Facility-level Ventilator Liberation Rate for patients admitted to an long-term care hospital (LTCH) requiring ventilation support and weaning was expected or anticipated.

The numerator represents the number of patients who were reported as fully liberated (weaned) at discharge on the Planned or Unplanned Discharge Assessments. A patient is included in the numerator if the LTCH reports that Item O0250A (Invasive Mechanical Ventilator: Weaning Status at Discharge) = 1 (Fully liberated at discharge) on the LTCH CARE Data Set Planned or Unplanned Discharge Assessments.

The target population is patients discharged from an LTCH AND who were on invasive mechanical ventilation support upon admission to the LTCH, for whom at admission weaning attempts were expected or anticipated. For patients with more than one LTCH stay during the reporting period, each admission and discharge is included in the measure calculation and reporting. 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) 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) 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).

This measure is risk-adjusted to account for various risk factors using a statistical risk model including: 1. Age 2. Prior Functioning: Everyday Activities 3. Metastatic cancer 4. Severe cancer 5. Left ventricular assistive device with known ejection fraction ≤ 30% 6. Progressive Neuromuscular Disease 7. Severe Neurological Injury, Disease, or Dysfunction 8. Post-transplant (lung, heart, liver, kidney, and bone marrow) 9. Vasoactive medication (i.e. continuous infusions of vasopressors or inotropes) 10. Dialysis.

Data will be collected using items added to the LTCH CARE Data Set Admission, Planned Discharge and Unplanned Discharge Assessments. A patient is considered fully liberated (weaned) if he or she does not require any invasive mechanical ventilation support for at least 2 consecutive calendar days immediately prior to the date of discharge.

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