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  • Measure Summary
  • NQMC:011314
  • Mar 2017
  • NQF-Endorsed Measure

Excess days in acute care (EDAC): hospital-level, 30-day risk-standardized EDAC following acute myocardial infarction (AMI).

Yale New Haven Health Services Corporation (YNHHSC), Center for Outcomes Research and Evaluation (CORE). 2017 condition-specific measure updates and specifications report: hospital-level 30-day risk-standardized excess days in acute care measures. Baltimore (MD): Centers for Medicare & Medicaid Services (CMS); 2017 Mar. 61 p.

View the original measure documentation External Web Site Policy

This is the current release of the measure.

Primary Measure Domain

Related Health Care Delivery Measures: Use of Services

Secondary Measure Domain

Does not apply to this measure

Description

This measure assesses hospital-level, 30-day risk-standardized excess days in acute care (EDAC) for patients discharged from the hospital with a principal diagnosis of acute myocardial infarction (AMI). Days in acute care are defined as days spent in an emergency department (ED), admitted to observation status, or admitted as an unplanned readmission for any cause to a short-term acute care hospital.

The Centers for Medicare & Medicaid Services (CMS) annually reports the measure for individuals who are 65 years and older and are Medicare Fee-for-Service (FFS) beneficiaries hospitalized in non-federal short-term acute care hospitals (including Indian Health Services hospitals) and critical access hospitals.

CMS calculates EDAC, for each hospital, as the difference ("excess") between a hospital's predicted days and expected days per 100 discharges. "Expected days" is the average number of risk-adjusted days in acute care a hospital's patients would have been expected to spend if discharged from an average performing hospital with the same case mix. "Predicted days" is the average number of days a hospital's patients spent in acute care after adjusting for the risk factors (see Table D in the original measure documentation).

Rationale

In the context of the publicly reported Center for Medicare & Medicaid Services (CMS) 30-day acute myocardial infarction (AMI) readmission measure, the increasing use of emergency room (ED) visits and observation stays has raised concerns that the current CMS 30-day AMI readmission measure does not capture the full range of unplanned acute care in the post-discharge period. In particular, there exists concern that high use of observation stays could in some cases replace readmissions, and hospitals with high rates of observation stays in the post-discharge period may therefore have low readmission rates that do not accurately reflect the quality of care (Carlson, 2013). In response to these concerns, CMS has built a measure for AMI that incorporates the full range of post-discharge use of acute care.

The goal of this measure is to improve patient care by providing patients, physicians, and hospitals with information about hospital-level, risk-standardized acute care use following hospitalization for AMI. Measurement of patient outcomes allows for a broad view of quality of care that cannot be captured entirely by individual process-of-care measures. Safely transitioning patients from hospital to home requires a complex series of tasks which would be cumbersome to capture individually as process measures: timely and effective communication between providers, prevention of and response to complications, patient education about post-discharge care and self-management, timely follow-up, and more. Suboptimal transitions contribute to a variety of adverse outcomes post-discharge, including ED evaluation, need for observation, and readmission. Measures of unplanned readmission already exist, but there are no current measures for ED and observation stay utilization. It is thus difficult for providers and consumers to gain a complete picture of post-discharge outcomes. Moreover, separately reporting each outcome encourages "gaming," such as recategorizing readmissions as observation stays to avoid a readmission outcome. By capturing a range of outcomes that are important to patients, CMS can produce a more complete picture of post-discharge outcomes that better informs consumers about care quality and incentivizes global improvement in transitional care.

Evidence for Rationale

Carlson J. Faulty gauge? Readmissions are down, but observational-status patients are up and that could skew Medicare numbers. [internet]. Modern Healthcare; 2013 Jun 8. 

Yale New Haven Health Services Corporation (YNHHSC), Center for Outcomes Research & Evaluation (CORE). Excess days in acute care after hospitalization for acute myocardial infarction (AMI) (version 1.0): final measure methodology report. Baltimore (MD): Centers for Medicare & Medicaid Services (CMS); 2015 Aug. 58 p. [50 references]

Primary Health Components

Acute myocardial infarction (AMI); 30-day excess days in acute care (EDAC)

Denominator Description

The measure cohort consists of admissions for Medicare Fee-for-Service (FFS) beneficiaries aged 65 years or older and discharged from non-federal acute care hospitals and critical access hospitals, having a principal discharge diagnosis of acute myocardial infarction (AMI).

See the related "Denominator Inclusions/Exclusions" field.

Note: This outcome measure does not have a traditional numerator and denominator like a core process measure; thus, this field is used to define the measure cohort.

See the 2017 Condition-specific Measures Updates and Specifications Report: Hospital-level 30-day Risk-standardized Excess Days in Acute Care Measures External Web Site Policy for more details.

Numerator Description

This measure counts all-cause days in acute care within 30 days from the date of discharge from an index acute myocardial infarction (AMI) admission. Days in acute care are defined as days spent in an emergency department (ED), admitted to observation status, or admitted as an unplanned readmission for any cause to a short-term acute care hospital.

Each ED visit is counted as one half-day (0.5 days). Observation stays are recorded in terms of hours and converted for the measure into half-days (rounded up). A readmission is defined as any unplanned short-term acute care hospitalization within 30 days of the discharge date for the index admission. Each unplanned readmission is counted according to length of stay, which is calculated as the discharge date minus the admission ate. Admissions that extend beyond the 30-day follow-up period are truncated on day 30. All eligible outcomes occurring in the 30-day period are counted, even if they are repeat occurrences.

See the related "Numerator Inclusions/Exclusions" field.

Note: This outcome measure does not have a traditional numerator and denominator like a core process measure; thus, this field is used to define the outcome.

See the 2017 Condition-specific Measures Updates and Specifications Report: Hospital-level 30-day Risk-standardized Excess Days in Acute Care Measures External Web Site Policy for more details.

Type of Evidence Supporting the Criterion of Quality for the Measure

  • A systematic review of the clinical research literature (e.g., Cochrane Review)
  • One or more research studies published in a National Library of Medicine (NLM) indexed, peer-reviewed journal

Additional Information Supporting Need for the Measure

  • Acute myocardial infarction (AMI) was the tenth most common principal discharge diagnosis among patients with Medicare in 2012 (Agency for Healthcare Research and Quality, n.d.). AMI also accounts for a large fraction of hospitalization costs and it was the sixth most expensive condition billed to Medicare, accounting for 4.8% of Medicare's hospital bill, in 2011 (Torio & Andrews, 2013).
  • Patients admitted for AMI have disproportionately high readmission rates. Readmission rates following discharge for AMI are highly variable across hospitals in the United States (U.S.) (Krumholz et al., 2009; Bernheim et al., 2010). For the time period between July 2012 and June 2013, hospitals' 30-day risk-standardized readmission rates (RSRRs) for AMI ranged from 14.1% to 20.6% (Yale New Haven Health Services Corporation [YNHHSC] & Center for Outcomes Research and Evaluation [CORE], 2014).
  • Patients, however, are not only at risk of requiring rehospitalization in the post-discharge period. Emergency department (ED) visits represent a significant proportion of post-discharge acute care utilization. Two recent studies conducted in patients of all ages have shown that 9.5% of patients return to the ED within 30 days of hospital discharge and that about 12.0% of these patients are discharged from the ED and are not captured by the current Centers for Medicare & Medicaid Services (CMS) 30-day AMI readmission measure (Rising et al., 2013; Vashi et al., 2013).
  • Additionally, over the past decade, the use of observation stays has rapidly increased. Between 2001 and 2008, the use of observation services increased nearly three-fold (Venkatesh et al., 2011), and significant variation has been demonstrated in the use of observation services for conditions such as chest pain (Schuur et al., 2011). These rising rates of observation stays among Medicare beneficiaries have gained the attention of patients, providers, and policymakers (Feng, Wright, & Mor, 2012; Rising et al., 2013; Vashi et al., 2013). A report from the Office of the Inspector General (OIG) noted that in 2012, Medicare beneficiaries had 1.5 million observation stays. Many of these observation stays lasted longer than the intended one day. The OIG report also noted the potential relationship between hospital use of observation stays as an alternative to short-stay inpatient hospitalizations as a response to changing hospital payment incentives (Wright, 2013).

Evidence for Additional Information Supporting Need for the Measure

Agency for Healthcare Research and Quality (AHRQ). HCUPnet. Healthcare Cost and Utilization Project. [internet]. Rockville (MD): Agency for Healthcare Research and Quality (AHRQ);

Bernheim SM, Grady JN, Lin Z, Wang Y, Wang Y, Savage SV, Bhat KR, Ross JS, Desai MM, Merrill AR, Han LF, Rapp MT, Drye EE, Normand SL, Krumholz HM. National patterns of risk-standardized mortality and readmission for acute myocardial infarction and heart failure. Update on publicly reported outcomes measures based on the 2010 release. Circ Cardiovasc Qual Outcomes. 2010 Sep;3(5):459-67. PubMed External Web Site Policy

Feng Z, Wright B, Mor V. Sharp rise in Medicare enrollees being held in hospitals for observation raises concerns about causes and consequences. Health Aff (Millwood). 2012 Jun;31(6):1251-9. PubMed External Web Site Policy

Krumholz HM, Merrill AR, Schone EM, Schreiner GC, Chen J, Bradley EH, Wang Y, Wang Y, Lin Z, Straube BM, Rapp MT, Normand SL, Drye EE. Patterns of hospital performance in acute myocardial infarction and heart failure 30-day mortality and readmission. Circ Cardiovasc Qual Outcomes. 2009 Sep;2(5):407-13. PubMed External Web Site Policy

Rising KL, White LF, Fernandez WG, Boutwell AE. Emergency department visits after hospital discharge: a missing part of the equation. Ann Emerg Med. 2013 Aug;62(2):145-50. PubMed External Web Site Policy

Schuur JD, Baugh CW, Hess EP, Hilton JA, Pines JM, Asplin BR. Critical pathways for post-emergency outpatient diagnosis and treatment: tools to improve the value of emergency care. Acad Emerg Med. 2011 Jun;18(6):e52-63. PubMed External Web Site Policy

Torio CM, Andrews RM. National inpatient hospital costs: the most expensive conditions by payer, 2011. Rockville (MD): Agency for Healthcare Research and Quality (AHRQ); 2013 Aug. 12 p.  (HCUP statistical brief; no. 160).

Vashi AA, Fox JP, Carr BG, D'Onofrio G, Pines JM, Ross JS, Gross CP. Use of hospital-based acute care among patients recently discharged from the hospital. JAMA. 2013 Jan 23;309(4):364-71. PubMed External Web Site Policy

Venkatesh AK, Geisler BP, Gibson Chambers JJ, Baugh CW, Bohan JS, Schuur JD. Use of observation care in US emergency departments, 2001 to 2008. PLoS ONE. 2011;6(9):e24326. PubMed External Web Site Policy

Wright S. Hospitals’ use of observation stays and short inpatient stays for Medicare beneficiaries. Washington (DC): Department of Health and Human Services; 2013 Jul 29. 20 p.

Yale New Haven Health Services Corporation (YNHHSC), Center for Outcomes Research & Evaluation (CORE). Excess days in acute care after hospitalization for acute myocardial infarction (AMI) (version 1.0): final measure methodology report. Baltimore (MD): Centers for Medicare & Medicaid Services (CMS); 2015 Aug. 58 p. [50 references]

Yale New Haven Health Services Corporation (YNHHSC), Center for Outcomes Research and Evaluation (CORE). Medicare hospital quality chartbook: performance report on outcome measures. Baltimore (MD): Centers for Medicare & Medicaid Services (CMS); 2014 Sep. 105 p. [13 references]

Extent of Measure Testing

Assessment of Updated Models

The acute myocardial infarction (AMI) excess days in acute care (EDAC) measure estimates hospital-specific 30-day all-cause EDAC using a hierarchical generalized linear model. Refer to Section 2 in the original measure documentation for a summary of the measure methodology and model risk-adjustment variables. Refer to prior methodology reports for further details.

The Centers for Medicare & Medicaid Services (CMS) evaluated and validated the performance of the model using July 2013 to June 2016 data for the 2017 reporting period. They also evaluated the stability of the risk-adjustment model over the three-year measurement period by examining the model variable frequencies in each year.

CMS assessed the overall fit of the model using posterior predictive checking (PPC) for the three-year combined period. For the logit model of zero versus non-zero days, which includes all patients in the cohort, they calculated the c-statistic. For the truncated Poisson model of non-zero days, which includes only patients with some acute care, they calculated the deviance R2. The deviance R2 is computed from the difference in the log-likelihoods between the final model and an empty model (no covariates) attributed to each observation, averaged over all observations (Cameron & Windmeijer, 1996).

The results of these analyses are presented in Section 4.2 of the original measure documentation.

AMI EDAC 2017 Model Results

Frequency of AMI Model Variables

CMS examined the change in the frequencies of clinical and demographic variables. Frequencies of model variables were quite stable over the measurement period. The largest changes in the frequencies (those greater than 2% absolute change) include:

  • An increase in history of coronary artery bypass graft (CABG) surgery (11.9% to 14.1%)
  • A decrease in coronary atherosclerosis/other chronic ischemic heart disease (87.1% to 84.8%)

AMI Model Parameters and Performance

Table 4.2.2 in the original measure documentation shows the parameter estimates and 95% credible intervals (CIs) for the combined three-year dataset. Table 4.2.3 in the original measure documentation shows the PPC results for the combined three-year dataset. The c-statistic for the logit part was 0.60. The deviance R2 for the truncated Poisson part was 0.062.

Refer to the original measure documentation for additional information.

Evidence for Extent of Measure Testing

Cameron AC, Windmeijer FA. R-squared measures for count data regression models with applications to health-care utilization. J Bus Econ Stat. 1996 Apr;14(2):209-20.

Yale New Haven Health Services Corporation (YNHHSC), Center for Outcomes Research and Evaluation (CORE). 2017 condition-specific measure updates and specifications report: hospital-level 30-day risk-standardized excess days in acute care measures. Baltimore (MD): Centers for Medicare & Medicaid Services (CMS); 2017 Mar. 61 p.

State of Use

Current routine use

Current Use

Collaborative inter-organizational quality improvement

External oversight/Medicare

Monitoring and planning

Pay-for-reporting

Public reporting

Measurement Setting

Hospital Inpatient

Professionals Involved in Delivery of Health Services

Does not apply to this measure (e.g., measure is not provider specific)

Least Aggregated Level of Services Delivery Addressed

Single Health Care Delivery or Public Health Organizations

Statement of Acceptable Minimum Sample Size

Specified

Target Population Age

Age greater than or equal to 65 years

Target Population Gender

Either male or female

IOM Care Need

Not within an IOM Care Need

IOM Domain

Not within an IOM Domain

Case Finding Period

Discharges July 1, 2013 to June 30, 2016

Denominator Sampling Frame

Patients associated with provider

Denominator (Index) Event or Characteristic

Clinical Condition

Institutionalization

Patient/Individual (Consumer) Characteristic

Denominator Time Window

Time window precedes index event

Denominator Inclusions/Exclusions

Inclusions
An index admission is the hospitalization to which the excess days in acute care (EDAC) outcome is attributed and includes admissions for patients:

  • Having a principal discharge diagnosis of acute myocardial infarction (AMI)*
  • Enrolled in Medicare Fee-for-Service (FFS) Part A and Part B for the 12 months prior to the date of the admission, and enrolled in Part A during the index admission
  • Aged 65 or over
  • Discharged alive from a non-federal short-term acute care hospital
  • Not transferred to another acute care facility

*The International Classification of Diseases, 10th Revision, Clinical Modification (ICD-10-CM) codes used to define the AMI cohort inclusions for discharges on or after October 1, 2015:

  • I21.01 ST elevation myocardial infarction (STEMI) involving left main coronary artery
  • I21.02 STEMI involving left anterior descending coronary artery
  • I21.09 STEMI involving other coronary artery of anterior wall
  • I21.11 STEMI involving right coronary artery
  • I21.19 STEMI involving other coronary artery of inferior wall
  • I21.21 STEMI involving left circumflex coronary artery
  • I21.29 STEMI involving other sites
  • I21.3 STEMI of unspecified site
  • I21.4 Non-ST elevation (NSTEMI) myocardial infarction

Note: International Classification of Diseases, Ninth Revision (ICD-9) code lists for discharges prior to October 1, 2015 can be found in the Excess Days in Acute Care after Hospitalization for Acute Myocardial Infarction (AMI) (Version 1.1): Updated Measure Methodology Report External Web Site Policy.

Exclusions

  • Without at least 30 days of post-discharge enrollment in Medicare FFS
  • Discharged against medical advice
  • Same-day discharges
  • AMI admissions within 30 days of discharge from a prior AMI index admission

Exclusions/Exceptions

Does not apply to this measure

Numerator Inclusions/Exclusions

Inclusions
All-cause days in acute care within 30 days from the date of discharge from an index acute myocardial infarction (AMI) admission

Days in acute care are defined as days spent in an emergency department (ED), admitted to observation status, or admitted as an unplanned readmission for any cause within 30 days from the date of discharge from the index admissions.

  • Each ED visit is counted as one half-day (0.5 days).
  • Observation stays are recorded in terms of hours and converted for the measure into half-days (rounded up).
  • The Centers for Medicare & Medicaid Services (CMS) defines a readmission as any unplanned acute care hospital inpatient hospitalization within 30 days of the discharge date for the index hospitalization. "Planned" readmissions are those planned by providers for anticipated medical treatment or procedures that must be provided in the inpatient setting. To exclude planned readmissions, use the planned readmission algorithm previously developed for the publicly reported CMS 30-day AMI readmission measure (see Appendix E in the original measure documentation). Each rehospitalization is counted according to the length of stay, which is calculated as the discharge date minus the admission date. Admissions that extend beyond the 30-day follow-up period are truncated on day 30.
  • When an ED visit, observation stay, or readmission overlaps with another event on the same day, only the most severe of the overlapping events is counted.

Because some patients do not survive 30 days, not all patients are at risk for an acute event for the same amount of time. "Exposure time" is calculated as the number of days each patient survived after discharge, up to 30. This exposure time was incorporated as part of the outcome to reflect differential risk for EDAC after discharge. This differs from the existing CMS AMI 30-day readmission measure, which consider all patients to be equally at risk for a hospital event regardless of survival time.

Note: This outcome measure does not have a traditional numerator and denominator like a core process measure; thus, this field is used to define the outcome.

See the 2017 Condition-specific Measures Updates and Specifications Report: Hospital-level 30-day Risk-standardized Excess Days in Acute Care Measures External Web Site Policy for more details.

Exclusions
Admissions identified as planned by the planned readmissions algorithm are not counted. The planned readmission algorithm is a set of criteria for classifying readmissions and planned among the general Medicare population using Medicare administrative claims data. The algorithm identifies admissions that are typically planned and may occur within 30 days of discharge from the hospital.

The planned readmission algorithm has three fundamental principles:

  1. A few specific, limited types of care are always considered planned (transplant surgery, maintenance chemotherapy/immunotherapy, rehabilitation);
  2. Otherwise, a planned readmission is defined as a non-acute readmission for a scheduled procedure; and
  3. Admissions for acute illness or for complications of care are never planned.

The planned readmission algorithm uses a flow chart and four tables of specific procedure categories and discharge diagnosis categories to classify readmissions as planned. The flow chart and tables are available in the original measure documentation.

Numerator Search Strategy

Fixed time period or point in time

Data Source

Administrative clinical data

Type of Health State

Proxy for Outcome

Instruments Used and/or Associated with the Measure

Planned Readmission Algorithm Version 4.0 (ICD-10) Flowchart

Measure Specifies Disaggregation

Does not apply to this measure

Scoring

Count

Interpretation of Score

Desired value is a lower score

Allowance for Patient or Population Factors

Case-mix adjustment

Risk adjustment devised specifically for this measure/condition

Description of Allowance for Patient or Population Factors

Risk-Adjustment Variables

In order to account for differences in case mix among hospitals, the measure adjusts for variables (for example, age, comorbid diseases, and indicators of patient frailty) that are clinically relevant and have relationships with the outcome. For each patient, risk-adjustment variables are obtained from inpatient, outpatient, and physician Medicare administrative claims data extending 12 months prior to, and including, the index admission.

The measure adjusts for case mix differences among hospitals based on the clinical status of the patient at the time of the index admission. Accordingly, only comorbidities that convey information about the patient at that time or in the 12 months prior, and not complications that arise during the course of the hospitalization, are included in the risk adjustment.

The measure does not adjust for socioeconomic status (SES) because the association between SES and health outcomes can be due, in part, to differences in the quality of healthcare that groups of patients with varying SES receive. The intent is for the measure to adjust for patient demographic and clinical characteristics while illuminating important quality differences. As part of the National Quality Forum's (NQF's) endorsement process for this measure, the Centers for Medicare & Medicaid Services (CMS) completed analyses for the two-year Sociodemographic Trial Period. Although univariate analyses found that the patient-level observed days in acute care is higher for dual-eligible patients (for patients living in lower Agency for Healthcare Research and Quality [AHRQ] SES Index census block groups) and African-American patients compared with all other patients, analyses in the context of a multivariable model demonstrated that the effect size of these variables was small, and that the c-statistics for the logit part of the models and the deviance R2 values for the Poisson part of the models are similar with and without the addition of these variables.

Refer to Appendix D of the original measure documentation for the list of comorbidity risk-adjustment variables and the list of complications that are excluded from risk adjustment if they occur only during the index admission.

Standard of Comparison

External comparison at a point in, or interval of, time

External comparison of time trends

Internal time comparison

Original Title

Hospital-level 30-day EDAC following AMI.

Measure Collection Name

National Hospital Inpatient Quality Measures

Measure Set Name

Excess Days in Acute Care (EDAC) Measures

Submitter

Centers for Medicare & Medicaid Services - Federal Government Agency [U.S.]

Developer

Centers for Medicare & Medicaid Services - Federal Government Agency [U.S.]

Yale-New Haven Health Services Corporation/Center for Outcomes Research and Evaluation under contract to Centers for Medicare & Medicaid Services - Academic Affiliated Research Institute

Funding Source(s)

Centers for Medicare & Medicaid Services (CMS)

Composition of the Group that Developed the Measure

This measure was developed by a team of experts:

  • Michael A. Ross, MD, FACEP, Emory University School of Medicine
  • Mark L. Sanz, MD, International Heart Institute of Montana
  • Paul Takahashi, MD, Mayo Clinic College of Medicine
  • Anonymous Patient
  • Arlene Ash, PhD, University of Massachusetts Medical School
  • Jeremiah Brown, MS, PhD, The Dartmouth Institute for Health Policy and Clinical Practice
  • Grant Ritter, PhD, MS, MA, Schneider Institute for Health Policy & Heller Graduate School
  • Patrick Romano, MD, MPH, University of California Davis School of Medicine
  • Kevin E. Driesen, PhD, MPH, MA, Mel and Enid Zuckerman College of Public Health
  • David Engler, PhD, America's Essential Hospitals
  • Timothy Farrell, MD, University of Utah School of Medicine
  • Karen Farris, PhD, University of Michigan College of Pharmacy
  • Maura C. Feldman, MSW, Blue Cross Blue Shield of Massachusetts
  • Jay A. Gold, MD, JD, MPH, MetaStar
  • Sally Hinkle, DNP, MPA, RN, Temple University Hospital
  • Amy Jo Haavisto Kind, MD, PhD, University of Wisconsin School of Medicine and Public Health
  • Marjorie King, MD, FACC, MAACVPR, Helen Hayes Hospital
  • Eugene Kroch, PhD, Premier
  • Keith D. Lind, JD, MS, BSN, American Association of Retired Persons (AARP) Public Policy Institute
  • Grace McConnell, PhD, Patient Representative
  • Harlan M. Krumholz, MD, SM, Yale School of Medicine
  • Jeph Herrin, PhD, Yale School of Medicine
  • Nihar Desai, MD, MPH, Yale School of Medicine
  • Yongfei Wang, MS, Yale School of Medicine
  • Leora Horwitz, MD, MHS, New York University School of Medicine
  • Sharon-Lise Normand, PhD, Harvard School of Public Health
  • Lein Han, PhD, Centers for Medicare & Medicaid Services (CMS)
  • Pierre Yong, MD, CMS
  • Vinitha Meyyur, PhD, CMS
  • Alicia Budd, MPH, CMS
  • Kate Goodrich, MD, MHS, CMS
  • Zhenqiu Lin, PhD, Yale New Haven Health Services Corporation/Center for Outcomes Research & Evaluation (YNHHSC/CORE)
  • Arjun K. Venkatesh, MD, MBA, MHS, YNHHSC/CORE
  • Jacqueline Grady, MS, YNHHSC/CORE
  • Kanchana R. Bhat, MPH, YNHHSC/CORE
  • Lori Geary, MPH, YNHHSC/CORE
  • Changqin Wang, MD, MS, YNHHSC/CORE
  • Susannah M. Bernheim, MD, MHS, YNHHSC/CORE
  • Steven Susaña-Castillo, BA, YNHHSC/CORE
  • Faseeha K. Altaf, MPH, YNHHSC/CORE
  • Chi K. Ngo, MPH, YNHHSC/CORE
  • Shuling Liu, PhD, YNHHSC/CORE
  • Jinghong Gao, MS, YNHHSC/CORE

Financial Disclosures/Other Potential Conflicts of Interest

None

Endorser

National Quality Forum

NQF Number

2881

Date of Endorsement

2016 Dec 9

Core Quality Measures

Does not apply to this measure

Measure Initiative(s)

Hospital Compare

Hospital Inpatient Quality Reporting Program

Adaptation

This measure was not adapted from another source.

Date of Most Current Version in NQMC

2017 Mar

Measure Maintenance

Annual

Date of Next Anticipated Revision

2018 May

Measure Status

This is the current release of the measure.

Source(s)

Yale New Haven Health Services Corporation (YNHHSC), Center for Outcomes Research and Evaluation (CORE). 2017 condition-specific measure updates and specifications report: hospital-level 30-day risk-standardized excess days in acute care measures. Baltimore (MD): Centers for Medicare & Medicaid Services (CMS); 2017 Mar. 61 p.

Measure Availability

Source available from the QualityNet Web site External Web Site Policy.

Check the QualityNet Web site regularly for the most recent version of the specifications manual and for the applicable dates of discharge.

Companion Documents

The following are available:

  • Yale New Haven Health Services Corporation (YNHHSC), Center for Outcomes Research & Evaluation (CORE). Excess days in acute care after hospitalization for acute myocardial infarction (AMI) (version 1.0): final measure methodology report. Baltimore (MD): Centers for Medicare & Medicaid Services (CMS); 2015 Aug. 58 p. Available from the QualityNet Web site External Web Site Policy.
  • Hospital compare: a quality tool provided by Medicare. [internet]. Washington (DC): U.S. Department of Health and Human Services; [accessed 2017 Oct 3]. This is available from the Medicare Web site External Web Site Policy.
  • Yale New Haven Health Services Corporation (YNHHSC), Center for Outcomes Research and Evaluation (CORE). Medicare hospital quality chartbook: performance report on outcome measures. Baltimore (MD): Centers for Medicare & Medicaid Services (CMS); 2017 Sep. Available from the Centers for Medicare & Medicaid Services (CMS) Web site External Web Site Policy.
  • Yale New Haven Health Services Corporation (YNHHSC), Center for Outcomes Research and Evaluation (CORE). 2017 condition-specific EDAC measures updates and specifications report: supplemental ICD-10 code lists for use with claims for discharges on or after October 1, 2015. Baltimore (MD): Centers for Medicare & Medicaid Services (CMS); 2017. Available from the QualityNet Web site External Web Site Policy.

NQMC Status

This NQMC summary was completed by ECRI Institute on December 29, 2017. The information was verified by the measure developer on January 17, 2018.

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