The measure calculates a skilled nursing facility’s (SNFs) average change in self care for patients admitted from a hospital who are receiving therapy. The measure calculates the average change in self care score between admission and discharge for all residents admitted to a SNF from a hospital or another post-acute care setting for therapy (i.e., PT or OT) regardless of payor status. This is a risk adjusted outcome measure, based on the self care subscale of the Continuity Assessment and Record Evaluation (CARE) Tool and information from the admission MDS 3.0 assessment. The measure is calculated on a rolling 12 month, average updated quarterly.
- Measure TypeElectronic Clinical Quality Measure (eCQM)Level Of AnalysisCare SettingNumerator
This outcome measure assesses the change in self-care. The numerator is the risk adjusted sum of the change in the CARE Tool self care subscale items between admission and discharge for each individual admitted from a hospital or another post-acute care setting regardless of payor status and are receiving therapy (PT or OT) for any reason in a skilled nursing center.
DenominatorThe denominator includes all residents admitted to a SNF from a hospital or another post-acute care setting who receive either PT or OT therapy for any reason during their stay regardless of payor status, have a completed self care subscale of the CARE Tool at admission and discharge and do not meet any of the exclusion criteria and do not have missing data. The self care items used from the CARE tool are listed below and rated on a 1-6 scale (see Appendix for CARE Tool).
The items included in the CARE Tool self care subscale include:
• A1. Eating
• A3. Oral Hygiene
• A4. Toilet Hygiene
• A5. Upper Body Dressing
• A6. Lower Body Dressing
• C1. Wash Upper Body
• C2. Shower / Bathe
• C6. Putting on / taking off footwearExclusionsIndividual patients are excluded for two broad reasons:
1. if they have conditions where improvement in self-care is very unlikely,
OR
2. have missing data necessary to calculate the measure
Additionally, facilities with denominator size of fewer than 30 patients during a 12 month period are excluded from reporting of their data.Testing Data Sources
- Measure StructureNon Condition SpecificTarget PopulationMeasure Selection AttributesNational Quality Strategy PrioritiesPerson- and Family-Centered Care
- Risk Adjustment
- Current or planned use(s)
- Most Recent Endorsement ActivityMeasure Retired and Endorsement Removed Patient Experience and Function Spring Cycle 2020Initial EndorsementEndorsement StatusLast UpdatedRemoval Date
- StewardSteward Organization EmailSteward Organization Copyright
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