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Coordinated and Integrated Care

Hybrid Hospital-Wide Readmission (HWR) Measure with Claims and Electronic Health Record Data

  • This measure estimates a hospital-level, risk-standardized readmission rate (RSRR) of unplanned, all-cause readmission within 30 days of hospital discharge for any eligible condition. The measure reports a single summary RSRR, derived from the volume-weighted results of five different models, one for each of the following specialty cohorts based on groups of discharge condition categories or procedure categories: surgery/gynecology, general medicine, cardiorespiratory, cardiovascular, and neurology.

    CBE ID
    2879e

Measuring the Value-Functions of Primary Care: Provider Level Continuity of Care Measure

  • This is a process measure evaluating primary care physicians; for each physician, their denominator is all of the patients they saw during the evaluation period who had at least 2 PCP visits (could include visits to other PCPs), and the numerator is the number of those patients whose Bice-Boxerman Continuity of Care Index is >= 0.7.

    CBE ID
    3617

Medication Reconciliation on Admission

  • Percentage of patients for whom a designated PTA medication list was generated by referencing one or more external sources of PTA medications and for which all PTA medications have a documented reconciliation action by the end of Day 2 of the hospitalization.

    CBE ID
    3317

Medication Reconciliation Post-Discharge

  • The percentage of discharges from January 1–December 1 of the measurement year for patients 18 years of age and older for whom medications were reconciled the date of discharge through 30 days after discharge (31 days total).

    CBE ID
    0097

National Healthcare Safety Network (NHSN) Antimicrobial Use Measure

  • This measure assesses antimicrobial use in hospitals based on medication administration data that hospitals collect electronically at the point of care and report via electronic file submissions to CDC’s National Healthcare Safety Network (NHSN).

    CBE ID
    2720