admission: Rationale: These patients are excluded because no improvement in mobility skills can be measured with the mobility items used in this quality measure. Facility-level quality measure exclusion: For LTCHs with fewer than 20 patient stays, data for this quality measure are not publicly reported.

Yes, statistical risk model. Risk adjustment variables: • Age group at LTCH admission • Communication Impairment • Prior functioning: indoor ambulation • Prior Device Use • Primary Medical Condition Category • Presence of Stage 3, 4, or unstageable pressure ulcer/injury • Total Parenteral Nutrition on Admission • Comorbidities.

The LTCH QRP creates LTCH quality reporting requirements, as mandated by Section 3004(a) of the Patient Protection and Affordable Care Act (ACA) of 2010. Every year, by October 1, we publish the quality measures LTCHs must report.

Internet Quality Improvement and Evaluation System (iQIES).

Centers for Medicare & Medicaid Services (CMS), United States. Specifications for the Function Quality Measures Adopted in the Long-Term Care Hospital Quality Reporting Program. Accessed August 3, 2023. Available from: www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/Post-Acute-Care-Quality-Initiatives/Downloads/LTCH-QRP-Function-Quality-Measure-Specifications-August-2018.pdf.

National Quality Forum (NQF). Long-Term Care Hospital (LTCH) Functional Outcome Measure: Change in Mobility Among Patients Requiring Ventilator Support. Accessed August 3, 2023. Available from: www.qualityforum.org/QPS/QPSTool.aspx?Exact=false&Keyword=affordability#qpsPageState=%7B%22TabType%22%3A1,%22TabContentType%22%3A2,%22SearchCriteriaForStandard%22%3A%7B%22TaxonomyIDs%22%3A%5B%5D,%22SelectedTypeAheadFilterOption%22%3A%7B%22ID%22%3A2632,%22FilterOptionLabel%22%3A%222632%22,%22TypeOfTypeAheadFilterOption%22%3A4,%22TaxonomyId%22%3A0%7D,%22Keyword%22%3A%222632%22,%22PageSize%22%3A%2225%22,%22OrderType%22%3A3,%22OrderBy%22%3A%22ASC%22,%22PageNo%22%3A1,%22IsExactMatch%22%3Afalse,%22QueryStringType%22%3A%22%22,%22ProjectActivityId%22%3A%220%22,%22FederalProgramYear%22%3A%220%22,%22FederalFiscalYear%22%3A%220%22,%22FilterTypes%22%3A0,%22EndorsementStatus%22%3A%22%22,%22MSAIDs%22%3A%5B%5D%7D,%22SearchCriteriaForForPortfolio%22%3A%7B%22Tags%22%3A%5B%5D,%22FilterTypes%22%3A0,%22PageStartIndex%22%3A1,%22PageEndIndex%22%3A25,%22PageNumber%22%3Anull,%22PageSize%22%3A%2225%22,%22SortBy%22%3A%22Title%22,%22SortOrder%22%3A%22ASC%22%7D,%22ItemsToCompare%22%3A%5B%5D,%22SelectedStandardIdList%22%3A%5B%5D,%22StandardID%22%3A1419,%22EntityTypeID%22%3A1%7D.

Centers for Medicare & Medicaid Services (CMS), United States. Long-Term Care Hospital Quality Reporting Program Measure Calculations and Reporting User’s Manual Change Table Version 4.0. Accessed August 3, 2023. Available from: www.cms.gov/files/document/ltch-qrp-measure-calculations-and-reporting-users-manual-v40-change-table.pdf.

Technical specifications:https://www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/Post-Acute-Care-Quality-Initiatives/Downloads/LTCH-QRP-Function-Quality-Measure-Specifications-August-2018.pdf National Quality Forum technical specifications (simplified):https://www.qualityforum.org/QPS/QPSTool.aspx?Exact=false&Keyword=affordability#qpsPageState=%7B%22TabType%22%3A1,%22TabContentType%22%3A2,%22SearchCriteriaForStandard%22%3A%7B%22TaxonomyIDs%22%3A%5B%5D,%22SelectedTypeAheadFilterOption%22%3A%7B%22ID%22%3A2632,%22FilterOptionLabel%22%3A%222632%22,%22TypeOfTypeAheadFilterOption%22%3A4,%22TaxonomyId%22%3A0%7D,%22Keyword%22%3A%222632%22,%22PageSize%22%3A%2225%22,%22OrderType%22%3A3,%22OrderBy%22%3A%22ASC%22,%22PageNo%22%3A1,%22IsExactMatch%22%3Afalse,%22QueryStringType%22%3A%22%22,%22ProjectActivityId%22%3A%220%22,%22FederalProgramYear%22%3A%220%22,%22FederalFiscalYear%22%3A%220%22,%22FilterTypes%22%3A0,%22EndorsementStatus%22%3A%22%22,%22MSAIDs%22%3A%5B%5D%7D,%22SearchCriteriaForForPortfolio%22%3A%7B%22Tags%22%3A%5B%5D,%22FilterTypes%22%3A0,%22PageStartIndex%22%3A1,%22PageEndIndex%22%3A25,%22PageNumber%22%3Anull,%22PageSize%22%3A%2225%22,%22SortBy%22%3A%22Title%22,%22SortOrder%22%3A%22ASC%22%7D,%22ItemsToCompare%22%3A%5B%5D,%22SelectedStandardIdList%22%3A%5B%5D,%22StandardID%22%3A1419,%22EntityTypeID%22%3A1%7D

Change in target period: www.cms.gov/files/document/ltch-qrp-measure-calculations-and-reporting-users-manual-v40-change-table.pdf

Inpatient Rehabilitation Facility Patient Assessment Instrument (IRF-PAI)