Home Management Plan of Care (HMPC) Document Given to Patient/Caregiver

Last updated: May 4, 2017

CMS Measure ID: CMS26v4
Version: 4
NQF Number: None
Measure Description:

An assessment that there is documentation in the medical record that a Home Management Plan of Care (HMPC) document was given to the pediatric asthma patient/caregiver

Initial Patient Population:

Pediatric asthma inpatients with an age of 2 through 17 years, and length of stay less than or equal to 120 days

Denominator Statement:

Patients discharged to home or police custody

Denominator Exclusions:

None

Numerator Statement:

Pediatric asthma inpatients with documentation that they or their caregivers were given a written Home Management Plan of Care (HMPC) document that addresses all of the following:

1. Arrangements for follow-up care

2. Environmental control and control of other triggers

3. Method and timing of rescue actions

4. Use of controllers

5. Use of relievers

Numerator Exclusions:

Not Applicable

Denominator Exceptions:

None

Measure Steward: The Joint Commission
Domain: Person and Caregiver-Centered Experience Outcomes
Short Name: HMPC
Previous Version: Home Management Plan of Care (HMPC) Document Given to Patient/Caregiver
Improvement Notation:

Improvement noted as an increase in rate

Guidance:

The home management plan of care document should be a separate and patient-specific written instruction. The document must be present in the form of an explicit and separate document specific to the patient rather than components or segments of the plan spread across discharge instruction sheets, discharge orders, education sheets, or other instruction sheets.

The home management plan of care is represented in the eMeasure logic by a LOINC code for an asthma action plan document. This form, or equivalent, contains most of the components required for the home management plan of care, including information on:

  • Methods and timing of rescue actions: the home management plan of care addresses what to do if asthma symptoms worsen after discharge, including all of the following:
    • 1) When to take action, i.e., assessment of severity (eg, peak flow meter reading, signs and symptoms to watch for)
    • 2) What specific steps to take, i.e., initial treatment instructions (eg, inhaled relievers up to three treatments of 2-4 puffs by MDI at 20-minute intervals or single nebulizer treatment)
    • 3) Contact information to be used, when an asthma attack occurs or is about to occur.
  • Appropriate use of long-term asthma medications (controllers), including the medication name, dose, frequency, and method of administration.
  • Appropriate use of rescue, quick-relief, or short acting medications of choice to quickly relieve asthma exacerbations (relievers), including the medication name, dose, frequency, and method of administration.
  • Environmental control and control of other triggers: information on avoidance or mitigation of environmental and other triggers.

In addition to the information outlined in the asthma action plan form (or equivalent document), the home management plan of care is required to include information regarding arrangements for referral or follow-up care with a healthcare provider, namely:

  • If an appointment for referral or follow-up care with a healthcare provider has been made, the home management plan of care is required to include the provider/clinic/office name, as well as the date and time of the appointment.
  • If an appointment for referral of follow-up care with a healthcare provider has NOT been made, the home management plan of care is required to include information for the patient/caregiver to be able to make arrangements for follow-up care, i.e., provider/clinic/office name, telephone number and time frame for appointment for follow-up care (eg, 7-10 days).

The home management plan of care can only be considered to comply with the criteria outlined in the measure logic if it meets the requirements outlined above and is appropriately filled-out with information specific to the patient.

Patient refusal includes refusal by a caregiver. The caregiver is defined as the patient's family or any other person (eg, home health, VNA provider, prison official or other law enforcement personnel) who will be responsible for care of the patient after discharge.

The Discharge To Home Or Police Custody value set also intends to capture the following discharge disposition values:

  • Assisted Living Facilities
  • Court/Law Enforcement - includes detention facilities, jails, and prison
  • Home - includes board and care, foster or residential care, group or personal care homes, and homeless shelters
  • Home with Home Health Services
  • Outpatient Services including outpatient procedures at another hospital, Outpatient Chemical Dependency Programs and Partial Hospitalization.

Specifications

Release Notes

Header

  • Updated Copyright.

    Section: Copyright

    Source: Annual Update

  • Revised to reflect logic. Previously, the Denominator stated both the IP and Denominator logic. Revise to reflect only the conditions specified in the denominator.

    Section: Denominator

    Source: Measure Lead

  • Incremented eMeasure Version number.

    Section: eMeasure Version number

    Source: Measure Lead

  • Removed unit of measurement language from Guidance. HQMF now has a header field, 'measure item count', where the unit of measurement can be identified in a computable fashion.

    Section: Guidance

    Source: Measure Lead

Logic

  • Introduced the operator 'Intersection of' to condense logic and reduce complexity.

    Section: Initial Population

    Source: Measure Lead

  • Replaced 'Diagnosis, Active: XXX (ordinality: Principal)' datatype with 'Encounter, Performed: XXX (principal diagnosis: XXX)' datatype to conform with QDM 4.2 changes and provide more accurate logic.

    Section: Initial Population

    Source: QDM Standards

  • Added Attribute: 'Principle diagnosis: Asthma' using 'Asthma Grouping Value Set (2.16.840.1.113883.3.117.1.7.1.271) to conform with QDM 4.2 replacement of 'Diagnosis, Active: XXX (ordinality: Principal)' datatype with 'Encounter, Performed: XXX (principal diagnosis: XXX)'.

    Section: QDM Data Elements

    Source: QDM Standards

Value Set

  • Value set Asthma (2.16.840.1.113883.3.117.1.7.1.271): Added 42 SNOMEDCT codes and deleted 7 SNOMEDCT codes (233681001, 233685005, 266364000, 427354000, 57546000, 59327009, 91340006).

    Section: None

    Source: None

External Resources