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  2. CQM-5718

CRP: Exclude patients who discharged against medical advice

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    • Other
    • Resolution: Resolved
    • Moderate
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      Brief description of measure
      CMS506: Safe Use of Opioids - Concurrent Prescribing:
      Proportion of inpatient hospitalizations for patients 18 years of age and older prescribed, or continued on, two or more opioids or an opioid and benzodiazepine concurrently at discharge

      Description of issue
      ​​The Safe Use of Opioids measure currently includes patients who are discharged against medical advice (AMA). However, many hospitals do not conduct medication reconciliation the same way for patients that are discharged AMA as compared to other discharge types. As a result, clinicians that are unable to reconcile medication for AMA patients might be unfairly penalized.

      Goal of review
      Obtain clinical and technical feedback
      Show
      Brief description of measure CMS506: Safe Use of Opioids - Concurrent Prescribing: Proportion of inpatient hospitalizations for patients 18 years of age and older prescribed, or continued on, two or more opioids or an opioid and benzodiazepine concurrently at discharge Description of issue ​​The Safe Use of Opioids measure currently includes patients who are discharged against medical advice (AMA). However, many hospitals do not conduct medication reconciliation the same way for patients that are discharged AMA as compared to other discharge types. As a result, clinicians that are unable to reconcile medication for AMA patients might be unfairly penalized. Goal of review Obtain clinical and technical feedback
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      Proposed solution
      CURRENT HEADER:
      Denominator Exclusions: 
      Inpatient hospitalizations where patients have cancer that begins prior to or during the encounter or are receiving palliative or hospice care (including comfort measures, terminal care, and dying care) during the encounter, patients discharged to another inpatient care facility, and patients who expire during the inpatient stay.

      CURRENT LOGIC:
      Denominator Exclusion
      /*Excludes encounters of patients with cancer or who are receiving palliative or hospice care at the time of the encounter*/
      "Inpatient Encounters with an Opioid or Benzodiazepine at Discharge" InpatientEncounter
           where exists [...]
           or exists ( "Inpatient Encounters with an Opioid or Benzodiazepine at Discharge" InpatientEncounter
               where InpatientEncounter.dischargeDisposition in "Discharge To Acute Care Facility" or InpatientEncounter.dischargeDisposition in "Hospice Care Referral or Admission" or InpatientEncounter.dischargeDisposition in "Patient Expired" )

      PROPOSED HEADER:
      Denominator Exclusions:
      Inpatient hospitalizations where patients have cancer that begins prior to or during the encounter or are receiving palliative or hospice care (including comfort measures, terminal care, and dying care) during the encounter, patients discharged to another inpatient care facility or discharged AMA, and patients who expire during the inpatient stay.

      PROPOSED LOGIC:
      Denominator Exclusion
      /*Excludes encounters of patients with cancer or who are receiving palliative or hospice care at the time of the encounter*/
       "Inpatient Encounters with an Opioid or Benzodiazepine at Discharge" InpatientEncounter
         where exists [...]
           or exists ( "Inpatient Encounters with an Opioid or Benzodiazepine at Discharge" InpatientEncounter
               where InpatientEncounter.dischargeDisposition in "Discharge To Acute Care Facility"
      or InpatientEncounter.dischargeDisposition in "Hospice Care Referral or Admission" or InpatientEncounter.dischargeDisposition in "Left Against Medical Advice" (2.16.840.1.113883.3.117.1.7.1.308)or InpatientEncounter.dischargeDisposition in "Patient Expired" )

      Rationale for change
      Excluding patients who are discharged AMA would avoid penalizing clinicians for being unable to reconcile medications for these patients.
      Show
      Proposed solution CURRENT HEADER: Denominator Exclusions:  Inpatient hospitalizations where patients have cancer that begins prior to or during the encounter or are receiving palliative or hospice care (including comfort measures, terminal care, and dying care) during the encounter, patients discharged to another inpatient care facility, and patients who expire during the inpatient stay. CURRENT LOGIC: Denominator Exclusion /*Excludes encounters of patients with cancer or who are receiving palliative or hospice care at the time of the encounter*/ "Inpatient Encounters with an Opioid or Benzodiazepine at Discharge" InpatientEncounter      where exists [...]      or exists ( "Inpatient Encounters with an Opioid or Benzodiazepine at Discharge" InpatientEncounter          where InpatientEncounter.dischargeDisposition in "Discharge To Acute Care Facility" or InpatientEncounter.dischargeDisposition in "Hospice Care Referral or Admission" or InpatientEncounter.dischargeDisposition in "Patient Expired" ) PROPOSED HEADER: Denominator Exclusions: Inpatient hospitalizations where patients have cancer that begins prior to or during the encounter or are receiving palliative or hospice care (including comfort measures, terminal care, and dying care) during the encounter, patients discharged to another inpatient care facility or discharged AMA, and patients who expire during the inpatient stay. PROPOSED LOGIC: Denominator Exclusion /*Excludes encounters of patients with cancer or who are receiving palliative or hospice care at the time of the encounter*/  "Inpatient Encounters with an Opioid or Benzodiazepine at Discharge" InpatientEncounter    where exists [...]      or exists ( "Inpatient Encounters with an Opioid or Benzodiazepine at Discharge" InpatientEncounter          where InpatientEncounter.dischargeDisposition in "Discharge To Acute Care Facility" or InpatientEncounter.dischargeDisposition in "Hospice Care Referral or Admission" or InpatientEncounter.dischargeDisposition in "Left Against Medical Advice" (2.16.840.1.113883.3.117.1.7.1.308)or InpatientEncounter.dischargeDisposition in "Patient Expired" ) Rationale for change Excluding patients who are discharged AMA would avoid penalizing clinicians for being unable to reconcile medications for these patients.

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          sgearhart Mathematica EH eCQM Team
          sgearhart Mathematica EH eCQM Team
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            Updated:
            Resolved: