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Cross-Setting Discharge Function Score – for Home Health Agencies

CBE ID
4645
Endorsement Status
1.0 New or Maintenance
1.1 Measure Structure
Previous Endorsement Cycle
Is Under Review
No
Next Maintenance Cycle
Fall 2029
1.6 Measure Description

This outcome measure estimates the percentage of Home Health (HH) Medicare patients (18+) who meet or exceed an expected discharge function score over a 12-month period.

The expected discharge function score is a risk-adjusted estimate that accounts for patient characteristics.

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
1.9 Care Setting
1.10 Measure Rationale

Measuring functional status of home health patients can provide valuable information about a home health agency’s (HHAs) 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 home 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.

 

Home health care can positively impact functional outcomes. In stroke patients, home-based rehabilitation programs administered by home health clinicians have shown significantly improved function.  Home health services, delivered by a registered nurse positively impacted patient quality of life and clinical outcomes, including significant improvement in dressing lower body and bathing activities of daily living, meal preparation, shopping, and housekeeping instrumental activities of daily living. 

 

The Cross-Setting Discharge Function Score for HH measure determines how successful each HHA 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 HHA quality episode by accounting for patient characteristics that impact their functional status. The final Cross-Setting Discharge Function Score for HH for a given HHA is the proportion of that HHA’s quality episodes where a patient’s observed discharge function score meets or exceeds their expected discharge function score. HHAs with low scores indicate that they are not achieving the functional gains at discharge that are expected based upon patient characteristics and patient status at start of care (SOC) or resumption of care (ROC) for a larger share of their patients. The measure provides information to HHAs 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 HH setting. The Cross-Setting Discharge Function Score for HH measure adds value to the HH Quality Reporting Program (QRP) function measure portfolio by using specifications that allow for better comparisons across Post-Acute Care (PAC) settings, considering both self-care and mobility activities in the function score, and refining the approach to addressing activity not attempted codes.

1.20 Types of Data Sources
1.25 Data Source Details

The data source used is Outcome and Assessment Information Set also known as OASIS. See https://www.cms.gov/medicare/quality/home-health/home-health-quality-measures for more information.