Facility-level compliance with breathing trials by day 2 of stay for long-term care hospital (LTCH) patients expected to wean from ventilator support.

Numerator The numerator represents patients admitted on invasive mechanical ventilation who were assessed for readiness for spontaneous breathing trial (SBT) [including tracheostomy collar trial (TCT) or continuous positive airway pressure (CPAP) breathing trial] by Day 2 of the LTCH stay and, if deemed ready, who received an SBT (including TCT or CPAP breathing trial) by Day 2 of the LTCH stay. The numerator will be computed and reported separately according to each of the components below. Each component numerator is the number of patients in the following components: Component 1, Percentage of Patients Assessed for Readiness for SBT by Day 2 of the LTCH Stay The numerator represents the number of patients admitted on invasive mechanical ventilation during the reporting period who were assessed for readiness for spontaneous breathing trial (SBT) (including TCT or CPAP breathing trial) by Day 2 of the LTCH stay For the purpose of this measure component, a patient is considered in the numerator if the LTCH reports, on the LTCH CARE Data Set Admission Assessment, either of the following combinations of items: O0150B = 1 (Yes) AND O0150C = 1 (Yes). Assessed for readiness for spontaneous breathing trial (SBT) by day 2 of the LTCH stay and Deemed medically ready for a SBT by day 2 of the LTCH stay. OR O0150B = 1 (Yes) AND O0150D= 1 (Yes): Assessed for readiness for spontaneous breathing trial (SBT) by day 2 of the LTCH stay and documentation of reason(s) that patient was deemed medically unready for a SBT by day 2 of the LTCH stay. The sum of the numbers of patients in these two groups represents the number of patients admitted on invasive mechanical ventilation who were assessed for readiness for spontaneous breathing trial (SBT) by day 2 of the LTCH stay, as reported on the Admission Assessment. Component 2, Percentage of Patients Ready for SBT Who Received SBT by Day 2 of LTCH Stay The numerator represents the number of patients admitted on invasive mechanical ventilation during the reporting period who were ready for SBT and who received an SBT (including TCT or CPAP breathing trial) by Day 2 of the LTCH stay. For the purpose of this measure component, a patient is considered in the numerator if the LTCH reports on the LTCH CARE Data Set Admission Assessment item O0150E = 1 (Yes), SBT performed by day 2 of the LTCH stay. Compliance with SBT (including TCT or CPAP breathing trial) by day 2 of LTCH stay is reported as a percentage and is calculated and reported for these two numerator components separately.

The target population for this measure is patients who were on invasive mechanical ventilation support upon admission to the LTCH, for whom weaning attempts were expected or anticipated at admission. If a patient has more than one LTCH stay during the reporting period, each discharge will be reported and included in the measure calculation. The denominator will be calculated separately according to each of the component groups below: • Component 1, Percentage of Patients Assessed for Readiness for SBT by Day 2 of LTCH Stay The denominator for Component 1 is patients who were on invasive mechanical ventilation upon admission to an LTCH, for whom weaning attempts are expected or anticipated at admission. • Component 2, Percentage of Patients Ready for SBT Who Received SBT by Day 2 of LTCH Stay The denominator for Component 2 is the subset of patients in the denominator of Component 1, who were assessed and deemed ready for SBT by Day 2 of the LTCH stay. For patients with more than one LTCH stay during the reporting period, each admission and discharge is reported and included in the measure calculation. For example, if an LTCH patient is transferred to a short-stay acute care hospital for a procedure, surgery, or some other reason(s), returns to the LTCH within three (3) calendar days, and is subsequently discharged from the LTCH, this is considered one "patient stay." However, if this patient's "stay" at the short-stay acute care hospital exceeds three (3) calendar days, whereby day one begins on the day of transfer from the LTCH to the short-stay acute care hospital, regardless of the hour of transfer, then a new LTCH CARE Data Set Admission Assessment is conducted upon return of the patient to the LTCH, and a second LTCH CARE Data Set Discharge Assessment accompanies the second discharge. Admission and Discharge (Planned or Unplanned) Assessments are completed for this patient for the first stay, and Admission and Discharge (Planned or Unplanned) Assessments are completed for the second stay. Both stays for this patient are included in the measure calculation and reporting.

Denominator exclusion details Patients are excluded from the target population (i.e., denominator) if they meet either of the following criteria: 1. O0150A. Spontaneous Breathing Trial (SBT) (including Tracheostomy Collar or Continuous Positive Airway Pressure (CPAP) Breathing Trial) by Day 2 of LTCH Stay: Invasive Mechanical Ventilation Support upon Admission to the LTCH = 0 (i.e., No, not on invasive mechanical ventilation support), OR: 2. O0150A. Spontaneous Breathing Trial (SBT) (including Tracheostomy Collar or Continuous Positive Airway Pressure (CPAP) Breathing Trial) by Day 2 of LTCH Stay: Invasive Mechanical Ventilation Support upon Admission to the LTCH = 2, Yes, non-weaning (i.e., No weaning attempts are expected or anticipated at admission).

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LTCH CARE Data Set. 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.

Centers for Medicare & Medicaid Services (CMS), United States. Final Specifications for LTCH QRP Quality Measures and Standardized Patient Assessment Data Elements. Accessed August 3, 2023. Available from: www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/LTCH-Quality-Reporting/Downloads/Final-Specifications-for-LTCH-QRP-Quality-Measures-and-Standardized-Patient-Assessment-Data-Elements-Effective-July-1-2018.pdf.

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: www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/LTCH-Quality-Reporting/Downloads/Final-Specifications-for-LTCH-QRP-Quality-Measures-and-Standardized-Patient-Assessment-Data-Elements-Effective-July-1-2018.pdf

Target period and data availability: www.cms.gov/files/document/ltch-qrp-measure-calculations-and-reporting-users-manual-v40-change-table.pdf

LTCH CARE Data Set