Stratification by risk factor category

30-Day Unplanned Readmissions for Cancer Patients measure is a cancer-specific measure. It provides the rate at which adult cancer patients have an unplanned readmission within 30 days of discharge from an acute care hospital. The unplanned readmission is defined as a subsequent inpatient admission to a short-term acute care hospital, which occurs within 30 days of the discharge date of an eligible index admission and has an admission type of “emergency” or “urgent.”

Annual standardized infection ratio (SIR) of bloodstream infections (BSIs) among children and adults receiving maintenance hemodialysis at outpatient hemodialysis facilities. BSIs are defined as positive blood cultures for hemodialysis patients which are reported monthly by participating facilities. The SIR is reported for a yearly period (calendar year) and is calculated by dividing the number of observed BSIs by the number of predicted BSIs during the year.

This is an ACO-level measure of days at home or in community settings (that is, not in acute care such as inpatient hospital or emergent care settings or post-acute skilled nursing) among adult Medicare Fee-for-Service (FFS) beneficiaries with complex, chronic conditions who are attributed to ACOs participating in the ACO REACH model. The measure includes risk adjustment for differences in patient mix across ACOs, with an additional adjustment based on patients’ risk of death.

This intermediate outcome eCQM captures the proportion of visits for patients of all ages that experience emergency care access barriers during a one-year performance period.

Hybrid Hospital-Wide Readmission (HWR) Measure with Claims and Electronic Health Record Data measures facility-level risk-standardized rate of readmission (RSRR) within 30 days of discharge from an inpatient admission, among Medicare Fee-For-Service (FFS) and Medicare Advantage (MA) patients aged 65 years and older. 

This outcome measure assesses individuals on the activities that are meaningful to them. The target population for this measure is adults with disabilities who receive HCBS or HCBS-like services. This is a self-contained measure that can be administered independently of other RTCOM measures. 

This outcome measure assesses an individual's level of social inclusion and to what degree they are connected to others in their community. The target population for this measure is adults with disabilities who receive HCBS or HCBS-like services. This is a self-contained measure that can be administered independently of other RTCOM measures. 

The measure is administered through an in-person or video-conferencing interview where an interviewer guides an individual through a series of questions (i.e., items) on the measure. There are 14 items on this measure:

This instrument assesses an individual’s experiences in paid employment as well as their experiences searching for paid employment. The target population for this instrument is adults with disabilities who receive HCBS or HCBS-like services. This is a self-contained instrument that can be administered independently of other RTCOM instruments.

This instrument assesses an individual’s experiences in paid employment as well as their experiences searching for paid employment. The target population for this instrument is adults with disabilities who receive HCBS or HCBS-like services. This is a self-contained instrument that can be administered independently of other RTCOM instruments.

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.