Skip to main content

Cross-Setting Discharge Function Score for Long-Term Care Hospitals

CBE ID
4635
Endorsement Status
1.0 New or Maintenance
Is Under Review
Yes
Next Maintenance Cycle
Fall 2024
1.6 Measure Description

This outcome measure estimates the percentage of Long-Term Care Hospital (LTCH) patient stays that meet or exceed an expected discharge function score. The expected discharge function score is a risk-adjusted estimate that accounts for resident characteristics. The measure includes patients 18 years of age or older and the measure timeframe is 12 months.

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

Measuring functional status of long-term care hospital (LTCH) patients can provide valuable information about a LTCH’s quality of care. A patient’s functional status may be associated with adverse health outcomes such as falls, fractures, exacerbation of chronic conditions, and a higher risk of readmissions following LTCH care. Predictors of poorer recovery in function include greater age, complications after hospital discharge, and residence in a nursing home. Understanding factors associated with poorer functional recovery facilitates the ability to estimate expected functional outcome recovery for patients, based on their personal characteristics.

LTCHs can positively impact their patients’ functional outcomes. During a LTCH stay, the goals of treatment include fostering the patient’s ability to manage their daily activities so that the patient can complete functional (i.e., self-care and mobility) activities as independently as possible and, if feasible, return to a safe, active and productive life in a community-based setting. 

The Cross-Setting Discharge Function Score (Discharge Function) measure determines how successful each LTCH is at achieving or exceeding an expected level of functional ability for its patients at discharge. An expectation for discharge function score is built for each LTCH stay by accounting for patient characteristics that impact their functional status. The Cross-Setting Discharge Function for a given LTCH is the proportion of that LTCH’s stays where a patient’s observed discharge function score meets or exceeds their expected discharge function score. LTCHs with a low percentage indicate that they are not achieving the functional gains at discharge that are expected based upon patient characteristics and patient status at admission for a larger share of their patients. The measure provides information to LTCHs that has the potential to hold providers accountable for functional outcomes and encourages them to improve the quality of care they deliver. This measure also promotes patient wellness, encourages adequate nursing and therapy services to help prevent adverse outcomes (e.g., potentially preventable hospitalization) and increases the transparency of quality of care in the LTCH setting. Discharge Function adds value to the LTCH QRP function measure portfolio by using specifications that allow for better comparisons across Post-Acute Care settings, considering both self-care and mobility activities in the function score, and refining the approach to addressing missing activity scores including those coded with activity not attempted codes.

1.20 Types of Data Sources
1.25 Data Source Details

The LTCH CARE Data Set is the assessment instrument LTCH providers use to collect patient assessment data for quality measure calculation in accordance with the LTCH QRP. Completion is required for all patients receiving inpatient services in a facility certified as a hospital and designated as an LTCH under the Medicare program, regardless of payer.