ecqm.measure

CMS111v7 - Median Admit Decision Time to ED Departure Time for Admitted Patients (ED-2)

Rationale:

Median Admit Decision Time to ED Departure Time for Admitted Patients (ED-2). Reducing the time patients remain in the emergency department (ED) can improve access to treatment and increase quality of care. Reducing this time potentially improves access to care specific to the patient condition and increases the capability to provide additional treatment. In recent times, EDs have experienced significant overcrowding. Although once only a problem in large, urban, teaching hospitals, the phenomenon has spread to other suburban and rural healthcare organizations. According to a 2002 national U.S. survey, more than 90 percent of large hospitals report EDs operating 'at' or 'over' capacity. Approximately one third of hospitals in the U.S. report increases in ambulance diversion in a given year, whereas up to half report crowded conditions in the ED. In a recent national survey, 40 percent of hospital leaders viewed ED crowding as a symptom of workforce shortages. ED crowding may result in delays in the administration of medication such as antibiotics for pneumonia and has been associated with perceptions of compromised emergency care. For patients with non-ST-segment-elevation myocardial infarction, long ED stays were associated with decreased use of guideline-recommended therapies and a higher risk of recurrent myocardial infarction. Overcrowding and heavy emergency resource demand have led to a number of problems, including ambulance refusals, prolonged patient waiting times, increased suffering for those who wait, rushed and unpleasant treatment environments, and potentially poor patient outcomes. When EDs are overwhelmed, their ability to respond to community emergencies and disasters may be compromised.

Data Elements

DecisionToAdmitToHospitalInpatientOrder

Clinical Focus: This grouping of value sets identifies procedures that are commonly used for capturing an emergency decision to admit a patient to an inpatient hospital setting.

Data Element Scope: The intent of this data element is to identify an emergency decision to admit a patient to an inpatient hospital setting. Using the Quality Data Model, this particular element will map to the 'Encounter' category.

Inclusion Criteria: Include codes representing an emergency decision to admit a patient to an inpatient hospital setting utilizing the SNOMED CT system.

Exclusion Criteria: Exclude codes that do not meet the inclusion criteria.

Subject constrained to the Decision to Admit to Hospital Inpatient

EncounterOrder: Data elements that meet criteria using this datatype should document that an order for the encounter indicated by the QDM category and its corresponding value set has been recommended. Timing: The time the order is signed; Author dateTime.

DataType

Cardinality

DecisionToAdmitToHospitalInpatientOrder

0..*

EmergencyDepartmentVisitPerformed

Clinical Focus: This set of values identifies procedures representing an emergency department encounter.

Data Element Scope: The intent of this data element is to identify patients who have had an emergency department encounter. Using the Quality Data Model, this particular element will map to the 'Encounter' category.

Inclusion Criteria: Include codes representing an emergency department visit encounter utilizing the SNOMED CT code system.

Exclusion Criteria: None

Subject constrained to the Emergency Department Visit

EncounterPerformed: Data elements that meet criteria using this datatype should document that the encounter indicated by the QDM category and its corresponding value set is in progress or has been completed. Timing: The Relevant Period addresses: startTime – The time the encounter began (admission time) stopTime – The time the encounter ended (discharge time). The Author dateTime addresses when an Encounter is documented. Documentation can occur at the beginning, during, at the end or subsequent to the end of an Encounter. The Author dateTime should be used only if the Relevant Period cannot be obtained. The Location Period is an attribute of the attribute facility location addresses: startTime = the time the patient arrived at the location; stopTime = the time the patient departed from the location

DataType

Cardinality

EmergencyDepartmentVisitPerformed

0..*

HospitalSettingsAdmissionSource

Clinical Focus: This set of values identifies hospital environments where a patient may receive inpatient or outpatient care.

Data Element Scope: The intent of this data element is to identify hospital environments where a patient may receive inpatient or outpatient care. Using the Quality Data Model, this particular element will map to the Transfer category.

Inclusion Criteria: Use the concept of hospital environment (22232009) and all its children. Codes used are to be SNOMED-CT codes only.

Exclusion Criteria: None.

AdmissionSource: The location from which the patient was admitted (e.g., physician referral, facility from which the patient was transferred).

DataType

Cardinality

HospitalSettingsAdmissionSource

0..*

EncounterInpatientPerformed

Clinical Focus: This set of values identify the most common inpatient encounter types.

Data Element Scope: The intent of this data element is to identify patients who have had an inpatient encounter. Using the Quality Data Model, this particular element will map to the 'encounter' category.

Inclusion Criteria: Only SNOMED CT codes representing inpatient encounter should be included.

Exclusion Criteria: None.

Subject constrained to the Encounter Inpatient

EncounterPerformed: Data elements that meet criteria using this datatype should document that the encounter indicated by the QDM category and its corresponding value set is in progress or has been completed. Timing: The Relevant Period addresses: startTime – The time the encounter began (admission time) stopTime – The time the encounter ended (discharge time). The Author dateTime addresses when an Encounter is documented. Documentation can occur at the beginning, during, at the end or subsequent to the end of an Encounter. The Author dateTime should be used only if the Relevant Period cannot be obtained. The Location Period is an attribute of the attribute facility location addresses: startTime = the time the patient arrived at the location; stopTime = the time the patient departed from the location

DataType

Cardinality

EncounterInpatientPerformed

0..*

PsychiatricMentalHealthDiagnosisPrincipalDiagnosis

Clinical Focus: This grouping value set identifies diagnoses that are commonly used in the inpatient setting for psychiatric and mental health disorders.

Data Element Scope: The intent of this data element is to identify patients who have an active diagnosis for a psychiatric or mental health disorder. Using the Quality Data Model, this particular element will map to the 'diagnosis' category.

Inclusion Criteria: Include codes representing an active diagnosis for psychiatric and mental health disorders utilizing ICD 10 CM and SNOMED CT codes systems.

Exclusion Criteria: None.

PrincipalDiagnosis: The coded diagnosis/problem established after study to be chiefly responsible for occasioning the admission of the patient to the hospital for care.

DataType

Cardinality

PsychiatricMentalHealthDiagnosisPrincipalDiagnosis

0..*

EthnicityPatientCharacteristicEthnicity

Clinical Focus:

Data Element Scope:

Inclusion Criteria:

Exclusion Criteria:

ResultValue constrained to codes in the Ethnicity valueset (2.16.840.1.114222.4.11.837)

PatientCharacteristicEthnicity: Data elements that meet criteria using this datatype should document that the patient has one or more of the ethnicities indicated by the QDM category and its corresponding value set. Timing: Ethnicity does not have a specific timing. Measures using Patient Characteristic, Ethnicity should address the most recent entry in the clinical record.

DataType

Cardinality

EthnicityPatientCharacteristicEthnicity

0..*

OncAdministrativeSexPatientCharacteristicGender

Clinical Focus: Gender identity restricted to only Male and Female used in administrative situations requiring a restriction to these two categories.

Data Element Scope: Gender

Inclusion Criteria: Male and Female only.

Exclusion Criteria: Any gender identity that is not male or female.

ResultValue constrained to codes in the ONC Administrative Sex valueset (2.16.840.1.113762.1.4.1)

PatientCharacteristicGender: Data elements that meet criteria using this datatype should document that the patient's sex matches the QDM category and its corresponding value set. Timing: Birth (administrative) sex does not have a specific timing.

DataType

Cardinality

OncAdministrativeSexPatientCharacteristicGender

0..*

PayerPatientCharacteristicPayer

Clinical Focus: Categories of types of health care payor entities as defined by the US Public Health Data Consortium SOP code system

Data Element Scope: @code in CCDA r2.1 template Planned Coverage [act: identifier urn:oid:2.16.840.1.113883.10.20.22.4.129 (open)] DYNAMIC

Inclusion Criteria: All codes in the code system

Exclusion Criteria: none

ResultValue constrained to codes in the Payer valueset (2.16.840.1.114222.4.11.3591)

PatientCharacteristicPayer: Data elements that meet criteria using this datatype should document that the patient has one or more of the payers indicated by the QDM category and its corresponding value set. Timing: The Relevant Period addresses: startTime – The first day of insurance coverage with the referenced payer stopTime – The last day of insurance coverage with the referenced payer

DataType

Cardinality

PayerPatientCharacteristicPayer

0..*

RacePatientCharacteristicRace

Clinical Focus:

Data Element Scope:

Inclusion Criteria:

Exclusion Criteria:

ResultValue constrained to codes in the Race valueset (2.16.840.1.114222.4.11.836)

PatientCharacteristicRace: Data elements that meet criteria using this datatype should document the patient’s race. Timing: Race does not have a specific timing. Measures using Patient Characteristic, Race should address the most recent entry in the clinical record.

DataType

Cardinality

RacePatientCharacteristicRace

0..*