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Hospitalization for Ambulatory Care Sensitive Conditions for Dual Eligible Beneficiaries

CBE ID
3449
1.4 Project
All-Cause Admissions and Readmissions
Endorsement Status
Endorsement Removed
1.1 New or Maintenance
Maintenance
Previous Endorsement Cycle
Fall 2018
Is Under Review
No
1.3 Measure Description

For dual eligible beneficiaries age 18 years and older, state-level observed and risk-adjusted rates of hospital admissions for ambulatory care sensitive conditions (ACSC) per 1,000 beneficiaries for ACSC by chronic and acute conditions. This measure has three rates reported as both observed and risk-adjusted rates:
• Chronic Conditions Composite
• Acute Conditions Composite
• Total (Acute and Chronic Conditions) Composite
The observed and risk-adjusted rates are stratified and reported for three populations: (1) community-dwelling home and community-based services (HCBS) users; (2) community-dwelling non-HCBS users; or, (3) non-community-dwelling (institutionalized) population.

This measure is planned for public reporting and quality improvement at the state level. This population health measure can help states understand the underlying quality of outpatient care, including home- and community-based services, provided to dual eligible beneficiaries for acute conditions, chronic conditions, and overall. The state-level measure can assess the quality of a breadth of outpatient services by providers that may not be linked to a single accountable healthcare facility.

    • 1.14 Numerator

      Chronic Composite: Number of acute inpatient hospital admissions in the measurement year for diabetes short term complications, diabetes long term complications, uncontrolled diabetes, low-extremity amputation, chronic obstructive pulmonary disease (COPD), asthma, hypertension, and heart failure.
      Acute Composite: Number of acute inpatient hospital admissions in the measurement year for bacterial pneumonia, urinary tract infection, cellulitis and pressure ulcers.
      Total Composite: Sum of acute and chronic composites

    • 1.15 Denominator

      Dual eligible adults age 18 years and older within each state

    • Exclusions

      • See the numerator details section for exclusions from the individual composite indicators
      • Hospitalizations for obstetrics
      • Hospice
      • Acute hospital transfers

    • Most Recent Endorsement Activity
      Measure Retired and Endorsement Removed All-Cause Admissions and Readmissions Fall Cycle 2018
      Initial Endorsement
      Last Updated
      Removal Date
    • Steward
      Centers for Medicare & Medicaid Services
      Steward Organization POC Email
      [email protected]