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30-Day Risk Standardized All-Cause Emergency Department Visit Following an Inpatient Psychiatric Facility Discharge

CBE ID
4190
Endorsement Status
E&M Committee Rationale/Justification

Due to No Consensus

1.0 New or Maintenance
Previous Endorsement Cycle
Is Under Review
No
1.6 Measure Description

The 30-Day Risk Standardized All-Cause Emergency Department Visit Following an Inpatient Psychiatric Facility (IPF) Discharge (IPF ED Visit) measure assesses the proportion of patients ages 18 and older with an emergency department (ED) visit, including observation stays, for any cause, within 30 days of discharge from an IPF, without subsequent admission. The IPF ED Visit measure is an outcome-based measure. 

Measure Specs
General Information
1.7 Measure Type
1.7 Composite Measure
No
1.3 Electronic Clinical Quality Measure (eCQM)
1.8 Level of Analysis
1.10 Measure Rationale

The 30-Day Risk Standardized All-Cause Emergency Department Visit Following an Inpatient Psychiatric Facility Discharge (IPF ED Visit) is a new measure that has not been endorsed, and therefore does not have an associated web page at this time. It has been well established that the first three months following an inpatient psychiatric facility (IPF) discharge, particularly the first month, is a period of high risk for readmissions, rehospitalization, and suicidality (Mutschler et al. 2019). The rationale for the IPF ED Visit measure is to encourage IPFs to proactively focus on discharge planning and community reintegration during patients’ IPF stays. The measure is complementary to the 30-Day All-Cause Unplanned Readmission Following Psychiatric Hospitalization in an IPF (IPF Readmission) measure (NQF #2860) and Follow-Up After Psychiatric Hospitalization (FAPH) measure. The proposed measure complements the IPF Readmission measure by providing information on emergency department (ED) visits, including observation, without readmission, thereby more comprehensively assessing IPF discharge planning quality and promoting care coordination post-discharge.

 

Relevant literature:

  • Mutschler, C., S. Lichtenstein, S.A. Kidd, and L. Davidson. “Transition Experiences Following Psychiatric Hospitalization: A Systematic Review of the Literature.” Community Mental Health Journal, vol. 55, no. 8, 2019, pp. 1255–1274. doi.org/10.1007/s10597-019-00413-9
1.20 Types of Data Sources
1.25 Data Source Details
  • Medicare beneficiary and coverage files. Provides information on patient demographic, enrollment, and vital status to identify the measure population and certain risk factors.
  • Medicare fee-for-service (FFS) Part A records. Contains final action claims submitted by acute care and critical access hospitals, IPFs, home health agencies, and skilled nursing facilities to identify the measure population, readmissions, and certain risk factors.
  • Medicare FFS Part B records. Contains final action claims submitted by physicians, physician assistants, clinical social workers, nurse practitioners, and other outpatient providers to identify certain risk factors. For this measure, claims for services such as laboratory tests, medical supplies, or other ambulatory services were not used. This ensures that diagnoses result from an encounter with a provider trained to establish diagnoses and not from a claim for a diagnostic test.