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

Last updated: September 14, 2018

CMS Measure ID: CMS26v6
Version: 6
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 that ends during the measurement period

Denominator Statement:

Patients discharged to home or police custody

Denominator Exclusions:

None

Numerator Statement:

Pediatric asthma inpatients with:

A. 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

-OR-

B. Pediatric asthma inpatients with documentation that they or their caregivers refused a written Home Management Plan of Care (HMPC) document. Patient refusal includes refusal by a caregiver. The caregiver is defined as the patient's family or any other person (e.g., home health, VNA provider, prison official or other law enforcement personnel) who will be responsible for care of the patient after discharge.

Numerator Exclusions:

Not Applicable

Denominator Exceptions:

None

Measure Steward: The Joint Commission
Short Name: CAC-3
Previous Version:
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 setinfo-icon 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.

Meaningful Measure: Preventive Care

Specifications

Release Notes

Header

  • Updated Version Number.

    Measure Section: eMeasure Version number

    Source of Change: Measure Lead

  • Updated Copyright.

    Measure Section: Copyright

    Source of Change: Annual Update

  • Removed outdated reference (American College of Chest Physicians , 2015) because linked document is no longer available.

    Measure Section: Reference

    Source of Change: Measure Lead

  • Updated Reference to include Asthma facts and figures.

    Measure Section: Reference

    Source of Change: Measure Lead

  • Revised the Numeratorinfo-icon header statement to better align with measure logic.

    Measure Section: Numerator

    Source of Change: Measure Lead

Logic

  • Replaced 'Discharge status' attribute with 'Discharge Disposition' attribute for 'Encounter, Performed' datatype to align with QDMinfo-icon 5.3 changes.

    Measure Section: Denominatorinfo-icon

    Source of Change: Standards Update

  • Added 'AuthorDateTime' attribute to QDM datatypes that include negation rationale: ‘Communication: From Provider to Patient, Not Done' to conform with QDM 5.3 changes.

    Measure Section: Numerator

    Source of Change: Standards Update

  • Assigned cardinality to each attribute to be more explicit in guiding specificationinfo-icon and implementation of QDM data elements. Cardinality refers to the number of instances of the attribute that can be included in the measure description. Cardinality for most attributes is 0.. 1 (i.e., can occur up to 1 time), but some attributes have a cardinality of 0.. * (i.e., can occur multiple times).

    Measure Section: Multiple Sections

    Source of Change: Standards Update

  • CQLinfo-icon libraries contain sets of CQL definitions, or CQL expression statements. A context statement, patient or population, can now be used in a CQL library to clearly establish how the subsequent list of CQL expressions will be interpreted. A 'Population' context will interpret the CQL expression with reference to the entire population of the item being counted, patients or encounters. A 'Patient' context will interpret the CQL expression with reference to a single patient. Context statements are not required, but one or more context statements may be used within a library to help clarify how the CQL expressions will be interpreted. Patient context is the default if none is specified.

    Measure Section: Multiple Sections

    Source of Change: Standards Update

  • Replaced measure-defined definitions with similar definitions and functions from CQL shared libraries for consistency across measures.

    Measure Section: Multiple Sections

    Source of Change: Standards Update

  • Updated measure logic from Quality Data Model (QDM)-based logic to Clinical Quality Language (CQL)-based logic. Information on CQL can be found at the eCQI Resource centerinfo-icon (https://ecqi.healthit.gov/cql). Information about specific versions of the new standards in use for CMS reporting periods can be found at the eCQI Resource Center (https://ecqi.healthit.gov/ecqm-tools-key-resources). Switching from QDM to CQL brings with it many changes, as well as enhanced expression capability, but only those changes with significant impact will be outlined in technical release notes. For example, in the case of timing operators, changes may only be summarized if those changes impact the measure calculation.

    Measure Section: Multiple Sections

    Source of Change: Standards Update

Value Setinfo-icon

The VSACinfo-icon is the source of truth for the value set content, please visit the VSAC for downloads of current value setsinfo-icon.

  • Value set Patient Refusal (2.16.840.1.113883.3.117.1.7.1.93): Deleted 2 SNOMEDCT codes (183956002, 385648002).

    Measure Section: QDM Data Elements

    Source of Change: Annual Update

  • Value set Payer (2.16.840.1.114222.4.11.3591): Added 11 SOP codes (299, 32127, 32128, 391, 517, 524, 614, 621, 622, 623, 629) and deleted 3 SOP codes (63, 64, 69).

    Measure Section: QDM Data Elements

    Source of Change: Annual Update

  • Value set Asthma (2.16.840.1.113883.3.117.1.7.1.271): Added 26 SNOMEDCT codes and deleted 1 SNOMEDCT code (641000119106).

    Measure Section: QDM Data Elements

    Source of Change: Annual Update

  • Replaced LOINC single code value sets with direct referenced codes. A direct referenced code is a single concept code that is used to describe a clinical element directly within the logic. The use of direct referenced codes replaces the need for single code value sets. Measures using other code systems in single value sets may optionally transition to direct referenced codes.

    Measure Section: QDM Data Elements

    Source of Change: Standards Update

  • Value set Payer (2.16.840.1.114222.4.11.3591): Deleted 1 SOP code (24).

    Measure Section: QDM Data Elements

    Source of Change: 2019 Addendum

External Resources