Emergency Care Access & Timeliness (REHQR)
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| Measure Information | 2027 Reporting Period |
|---|---|
| Title | Emergency Care Access & Timeliness (REHQR) |
| CMS eCQM ID | CMS1264v1 |
| CBE ID* | Not Applicable |
| Measure Steward | Centers for Medicare & Medicaid Services (CMS) |
| Description |
This measure assesses the variation in access and timeliness of emergency care to support rural emergency hospital (REH) quality improvement for patients requiring emergency care in an emergency department (ED). This measure is designed to align with incentives to promote improved care both in EDs and the broader health system to help identify where patients do not receive timely access to emergency care. Emergency care access and timeliness gaps are inclusive of several concepts pertaining to boarding and crowding in an ED, including significantly longer ED wait times, higher left without being seen rates, longer boarding times, and longer total length of stay in the ED. |
| Measure Scoring | Proportion |
| Measure Type | Intermediate Outcome |
| Stratification |
Stratification 1: Pediatric With No Mental Health Diagnosis All patients aged less than 18 years seen in the ED who do not have an ED encounter principal diagnosis consistent with mental health diagnosis. Patients who have an ED encounter principal diagnosis consistent with substance use disorders will be included in this stratification. Stratification 2: Adult With No Mental Health Diagnosis All patients aged 18 years and older seen in the ED who do not have an ED encounter principal diagnosis consistent with mental health diagnosis. Patients who have an ED encounter principal diagnosis consistent with substance use disorders will be included in this stratification. Stratification 3: Pediatric With Mental Health Diagnosis All patients aged less than 18 years seen in the ED who have an ED encounter principal diagnosis consistent with mental health diagnosis. Stratification 4: Adult With Mental Health Diagnosis All patients aged 18 years and older seen in the ED who have an ED encounter principal diagnosis consistent with mental health diagnosis. |
| Risk Adjustment |
None |
| Rationale |
This measure aims to reduce patient harm and improve outcomes for patients requiring emergency care in an ED by addressing the variation in emergency care and measuring access and timeliness of emergency care. There are long-standing concerns about parameters that impact access and timeliness of care in the ED. Currently, there are no national metrics to assess the proportion of patients impacted by access and timeliness of ED care. |
| Clinical Recommendation Statement |
Changes in care provision and workflow are anticipated from implementing this Emergency Care Access & Timeliness (ECAT) REH eCQM. To improve time to place a patient in a treatment space (as defined by the numerator below), changes in care may include improving patient flow processes, triaging interventions (such as inclusion of predictive models or different clinical deployment), or increased availability and access to outpatient clinical and social services. Other changes in care may include increases in local healthcare capacity including mental health care (mental health liaisons, co-located mental health services, or specialist psychiatry services), and use of ‘hospital home’ care models. Furthermore, changes to the following may also be considered: staffing models, ED observation units, diagnostic testing and imaging processes, or physical changes to ED layout. Such changes may result in the following: decreased waiting room time, decreased door to provider times, higher proportion of patients seen within 1 hour, decrease in proportion of patients who leave without being evaluated, better management of mental health diagnoses, reduced length of stay in the ED, decreased turnaround time for diagnostic tests and imaging, improved time to treatment, and decreased ambulance diversion. Changes in clinician or patient-reported outcomes and costs may include the following: improved patient experience, decrease in morbidity and mortality, increased ED revenue, and improved patient outcomes. |
| Improvement Notation |
Decreased score indicates improvement |
| Definition |
Boarding: The practice of holding transfer patients in the emergency department after a decision to transfer has been made. ED Observation: Observation stays are inclusive of both ED observation care in which a patient initially evaluated in the ED is cared for under observation status for an extended period of time in the ED or in a care area dedicated to observation care, as well as hospital observation stays in which a patient initially evaluated in the ED is cared for in observation status often in a hospital bed used for both inpatient or observation status admissions. Because these two forms of observation stays cannot be easily distinguished in a standardized fashion in existing electronic health record data ontologies, for the purposes of this quality measure all observation stays have been considered an exclusion from both numerator outcomes 3 and 4. Left Without Being Seen (LWBS): Patients arrive to the ED for evaluation and leave before seeing a physician, advanced practice nurse, or physician’s assistant. Mental Health: Mental health generally refers to mental health diagnoses, life stressors and crises, and stress-related physical symptoms (American Medical Association [AMA], 2022). For this measure, mental health conditions will be defined separately from substance use disorders. |
| Guidance |
Measure Score Calculation The measure score is calculated at the individual ED level as the proportion of ED visits where any one of the four outcomes occurred, as defined by the numerator. For CMS Certification Numbers (CCNs) with more than one ED, scores are combined as a weighted average for that CCN. This eCQM is an episode-based measure. An episode is defined as an ED visit that ends during the measurement period. This version of the eCQM uses QDM version 5.6. Please refer to the QDM page for more information on the QDM. |
| Initial Population |
All ED visits at REHs that end during the measurement period for all patients |
| Denominator |
Equals Initial Population |
| Denominator Exclusions |
None |
| Numerator |
The numerator is comprised of any ED visit in the denominator with any quality gap in access; if the patient experiences any of the following during a visit, the visit is included in the numerator: 1. The patient waited longer than 60 minutes (1 hour) after arrival to ED to be placed in a treatment room or dedicated treatment area that allows for audiovisual privacy during history-taking and physical examination, or 2. The patient left the ED without being evaluated, or 3. The patient, if transferred, boarded for longer than 240 minutes (4 hours), or 4. The patient had an ED length of stay (LOS) (time from ED arrival to ED departure as defined by the ED departure timestamp indicating when the patient physically left the ED) of longer than 480 minutes (8 hours). ED encounters with ED observation stays are excluded from numerator criteria #3 (boarded) and #4 (ED LOS) |
| Numerator Exclusions |
None |
| Denominator Exceptions |
None |
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