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  1. eCQM Issue Tracker
  2. CQM-1328

Encounter, Performed for patients who admit and discharge from ICU

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    • Icon: EH/CAH eCQMs - Eligible Hospitals/Critical Access Hospitals EH/CAH eCQMs - Eligible Hospitals/Critical Access Hospitals
    • Resolution: Resolved
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      The values in the Encounter Inpatient (2.16.840.1.113883.3.666.5.307) value set represent admission to the establishment whereas codes in the ICU Admission or Transfer value set (2.16.840.1.113883.3.117.1.7.1.305) are intended to represent the admission at the level of the department. As such, all patients admitted for an inpatient encounter should have a code found in the Encounter Inpatient value set regardless of location, while patients admitted to the ICU should have codes found on both the Encounter Inpatient value set and the ICU Admission or Transfer value set.
      In the stroke case reported, the patient should have had a value on the Non-Elective Inpatient Encounter value set (2.16.840.1.113883.3.117.1.7.1.424) as well as the ICU Admission or Transfer value set (2.16.840.1.113883.3.117.1.7.1.305) .
      In the case of the VTE-1 and VTE-2 measures, all admitted patients should have a code found in the Encounter Inpatient value set (2.16.840.1.113883.3.666.5.307), while those admitted to a location of ICU should also have a code on the ICU Admission or Transfer value set (2.16.840.1.113883.3.117.1.7.1.305). Codes on the ICU Admission or Transfer value set would be inappropriate to include on the Encounter Inpatient value set- For patients with an ICU stay, adding ICU codes to the Encounter Inpatient value set could potentially restrict the period of measurement to the ICU location, rather than the length of the hospitalization, which is not the intent of the measure.

      We acknowledge the need for harmonization related to the representation of ICU locations across measure sets.
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      The values in the Encounter Inpatient (2.16.840.1.113883.3.666.5.307) value set represent admission to the establishment whereas codes in the ICU Admission or Transfer value set (2.16.840.1.113883.3.117.1.7.1.305) are intended to represent the admission at the level of the department. As such, all patients admitted for an inpatient encounter should have a code found in the Encounter Inpatient value set regardless of location, while patients admitted to the ICU should have codes found on both the Encounter Inpatient value set and the ICU Admission or Transfer value set. In the stroke case reported, the patient should have had a value on the Non-Elective Inpatient Encounter value set (2.16.840.1.113883.3.117.1.7.1.424) as well as the ICU Admission or Transfer value set (2.16.840.1.113883.3.117.1.7.1.305) . In the case of the VTE-1 and VTE-2 measures, all admitted patients should have a code found in the Encounter Inpatient value set (2.16.840.1.113883.3.666.5.307), while those admitted to a location of ICU should also have a code on the ICU Admission or Transfer value set (2.16.840.1.113883.3.117.1.7.1.305). Codes on the ICU Admission or Transfer value set would be inappropriate to include on the Encounter Inpatient value set- For patients with an ICU stay, adding ICU codes to the Encounter Inpatient value set could potentially restrict the period of measurement to the ICU location, rather than the length of the hospitalization, which is not the intent of the measure. We acknowledge the need for harmonization related to the representation of ICU locations across measure sets.

      Recently, a client reached out asking us to investigate why a case was not qualifying for the Stroke measures. Upon investigation, we found that the only Encounter, Performed values were on the ED Visit and the ICU Admission or Transfer value sets. Thus, the case accurately is not included in any of the Stroke measure populations as there is no value on the non-Elective Inpatient Encounter value set.

      When reporting this back to the client, we learned that the patient had admitted to the ICU from the ED and was discharged from the ICU. Thus, the Encountered, Performed values were correct. The client understood that the case qualification calculated was accurate based on the measure logic, but expressed that they did not understand how this was consistent with the measure intent.

      As we were unable to respond, we are reaching out to you for guidance. While we understand that patients discharging from ICU is an infrequent occurrence, we also note that ICU is an inpatient area. As the values on the ICU Admission or Transfer value set are not included on any of the Inpatient Encounter value sets, these cases would never qualify for any of the inpatient measures, including the VTE-1 and VTE-2 measures which use the ICU Admission or Transfer element.

      Also, we would like to point out that other measures (SCIP and PN) use location to determine that the patient was in the ICU. Thus, we would like to understand why this logic was not mimicked in the VTE measures.

            JLeflore Joelencia Leflore
            cmccorkle Carla McCorkle (Inactive)
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