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What is the meaning of “Medication, Discharge” and how is it different from “Medication, Active” and “Medication, Order”?

"Medication, Discharge" defines medications intended for use when the patient leaves the hospital. As defined in the QDM, "Medication, Order" does not differentiate between an order for medications for administration immediately prior to discharge from those written for the patient to take after departure from the hospital. Further, although there maybe orders for some discharge medications (or prescribed), others may already be present in the home and still others may be over-the-counter substances for which orders are unnecessary. Hence, "Medication, Discharge" refers to reconciled medications listed on the patient’s Discharge Medication List. “Medication, Discharge” events should start and end within the time duration of the episode of care, even though the patient may not start the medication until after the episode ends. The expectation is that, at the time of discharge, discharge medications will be the same as the subsequent home medication lists for those medications that are germane to the quality measure, but you cannot assume this at the time of admission as changes may have occurred since the prior episode of care. United States Core (US Core) representation of Health Level Seven International® Fast Health Information Resources® (FHIR®) defines a medication list as one compiled from orders (MedicationRequest) with a status = active and intent = order (for physician orders) or intent = plan (for patient reporting or recommended medications). Thus, US Core represents active medications using order and, further, allows indication of the setting in which the patient should take the medication as category = community. Therefore, using US Core for data interchange, the order (MedicationRequest) can represent all discharge medications by using the category = community. QDM v.5.5 includes a setting attribute that maps directly to the US Core category for "Medication, Discharge" to assist with the transition to FHIRQuality Improvement Core (QI-Core) includes mapping from all QDM datatypes and attributes to FHIR.

Last Updated: Jun 13, 2022