HEDIS Patient File:
Measures included in patient file:
- Breast Cancer Screening (BCS)
- Colorectal Cancer Screening (COL)
- Adult BMI Assessment (ABA)
- Osteoporosis Management in Women Who Had a Fracture (OMW)
- Comprehensive Diabetes Care (CDC) – Eye Exam
- Comprehensive Diabetes Care (CDC) – Medical Attention of Nephropathy
- Comprehensive Diabetes Care (CDC) – HbA1c poor control (>9.0%)
- Controlling High Blood Pressure (CBP) and Disease-Modifying Anti-Rheumatic Drug Therapy for Rheumatoid Arthritis (ART).
Attributes:
- Contract Number
- HICN Number
- Logical vs. Quantitative Values in Numerators and Denominators
- Member Months Values and Value of Zero (0) in Member Months Field - 0 to 12 values
- “NR,” “NB,” and “NA” reporting rates in Patient-Level Submissions
HEDIS2016_SNP - Follow-Up After Hospitalization for Mental illness
PHYSICIAN QUALITY REPORTING OPTIONS FOR INDIVIDUAL MEASURES
EOC010 --> EOC010-0011 Metric:
Measure #391 (NQF 0576): Follow-Up After Hospitalization for Mental Illness (FUH) – National Quality Strategy Domain: Communication and Care Coordination
DESCRIPTION:
The percentage of discharges for patients 6 years of age and older who were hospitalized for treatment of selected mental illness diagnoses and who had an outpatient visit, an intensive outpatient encounter or partial hospitalization with a mental health practitioner.
Two rates are reported:
- The percentage of discharges for which the patient received follow-up within 30 days of discharge.
- The percentage of discharges for which the patient received follow-up within 7 days of discharge.
RATIONALE: It is important to provide regular follow-up therapy to patients after they have been hospitalized for mental illness.
This measure is consistent with guidelines of the National Institute of Mental Health and the Centers for Mental Health Services.
- An outpatient visit with a mental health practitioner after discharge is recommended to make sure that the patient’s transition to the home or work environment is supported and that gains made during hospitalization are not lost.
- It also helps health care providers detect early post-hospitalization reactions or medication problems and provide continuing care.
CLINICAL RECOMMENDATION STATEMENTS:
According to a guideline developed by the American Academy of Child and Adolescent Psychiatry and the American Psychiatric Association, there is a need for regular and timely assessments and documentation of the patient’s response to all treatments.
The organization should make a practice of helping schedule follow-up appointments when a patient is discharged, as part of the treatment or case management plan, and should educate patients and practitioners about the importance of follow-up visits.
Systems should be established to generate reminder or “reschedule” notices that are mailed to patients in the event that a follow-up visit is missed or canceled. In many cases, it may also be necessary to develop outreach systems or assign case managers to encourage recently released patients to keep follow-up appointments or reschedule missed appointments.
Measures - Reporting rate and performance rate
Reporting Criteria 1:
Start with Denominator
- Check Patient Age:
- If Age at Date of Service is equal to or greater than 6 Years, equals No during the measurement period, do not include in Eligible Patient Population. Stop Processing.
- If Age at Date of Service is equal to or greater than 6 Years, equals Yes during the measurement period, proceed to check Patient Diagnosis.
- Check Patient Diagnosis:
- If Diagnosis of Mental Illness as Listed in the Denominator equals No, do not include in Eligible Patient Population. Stop Processing.
- If Diagnosis of Mental Illness as Listed in the Denominator equals Yes, proceed to check Encounter Performed.
- Check Encounter Performed:
- If Encounter as Listed in the Denominator equals No, do not include in Eligible Patient Population. Stop Processing.
- If Encounter as Listed in the Denominator equals Yes, proceed to check Patient Alive at Time of Acute Inpatient Setting Discharge.
- Check Patient Alive at Time of Acute Inpatient Setting Discharge:
- If Patient Alive at Time of Acute Inpatient Setting Discharge equals No, do not include in Eligible Patient Population. Stop Processing.
- If Patient Alive at Time of Acute Inpatient Setting Discharge equals Yes, proceed to check Patient Discharged from Acute Inpatient Setting On or Between January 1 and December 1 of the Measurement Period.
- Check Patient Discharged from Acute Inpatient Setting On or Between January 1 and December 1 of the Measurement Period:
- If Patient Discharged from Acute Inpatient Setting On or Between January 1 and December 1 of the Measurement Period equals No, do not include in Eligible Patient Population. Stop Processing.
- If Patient Discharged from Acute Inpatient Setting On or Between January 1 and December 1 of the Measurement Period equals Yes, proceed to Discharge Followed by Readmission or Direct Transfer to Acute or Nonacute Facility Within 30-day Follow-Up Period.
- Check Not Discharged After Readmission or Direct Transfer to Acute or Nonacute Facility Within 30-day Follow-Up Period:
- If Not Discharged After Readmission or Direct Transfer to Acute or Nonacute Facility Within 30-day Follow-Up Period equals No, do not include in Eligible Patient Population. Stop Processing.
- If Not Discharged After Readmission or Direct Transfer to Acute or Nonacute Facility Within 30-day Follow-Up Period equals Yes, include in Eligible Population.
- Denominator Population:
- Denominator population is all Eligible Patients in the denominator. Denominator is represented as Denominator in the Sample Calculation listed at the end of this document. Letter d1 equals 8 patients in the sample calculation.
Start Numerator
- If Patient Received Follow-Up on the Date of Discharge or Within 30 Days After Discharge equals Yes, include in Reporting Met and Performance Met.
- Reporting Met and Performance Met letter is represented in the Reporting Rate and Performance Rate in the Sample Calculation listed at the end of this document. Letter a1 equals 2 visits in Sample Calculation.
- If Patient Received Follow-Up on the Date of Discharge or Within 30 Days After Discharge equals No, proceed to check Clinician Documented Reason Patient was Not Able to Complete 30 day Follow-Up from Acute Inpatient Setting Discharge.
- Check Clinician Documented Reason Patient was Not Able to Complete 30 day Follow-Up from Acute Inpatient Setting Discharge:
- If Clinician Documented Reason Patient was Not Able to Complete 30 day Follow-Up from Acute Inpatient Setting Discharge equals Yes, include in Reporting Met and Performance Exclusion.
- Reporting Met and Performance Exclusion letter is represented in the Reporting Rate in the Sample Calculation listed at the end of this document. Letter b1 equals 3 visits in the Sample Calculation.
- If Clinician Documented Reason Patient was Not Able to Complete 30 day Follow-Up from Acute Inpatient Setting Discharge equals No, proceed to check Patient did Not Receive Follow-Up On the Date of Discharge or Within 30 Days After Discharge.
- Check Patient did Not Receive Follow-Up On the Date of Discharge or Within 30 Days After Discharge:
- If Patient did Not Receive Follow-Up On the Date of Discharge or Within 30 Days After Discharge equals Yes, include in the Reporting Met and Performance Not Met.
- Reporting Met and Performance Not Met letter is represented in the Reporting Rate in the Sample Calculation listed at the end of this document. Letter c1 equals 2 visits in the Sample Calculation.
- If Patient did Not Receive Follow-Up On the Date of Discharge or Within 30 Days After Discharge equals No, proceed to Reporting Not Met.
- Check Reporting Not Met:
- If Reporting Not Met, the Quality Data Code or equivalent was not reported. 1 visit has been subtracted from the reporting numerator in sample calculation.
Check Patient Received Follow-Up on the Date of Discharge or Within 30 Days After Discharge:
References:
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