The measure algorithm lists "Encounter, Performed: Hospital Measures-Nursing home or extended care facility" as a Denominator Exclusion for Population 1 & 2. The time frame associated is less than or equal to 90 days. However, the Hospital Measures-Nursing Home or Extended Care Facility Value Set OID 2.16.840.1.113883. 3.666.5.717 only lists admission, with no way to identify any other situation.

Admission for respite care (procedure)
Admission to establishment (procedure)
Admission to community hospital (procedure)
Admission to GP hospital (procedure)
Admission to private hospital (procedure)
Admission to long stay hospital (procedure)
Admission to tertiary referral hospital (procedure)
Admission to ward (procedure)
Hospital admission (procedure)
Hospital admission, pre-nursing home placement (procedure)
Unexpected hospital admission (procedure)
Hospital re-admission (procedure)
Hospital admission, transfer from other hospital or health care facility (procedure)
Hospital admission, precertified by medical audit action (procedure)

Scenario:
Patient was admitted to a long-term care facility 120 days ago and is currently a resident of that same facility. This patient is still at risk of HAP but would not be excluded based upon the content of the Value Set.

o OR: "Diagnosis, Active: Hospital Measures-Leukemia"
o OR: "Diagnosis, Active: Hospital Measures-Neutropenia (severity: 'Hospital Measures-Severe')"
o OR: "Diagnosis, Active: Hospital Measures-Lymphoma"
o OR: "Diagnosis, Active: Hospital Measures-Myelogenic leukemia"
o OR: "Medication, Active: Hospital Measures-Systemic corticosteroid/prednisone therapy"
o OR: "Diagnosis, Active: Hospital Measures-Lymphocytic leukemia"
o OR: "Diagnosis, Active: Hospital Measures-Myeloma"
o OR: "Diagnosis, Active: Hospital Measures-Myelodysplasia"
o OR: "Diagnosis, Active: Hospital Measures-Pancytopenia"
o OR: "Occurrence A of Encounter, Performed: Encounter Inpatient"
o OR: "Laboratory Test, Result: Hospital Measures-Neutrophil count"
o OR: "Medication, Active: Hospital Measures-Systemic immunosuppressive therapy"
o OR: "Encounter, Performed: Hospital Measures-Nursing home or extended care facility"
o OR: "Procedure, Performed: Hospital Measures-Systemic Chemotherapy"
o <= 90 day(s) starts before start of "Occurrence A of Encounter, Performed: Encounter Inpatient"

1.) What development guidance can you offer?