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Home Health

Valid for Measure Submission

Cross-Setting Discharge Function Score – for Home Health Agencies

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.

CBE ID
4645

Improvement in Ambulation/locomotion

Percentage of home health episodes of care during which the patient improved in ability to ambulate. This is a rate/proportion measure targeted at older adults with multiple chronic conditions during home health quality of care episodes. 

CBE ID
0167

Improvement in Bathing

Percentage of home health episodes of care during which the patient got better at bathing self. This is a rate/proportion measure targeted at elderly individuals with multiple chronic conditions during home health quality of care episodes. 

CBE ID
0174

Improvement in Bed Transferring

Percentage of home health episodes of care during which the patient got better at getting in and out of bed. This is a rate/proportion measure targeted at elderly individuals with multiple chronic conditions during home health quality of care episodes. 

CBE ID
0175

Improvement in Management of Oral Medications

Percentage of home health episodes of care during which the patient improved in ability to take their medicines correctly, by mouth. This is a rate/proportion measure targeted at elderly individuals with multiple chronic conditions during home health quality of care episodes. 

CBE ID
0176

Timely Follow-Up After Acute Exacerbations of Chronic Conditions

This is a measure of follow-up clinical visits for patients with chronic conditions who have experienced an acute exacerbation of one of six conditions (eight categories) of interest (coronary artery disease [CAD] {high or low acuity}, hypertension {high or medium acuity}, heart failure [HF], diabetes, asthma, and chronic obstructive pulmonary disease [COPD]) and are among adult Medicare Fee-for-Service (FFS) beneficiaries who are attributed to entities participating in the CMMI Accountable Care Organization (ACO) Realizing Equity, Access, and Community Health (REACH) model.

CBE ID
3455