What is the metric?
This metric records the number of outpatient emergency department visits per 1,000 long-stay resident days.
The metric business rules are based on the CMS Claims Based Quality Measure:
Number of Outpatient Emergency Department Visits per 1,000 Long-Stay Resident days.
What does the metric mean?
This metric measures the number of outpatient ED visits that occurred among long-stay residents of a nursing home during a selected period, expressed as the number of outpatient ED visits for every 1,000 days that the long-stay residents were admitted to the nursing home.
How do we calculate the metric?
The Numerator is the number of emergency department (ED) visits by long-term nursing home residents in a given time period that did not result in an outpatient observation stay or inpatient hospital stay, for any diagnosis.
An outpatient ED Visit is defined as any discharge to the Emergency Department entered into PCC’s census (ADT) whose outcome was entered as “ED Visit Only” or with no outcome entered and the patient was readmitted to the facility in PCC within 72 Hours.
The Denominator is the total number of days that long-stay nursing home residents spent in the facility during the target period, after they had been residents for 100 cumulative days or more. Cumulative days are the sum of days within an episode of care uninterrupted by a break of 30 days or more living in the community or another institution. This number is expressed per 1000 resident days (resident days/1000).
The date finder selects all hospitalizations and long term days of care occurring during the period.
References
Nursing Home Compare ClaimsBased Quality Measure Technical Specifications