Readmissions Measures: Process & Outcome Barbara Brown, RN, PhD Vice President Virginia Hospital & Healthcare Association

Medication Reconciliation: Percent of patients, regardless of age, discharged from an inpatient facility to home or any other site of care who received a reconciled medication list at the time of discharge. o Numerator: Number of patients, regardless of age, discharged from an inpatient facility to home or any other site of care who received a reconciled medication list at the time of discharge. o Denominator: Total number of patients discharged per month 2 Readmission Process Measure

Medication Reconciliation Definition (based upon NQF-endorsed measure #646)Medication Reconciliation Definition (based upon NQF-endorsed measure #646) o Reconciled at discharge is defined as having a reconciled list of a) medications to be taken by patient (continued and new), b) prescribed dosage, instructions and intended duration for each continued and new, and c) medications not to be taken by patient (discontinued and due to allergies and adverse reactions). 3 Readmission Process Measure

o Sample: Random sample of 10 charts or 10% of discharges, whichever is greater, hospital-wide or unit-wide. o Frequency: Monthly o Submission: Quarterly enter data in NC secure QDS website within 20 days of close of quarter. 4 Readmission Process Measure

Month Data CollectedDate Due into QDS May & JuneJuly 20, 2012 July, August & SeptemberOctober 20, 2012 October, November & DecemberJanuary 20, Readmission Process Measure Enter the numerator and denominator in the QDS website

Outcome Measure 1: All Cause, all payer, all condition 30 day readmission rateOutcome Measure 1: All Cause, all payer, all condition 30 day readmission rate o Numerator: Number of patients readmitted to the index hospital or another hospital within 30 days of discharge o Denominator: Number of patients discharged to home or other site of care for the same time period. 6 Readmissions Outcome Measures:

Outcome Measure 2: % of patients with myocardial infarction readmitted to hospital within 30 days of discharge.Outcome Measure 2: % of patients with myocardial infarction readmitted to hospital within 30 days of discharge. Outcome Measure 3: % of patients with heart failure readmitted to hospital within 30 days of dischargeOutcome Measure 3: % of patients with heart failure readmitted to hospital within 30 days of discharge Outcome Measure 4: % of patients with pneumonia readmitted to hospital within 30 days of dischargeOutcome Measure 4: % of patients with pneumonia readmitted to hospital within 30 days of discharge Outcome Measure 5: Observed and Risk-adjusted 30- Day All-Cause Readmission RatesOutcome Measure 5: Observed and Risk-adjusted 30- Day All-Cause Readmission Rates 7 Readmissions Outcome Measures:

Outcome Measures Submission:Outcome Measures Submission: o No submission required by hospital. All outcome measures will be calculated using the inpatient patient level database and will be submitted quarterly. The observed/expected readmission rate will be calculated using the United Health Group methodology accepted by the National Quality Forum. The readmission rates for diabetes, heart failure and myocardial infarction will mirror CMS methodology. 8 Readmissions Outcome Measures: