Glossary of Definitions for Core Measures

All definitions are supplied by The Center for Medicare and Medicaid Services (CMS), the National Quality Measures Clearinghouse (NQMC), or the North Carolina Quality Center

Optimal Care ("All-or-None Bundle") - The optimal care measure is a condition-level summary score that uses the "all or none" methodology to determine if a patient received all of the recommended treatment for which they were eligible. For each condition on this site (AMI, heart failure, pneumonia, surgical care), performance is determined at the patient level and then summarized per hospital. A hospital optimal care percentage score is calculated with this formula (per condition): Total # patients receiving all care measures / Total # patients qualifying for any care

Acute Myocardial infarction Indicator (AMI) Core Measures

ACE Inhibitor or ARB for LVSD - Heart attack patients who receive either a prescription for a medicine called an “ACE inhibitor” or a medicine called an angiotensin receptor blocker (ARB) when they are discharged from the hospital. Most patients who have heart failure and who take ACE inhibitor medicine have fewer symptoms, are physically better, and reduce their risk of returning to the hospital. The number of patients prescribed this drug is measured.

Adult Smoking cessation advice/counseling -  Heart attack patients who are given advice about stopping smoking while they are in the hospital. This measure reports what percent of adult heart attack patients are provided advice and/or counseling to quit smoking. Smoking harms the heart, lungs and blood vessels and makes existing heart disease worse.

Aspirin at arrival - Heart attack patients receiving aspirin when arriving at the hospital. This measure reports what percent of heart attack patients receive aspirin within 24 hours before or after they arrive at the hospital. Aspirin is beneficial because it reduces the tendency of blood to clot in blood vessels of the heart and improves survival rates.

Aspirin prescribed at discharge - Heart attack patients who receive a prescription for aspirin when being discharged from the hospital. This measure reports how often aspirin was prescribed to heart attack patients when they are leaving a hospital. Aspirin is beneficial because it reduces the tendency of blood to clot in blood vessels of the heart and improves survival rates.

Beta blocker at arrival - Heart attack patients who receive a medicine called a “beta blocker” when they arrive at the hospital. This measure reports what percent of heart attack patients – within 24 hours after arrival were prescribed special type of medicine that reduces heart damage.

Beta blocker prescribed at discharge - heart attack patients who have a medicine called a “beta blocker” prescribed when they are discharged from the hospital. This measure reports what percent of heart attack patients were prescribed a special type of medicine when leaving the hospital that has been shown to reduce further heart damage.

Inpatient mortality - Death of a patient with a heart attack during a hospital stay.  This measure reports heart attack patients who die during their hospital stay. This measure accounts for the fact that some patients are sicker or have other preexisting conditions that make death more likely. This is called “risk adjustment."

Primary PCI received within 90 minutes of hospital arrival - Heart attack patient with a clogged artery in the heart that is opened with a balloon therapy called PCI within 90 minutes of hospital arrival. This measure reports how quickly heart attack patients had a clogged artery in the heart opened with a balloon therapy called PCI to increase blood flow to the heart and reduce heart damage. Lack of blood supply to heart muscle can cause lasting heart damage. In certain types of heart attacks, a small balloon is threaded into a blood vessel in the heart to open up a clogged artery that keeps the blood from flowing to the heart muscle.It is important that this therapy be given quickly after a heart attack is diagnosed.

Average Number of Minutes before Outpatients Transferred to Another Hospital - If a hospital does not have the facilities to provide specialized heart attack care, it transfers patients with possible heart attack to another hospital that can given them this care. This measure shows how long it takes, on average, for hospitals to identify patients who need specialized heart attack care the hospital cannot provide and begin their transfer to another hospital. It shows the average (median) number of minutes it takes from the time patients arrive in the Emergency Department until they are transported to a different hospital.

Average Number of Minutes before Outpatients Received an ECG - "ECG" (sometimes called EKG) stands for electrocardiogram. An ECG is a test that can help doctors know whether patients are having a heart attack. Process of care say that patients with chest pain or a possible heart attack should have an ECG upon arrival, preferably within 10 minutes. This measure tells the average (median) number of minutes it takes before patients got an ECG. Sometimes patients get an ECG done before they get to the hospital (for example, by the ambulance staff). This is counted as "0 minutes."

 Percent of AMI Outpatients who Received drugs to break up Blood Clots within 30 Minutes of Arrival - Blood clots can cause heart attacks. Certain patients having a heart attack should get a "clot busting" drug to help break up the blood clots and improve blood flow to the heart. Standards for care say that a clot busting drug should be given within 30 minutes of arrival at the hospital. This measure tells the percent of patients who got a clot busting drug within 30 minutes of arrival.

Percent of AMI Outpatients who Received Aspirin within 24 Hours of Arrival or Prior to Transfer - Blood clots can cause heart attacks. For many patients having a heart attack, taking aspirin soon after symptoms of a heart attack begin may help break up a clot and make the heart attack less severe. If patients have not taken aspirin themselves before going to the hospital, they should get aspirin when they arrive. Standards for care say patients should get aspirin within 24 hours of arrival at the hospital. This measure tells what percent of patients got aspirin within this time period.

Heart Failure (HF) Core Measures

ACE inhibitor or ARB for LVSD - Heart failure patients who receive a prescription for a medicine called an “ACE inhibitor” or a medicine called an angiotensin receptor blocker (ARB) when they are discharged from the hospital. Most patients who have heart failure and who take ACE inhibitor medicine have fewer symptoms, are physically better, and reduce their risk of returning to the hospital. The number of patients prescribed this drug is measured.

Adult smoking cessation advice/counseling -  Heart failure patients who are given advice about stopping smoking while they are in the hospital. This measure reports what percent of adult heart failure patients are provided advice and/or counseling to quit smoking. Smoking harms the heart, lungs and blood vessels and makes existing heart disease worse.

Discharge Instructions - Heart failure patients who receive all specific discharge instructions about their condition. This measure reports what percent of patients with heart failure are given all information about their condition and care when they leave the hospital. Patient education about medicines, diet, activities, and signs to watch for is important in order to prevent further hospitalization.

LVF assessment - Heart failure patients who have had the function of the main pumping chamber of the heart (i.e. ventricle) checked during their hospitalization. This measure reports what percent of patients with heart failure receive an in-depth evaluation of heart muscle function in order to receive the right treatments for their heart failure.

Community Acquired Pneumonia (CAP) Core Measures

Adult smoking cessation advice/counseling - Pneumonia patients who are given advice about stopping smoking while they are in the hospital. This measure reports what percent of adult pneumonia patients are provided advice and/or counseling to quit smoking. Smoking harms the heart, lungs and blood vessels and makes existing disease worse.

Blood cultures for pneumonia patents admitted through the Emergency Department –
Pneumonia patients who were admitted through the Emergency Department who had a blood test in the Emergency Department for the presence of bacteria in their blood. Before antibiotics are given, blood samples are taken to test for the type of infection. This measure reports the percent of pneumonia patients admitted through the Emergency Department who receive this test before antibiotics were given.

Blood cultures for pneumonia patients in intensive care - Pneumonia patients cared for in an intensive care unit who had a blood test for the presence of bacteria in their blood within 24 hours of hospital arrival. This measure reports the percent of pneumonia patients in intensive care units who had a blood culture with 24 hours prior to or after hospital arrival.

Influenza vaccination -  Pneumonia patients in the hospital during flu season (October through February) who were given the influenza vaccination prior to leaving the hospital. This measure reports how often pneumonia patients in the hospital during the flu season were given flu vaccine if needed, prior to leaving the hospital.

Initial antibiotic received within 4 hours of hospital arrival - Pneumonia patients who are given an antibiotic within 4 hours of arriving at the hospital. This measure reports the percent of adult pneumonia patients who are given an antibiotic within 4 hours of arriving at the hospital.

Initial antibiotic received within 8 hours of hospital arrival – Pneumonia patients who are given an antibiotic within 8 hours of arriving at the hospital. This measure reports the percent of adult pneumonia patients who are given an antibiotic within 8 hours of arriving at the hospital.

Initial antibiotic selection for pneumonia ICU patients - Patients in intensive care units that have community-acquired pneumonia who received the appropriate medicine (antibiotic) that has been shown to be effective for community-acquired pneumonia. This measure reports how often patients in intensive care units with community acquired pneumonia were given the correct antibiotic within 24 hours of hospital arrival, based on recommendations from written guidelines for the treatment of pneumonia.

Initial antibiotic for non ICU patients - Patients not in intensive care units who have community – acquired pneumonia who receive the appropriate medicine (antibiotic) that has been shown to be effective for community-acquired pneumonia. This measure reports how often patients with community-acquired pneumonia not cared for in intensive care units, were given the correct antibiotic within 24 hours of hospital arrival based on recommendations from written guidelines for the treatment of pneumonia.

Oxygenation Assessment - Patients with pneumonia in which the amount of oxygen in the blood stream was measured. This measure reports how many patients with pneumonia had their blood/oxygen level measured. Pneumonia reduces the amount of oxygen carried in a patient’s blood.

Pneumococcal vaccination - Pneumonia vaccination. This measure reports how many patients 65 years and older were screened and vaccinated to prevent pneumonia.

Patient Satisfaction (HCAHPS) Measures

Communication with Nurses - Patients reported how often their nurses communicated well with them during their hospital stay. "Communicated well' means nurses explained things clearly, listened carefully to the patient, and treated the patient with courtesy and respect. 

Communication with Doctors - Patients reported how often their doctors communicated well with them during their hospital stay. "Communicated well" means doctors explained things clearly, listened carefully to the patient, and treated the patient with courtesy and respect.

Responsiveness of Hospital Staff - Patients reported how often they were helped quickly when they used the call button or needed help in getting to the bathroom or using a bedpan.

Pain Management - If patients needed medicine for pain during their hospital stay, the survey asked how often their pain was well controlled. "Well controlled" means their pain was well controlled and that the hospital staff did everything they could to help patients with their pain.

Communication about Medicines - If patients were given medicine that they had not taken before, the survey asked how often staff explained about the medicine. "Explained" means that hospital staff told what the medicine was for and what side effects it might have before they gave it to the patient.

Cleanliness of Hospital Environment - Patients reported how often their hospital room and bathroom were kept clean.

Quietness of Hospital Environment - Patients reported how often the area around their room was quiet at night.

Discharge Information - The survey asked patients about information they were given when they were ready to leave the hospital. Patients reported whether hospital staff had discussed the help they would need at home. Patients also reported whether they were given written information about symptoms or health problems to watch for during their recovery.

Overall Rating of this Hospital - After answering all other questions on the survey, patients answered a separate question that asked for an overall rating of the hospital. Ratings were on a scale from 0 to 10, where "0" means "worst hospital possible" and "10" means "best hospital possible."

Willingness to Recommend this Hospital - The survey asked patients whether they would recommend the hospital to their friends and family.

Surgical Care Improvement / Surgical Infections Prevention (SCIP) Process of Care Measures

Receive Antibiotics One Hour Prior to Surgery - Research shows that surgery patients who get antibiotics within the hour before their operation are less likely to get wound infections. Getting an antibiotic earlier, or after surgery begins, is not as effective. This measure shows how often a surgery patient gets antibiotics at the right time.

Receive Appropriate Antibiotics - Certain antibiotics are recommended to help prevent wound infection for particular types of surgery. This measure looks at how often surgical patients get the appropriate antibiotic in order to prevent a surgical wound infection.

Discontinue Antibiotics 24 Hours After Surgery - While the likelihood of infection after surgery can be reduced by giving patients preventative antibiotics, taking these antibiotics for more than 24 hours after routine surgery is usually not necessary and can increase the risk of side effects such as diarrhea, and antibiotic resistance (when antibiotics are used too much, they will not work anymore.)

Receive Treatment to Prevent Blood Clots 24 Hours Before/After Selective Surgeries - A number of factors can increase a patient's risk of developing blood clots, but doctors can order preventive treatments called prophylaxis to reduce the risk. Prophylaxis may include blood thinning medications, elastic support stockings, or mechanical air stockings that promote circulation in the legs.

Ordered Treatment to Prevent Blood Clots After Selective Surgeries - Certain types of surgery can increase the risk of blood clots forming in the veins. This is because patients don't move much during and, usually, after some surgeries.

SCIP Outpatients Receiving an Antibiotic within One Hour Before Surgery - Hospitals can prevent surgical wound infections. Medical research shows that surgery patients who get antibiotics within the hour before their surgery are less likely to get wound infections. The timing is important: getting an antibiotic earlier, or after surgery begins, is not as effective. Hospital staff should make sure patients get antibiotics at the right time. Higher numbers are better.

SCIP Outpatients having Surgery who Received the Right Kind of Antibiotic - hospitals can prevent surgical wound infections. Medical research has shown that certain antibiotics work better to prevent wound infections for certain types of surgery. Hospital staff should make sure patients get the antibiotic that works best for their type of surgery. Higher numbers are better.

Diabetes (DIAB) Core Measures

HgAIc Test - Intensive therapy of glycosylated hemoglobin (A1c) reduces the risk of microvascular complications. American Association of Clinical Endocrinologists/American College of Endocrinology (AACE/ACE) recommends that a glycosylated hemoglobin be performed during an initial assessment and during follow-up assessments, which should occur at no longer than three-month intervals.

Lipid Profile (LDL) - Persons with diabetes are at increased risk for coronary heart disease (CHD). Lowering serum cholesterol levels can reduce the risk for CHD events. American Association of Clinical Endocrinologists/American College of Endocrinology (AACE/ACE) recommend that a fasting lipid profile be obtained during an initial assessment, each follow-up assessment, and annually as part of the cardiac-cerebrovascular-peripheral vascular module.

Microalbumin - Diabetes is the leading cause of end-stage renal disease (ESRD). In the United States, diabetic nephropathy accounts for about one-third of all cases of ESRD. The earliest clinical evidence of nephropathy is the appearance of low, but abnormal levels of albumin (protein) in the urine, referred to as microalbuminuria. Early detection and treatment may prevent or slow the progression of diabetic nephropathy.

Dilated Eye Exam - Retinopathy poses a serious threat to vision. The prevalence of retinopathy is strongly related to the duration of diabetes. Treatment modalities exist that can prevent or delay diabetic retinopathy. American Association of Clinical Endocrinologists/American College of Endocrinology (AACE/ACE), American Diabetes Association (ADA), and American Academy of Ophthalmology (AAO) recommend that a dilated eye examination be performed on patients with diabetes during an initial assessment and at least annually thereafter.

Proportion with HgAIc < 8 - (Pending)

Proportion with HgAIc < 7 - (Pending)

Proportion with LDL < 130 - This measure assesses the percentage of adult diabetes patients aged 18-75 years with most recent low-density lipoprotein-cholesterol (LDL-C) less than 130 mg/dL.

Proportion with LDL < 100 - This measure assesses the percentage of adult diabetes patients aged 18-75 years with most recent low-density lipoprotein-cholesterol (LDL-C) less than 100 mg/dL."

Proportion with BP < 140 systolic and < 80 diastolic. BP check each visit - This measure assesses the percentage of adult diabetes patients aged 18-75 years with most recent blood pressure less than 140/80 mm Hg. Intensive control of blood pressure in patients with diabetes reduces diabetes complications, diabetes-related deaths, strokes, heart failure, and microvascular complications.

 Proportion with BP < 130 systolic and < 80 diastolic - This measure assesses the percentage of adult diabetes patients aged 18-75 years with most recent blood pressure less than 130/80 mm Hg. Intensive control of blood pressure in patients with diabetes reduces diabetes complications, diabetes-related deaths, strokes, heart failure, and microvascular complications.

Hypertension (HYP) Core Measures

Proportion with BP < 140 systolic and < 90 diastolic. BP check each visit - This measure is used to assess the percentage of adult patients with hypertension who had a blood pressure reading less than 140/90 mmHg at their last clinic visit. The priority aim addressed by this measure is to increase the percentage of adult patients in blood pressure control.

Childhood Immunization (CHIMM) Core Measures

Children turning two who received appropriate vaccinations - This measure is used to assess the percentage of enrolled children who turned two years of age during the measurement year who were continuously enrolled for 12 months prior to the child's second birthday and who had four diphtheria, tetanus, and acellular pertussis (DTaP), three injectable polio virus (IPV), one measles, mumps, and rubella (MMR), two haemophilus influenza type B (HiB), three hepatitis B, one chicken pox vaccination (VZV) and four pneumococcal conjugate vaccines by their second birthday. Immunizations are the safest, most effective way to protect children from a variety of potentially serious childhood diseases.

Asthma (ASTH) Core Measures

Percentage of individuals with asthma classified using NAEPP guidelines - (Pending)

Percentage of individuals with persistent asthma prescribed long-term medication or alternative steroid sparing control medication - (Pending)

Dialysis (DIAL) Core Measures

Percent of medicare patients with average hemoglobin < 10.0 g/dL - This shows the percentage of people with a hemoglobin less than 10.0 g/dL. A hemoglobin is a blood test that measures anemia. If you are on a drug for anemia like Epogen®, the dialysis facility staff should keep your hemoglobin between 10.0 g/dL and 12.0 g/dL.

Percent of medicare patients with average hemoglobin > 12.0 g/dL - This shows the percentage of people with a hemoglobin greater than 12.0 g/dL. A hemoglobin is a blood test that measures anemia. If you are on a drug for anemia like Epogen®, the dialysis facility staff should keep your hemoglobin between 10.0 g/dL and 12.0 g/dL.

Percent of medicare patients with enough wastes removed from their blood during dialysis (Dialysis Adequacy) - Patients with kidney failure need to have wastes removed from their blood often. Too much waste in your blood makes you sick. Dialysis is used to remove wastes from your blood. It is important for a facility to remove enough wastes from your blood during dialysis to help you feel better. A number known as the urea reduction ratio (URR) measures how much urea is removed during dialysis. The URR is a way to measure dialysis adequacy. Your URR should be 65 or greater.

Visiting Nursing Association (VNA) Core Measures

Percentage of patients who get better at walking or moving around - Many patients who get home health care are recovering from an injury or illness. They may need help from a person or equipment (like a cane) to walk safely. If they use a wheelchair, they may have difficulty moving around safely. Getting better at walking or moving around in your wheelchair may be a sign that you are making progress or meeting the goals of your care plan.

Percentage of patients who improve at getting in and out of bed - Being able to get in and out of bed by yourself is a first step to doing many other things to care for yourself, like getting dressed or getting to the toilet. It is especially important if you don't have informal caregivers who can help you when your home health caregiver is not there or your home health care ends.

Percentage of patients who have less pain when moving around - The percentage of patients who have less pain that affects their ability to perform daily activities, like getting up, walking, dressing, or bathing.

Percentage of patients whose bladder control improves - Losing control of your bladder can be as mild as leaking urine when you cough to having no control of your bladder. At least 1 in 10 people over age 65 have this problem, but it is more common in women. If you lose control of your bladder, you can have skin irritation which can become serious. You may lose the ability or desire to perform normal daily activities. Loss of bladder control is often treatable, depending on the cause. It is important that your doctor and home health staff help you to improve your bladder control. A catheter is not the answer, except in rare cases.

Percentage of patients who get better at bathing - You need certain physical abilities (motor skills) to take a bath (or shower). You may need help from a person or special equipment. Your physical abilities can be developed or maintained by managing your symptoms or through physical or occupational therapy. Getting better at bathing yourself means you may need less assistance or equipment to bathe. This may be a sign that you are making progress or meeting the goals of your This may be a sign that you are making progress or meeting the goals of your care plan.

Percentage of patients who improve oral medication management - For medicines to work properly, they need to be taken correctly. Taking too much or too little medicine can keep it from helping you feel better and, in some cases, can make you sicker, make you confused (which could affect your safety), or even cause death. Home health staff can help teach you ways to organize your medicines and take them properly. Getting better at taking your medicines correctly means the home health agency is doing a good job teaching you how to take your medicines.

Percentage of patients who are short of breath less - Shortness of breath, or difficulty breathing, is uncomfortable. Many patients with heart or lung problems have shortness of breath because they can't get enough oxygen to their lungs. Shortness of breath is a big problem for many home care patients. If you have shortness of breath you breathe faster than normal and feel like you can't get enough air. This makes you uncomfortable and anxious. Shortness of breath can make you tire easily and unable to do normal activities. It is important that your doctor and home health staff check your breathing. They should teach you ways to improve your breathing and to be as comfortable as possible.

Percentage of patients who stay at home after an episode of home health care ends - The percentage of patients who are able to live at home alone or with others and can manage their condition independently or with help, and no longer need nursing or therapy from a home health agency. This means they did not go into a hospital or nursing home after home health care ended. Higher percentages are better.

Percentage of patients whose wounds improved or healed after an operation - The percentage of patients whose wounds improved or healed after an operation. Higher percentages are better. Home health agencies can assist with wound healing in several ways. They may change the wound dressing, depending on the doctor's orders, or teach the patient or caregiver to change the dressing. They will also teach the patient or caregiver about the signs of wound healing, teach the patient or caregiver the types of foods that promote healing and restore normal functioning, teach the patient or caregiver about any drugs the doctor has ordered, such as drugs used to relieve pain. They also teach the patient or caregiver about the signs or symptoms of infection or other problems and direct the patient to call the home health agency or their doctor.

Percentage of patients who had to be admitted to the hospital - The percentage of patients who were admitted to the hospital. Lower percentages for home health agencies are considered better, because agency staff, in many instances, can prevent the need for more care than can be provided at home. Timely hospitalization is an important safety net and must be ensured for each individual patient who requires hospital-based treatment or becomes critically ill and needs more extensive care. The measures on hospitalization and urgent care look at how services are used rather than the outcome of care provided.

Percentage of patients who need urgent, unplanned medical care - Patients may need to have urgent, unplanned medical care while they are getting home health care because of a sudden downturn in their health or because of an injury. They may need to make an urgent trip to the doctor or emergency room, or a doctor may have to make an urgent house call.

Percentage of patients who need unplanned medical care related to a wound that is new, is worse, or has become infected - The percentage of patients who need urgent medical care related to a new wound, a wound that is worse, or has become infected. (These wounds may or may not be related to surgery). Lower percentages are better. As part of home care, the nurse must assess and instruct the patient or caregiver on the signs of normal wound healing, signs and symptoms of wound infection, wounds that are getting worse, or new wounds, and the importance of calling the home health agency first with concerns about the wound. The home health agency also has a responsibility to visit the patient frequently enough to assess the wound, assist in care for the wound according to the doctor's orders, and look for any preventable problems such as pressure relief and proper nutrition.

Long Term Care (LTC)

Percent of long-stay residents whose need for help with daily activities has increased - Residents are checked routinely to see how they function doing these basic daily activities. Some loss of function may be expected in the elderly. If they are in poor health or if they are ill (like if they have pneumonia, an infection, a recent injury, or a chronic problem like asthma that has flared-up), they may have a temporary loss of function. Sudden or rapid loss of one or more of these basic daily tasks could mean the resident needs medical attention.

Percent of long-stay residents who have moderate to severe pain - This measure is shown to get you to talk to the nursing home staff about how they check and manage pain, and to make you aware of how important it is. Pain can be caused by a variety of medical conditions. Checking for pain and pain management are very complex.

Percent of high-risk long-stay residents who have pressure sores - A pressure sore is a skin wound. Pressure sores usually develop on bony parts of the body such as the tailbone, hip, ankle, or heel. They are usually caused by constant pressure on one part of the skin. Pressure sores are sometimes called bedsores. These sores can be caused from the pressure on the skin from chairs, wheelchairs, or beds. Severe pressure sores may take a long time to heal. As a result, some of the pressure sores included in this data may be ones that facilities are in the process of successfully treating and improving.

Percent of low-risk long-stay residents who have pressure sores - A pressure sore is a skin wound. Pressure sores usually develop on bony parts of the body such as the tailbone, hip, ankle, or heel. They are usually caused by constant pressure on one part of the skin. Pressure sores are sometimes called bedsores. These sores can be caused from the pressure on the skin from chairs, wheelchairs, or beds. Severe pressure sores may take a long time to heal. As a result, some of the pressure sores included in this data may be ones that facilities are in the process of successfully treating and improving.

Percent of long-stay residents who were physically restrained - A physical restraint is any device, material, or equipment attached or adjacent to a resident's body, that the individual cannot remove easily, which keeps a resident from moving freely or prevents them normal access to their body. Examples of physical restraints include special types of vests, chairs with lap trays, lap belts, enclosed walkers. Bed rails (side rails) are also considered restraints in certain situations, but they are not used in the calculation of this measure.

Percent of long-stay residents who are more depressed or anxious - Depression is a medical problem of the brain that can affect how you think, feel, and behave. Signs of depression may include fatigue, a loss of interest in normal activities, poor appetite, and problems with concentration and sleeping. Anxiety is excessive worry. Signs of anxiety can include trembling, muscle aches, problems sleeping, stomach pain, dizziness and irritability.

Percent of low-risk long-stay residents who lose control of their bowels or bladder - This information is only based on residents who have a low risk for losing control of their bowel or bladder (lower percentages are better). Residents have a "low risk" for losing bowel and bladder control, if they do not have severe dementia (memory loss) or if they do not have very limited ability to move on their own.

Percent of long-stay residents who have/had a catheter inserted and left in their bladder - A catheter is a thin, soft tube that is left in place and attached to a bag that collects the urine. It may be inserted into the bladder of people who lose control of their bladder or cannot use a toilet (for instance, someone in a coma.) Catheters may be used because there is a physical reason the urine cannot drain naturally, to keep a patient with pressure sores that are not healing clean and dry, or to measure the amount of urine being produced.

Percent of long-stay residents who spend most of their time in bed or in a chair - A decline in physical activity may come with age due to muscle loss, joint stiffness, fear of injury, worsening illness, or depression. Residents who spend too much time in bed or a chair may lose the ability to perform activities of daily living, like eating, dressing, or getting to the bathroom.

Percent of long-stay residents whose ability to move about in and around their room gets worse - A decline in physical activity may come with age due to muscle loss, joint stiffness, worsening illness, fear of injury, or depression. Residents who lose mobility may also lose the ability to perform other activities of daily living, like eating, dressing, or getting to the bathroom. In some cases, however, the decline measured may be temporary and due to a short-term illness the resident is experiencing at the time of the assessment.

Percent of long-stay residents who had a urinary tract infection - A urinary tract infection (UTI) is an infection in the urethra that left untreated, can spread to the bladder (bladder infection), and kidney (kidney infection). If the area where waste (urine and bowel movements) leaves your body is not kept clean, bacteria from your colon may multiply and enter the urethra (the tube that passes urine from your bladder to outside your body), causing a UTI. A UTI may also be caused by bacteria on a catheter (a soft tube used to drain urine) being used to drain the urine from the bladder.

Percent of long-stay residents who lose too much weight - A loss of 5% or more of body weight in one month is usually considered unhealthy (for example, a 150 pound person should not lose more than 71/2 pounds in one month)

Percent of long-stay residents given influenza vaccination during the flu season - The "flu" (also called influenza), is a very contagious respiratory infection. Flu is spread very easily from person to person. People are usually infected when a person coughs or sneezes. The flu shot (influenza vaccination) can prevent you from getting the flu or reduce your risk of becoming seriously ill from the flu. People who are age 65 and older are at higher risk for developing serious life-threatening medical complications from the flu. If you are age 65 or older, you should get the flu shot once every year.

Percent of long-stay residents who were assessed and given pneumococcal vaccination - The pneumococcal shot (pneumococcal vaccination) may help you prevent, or lower the risk of becoming seriously ill from pneumonia caused by bacteria. It may also help you prevent future infections.

Percent of short-stay residents given influenza vaccination during the flu season - The "flu" (also called influenza), is a very contagious respiratory infection. Flu is spread very easily from person to person. People are usually infected when a person coughs or sneezes. The flu shot (influenza vaccination) can prevent you from getting the flu or reduce your risk of becoming seriously ill from the flu. People who are age 65 and older are at higher risk for developing serious life-threatening medical complications from the flu. If you are age 65 or older, you should get the flu shot once every year.

Percent of short-stay residents who were assessed and given pneumococcal vaccination - The pneumococcal shot (pneumococcal vaccination) may help you prevent, or lower the risk of becoming seriously ill from pneumonia caused by bacteria. It may also help you prevent future infections.

Percent of short-stay residents who have delirium - Delirium is severe confusion and rapid changes in brain function, usually caused by a treatable physical or mental illness. Delirium is often misdiagnosed. Delirium may be caused by infection; a stroke; dehydration; reaction to surgery; anesthesia or medication; disease (like liver failure); uncorrected vision or hearing problems; improper restraint usage; or depression. Symptoms may develop over a short period of time, and change during the day.

Percent of short-stay residents who had moderate to severe pain - This measure is shown to get you to talk to the nursing home staff about how they check and manage pain, and to make you aware of how important it is. Pain can be caused by a variety of medical conditions. Checking for pain and pain management are very complex.

Percent of short-stay residents who have pressure sores - A pressure sore is a skin wound. Pressure sores usually develop on bony parts of the body such as the tailbone, hip, ankle, or heel. They are usually caused by constant pressure on one part of the skin. Pressure sores are sometimes called bedsores. These sores can be caused from the pressure on the skin from chairs, wheelchairs, or beds. Severe pressure sores may take a long time to heal. As a result, some of the pressure sores included in this data may be ones that facilities are in the process of successfully treating and improving.

Stroke (STK)

Percent of Stroke Patients Receiving VTE prophylaxis - Ischemic and hemorrhagic stroke patients who received VTE prophylaxis or have documentation why no VTE prophylaxis was given the day of or the day after hospital admission. Stroke patients are at increased risk of developing venous thromboembolism (VTE). One study noted proximal deep vein thrombosis in more than a third of patients with moderately severe stroke. Reported rates of occurrence vary depending on the type of screening used. Prevention of VTE, through the use of prophylactic therapies, in at risk patients is a noted recommendation in numerous clinical practice guidelines. For acutely ill stroke patients who are confined to bed, thromboprophylaxis with low-molecular-weight heparin (LMWH), low-dose unfractionated heaparin (LDUH), or fondaparinux is recommended if there are no contraindications. Aspirin alone is not recommended as an agent to prevent VTE.

Percent of Ischemic Stroke Patients Receiving VTE prophylaxis - Ischemic stroke patients who received VTE prophylaxis or have documentation why no VTE prophylaxis was given the day of or the day after hospital admission. Stroke patients are at increased risk of developing venous thromboembolism (VTE). One study noted proximal deep vein thrombosis in more than a third of patients with moderately severe stroke. Reported rates of occurrence vary depending on the type of screening used. Prevention of VTE, through the use of prophylactic therapies, in at risk patients is a noted recommendation in numerous clinical practice guidelines. For acutely ill stroke patients who are confined to bed, thromboprophylaxis with low-molecular-weight heparin (LMWH), low-dose unfractionated heaparin (LDUH), or fondaparinux is recommended if there are no contraindications. Aspirin alone is not recommended as an agent to prevent VTE.

Percent of Hemorrhagic Stroke Patients Receiving VTE prophylaxis - Hemorrhagic stroke patients who received VTE prophylaxis or have documentation why no VTE prophylaxis was given the day of or the day after hospital admission. Stroke patients are at increased risk of developing venous thromboembolism (VTE). One study noted proximal deep vein thrombosis in more than a third of patients with moderately severe stroke. Reported rates of occurrence vary depending on the type of screening used. Prevention of VTE, through the use of prophylactic therapies, in at risk patients is a noted recommendation in numerous clinical practice guidelines. For acutely ill stroke patients who are confined to bed, thromboprophylaxis with low-molecular-weight heparin (LMWH), low-dose unfractionated heaparin (LDUH), or fondaparinux is recommended if there are no contraindications. Aspirin alone is not recommended as an agent to prevent VTE.

Percent of Stroke Patients Discharged on Antithrombotic Therapy - Ischemic stroke patients prescribed antithrombotic therapy at hospital discharge. The effectiveness of antithrombotic agents in reducing stroke mortality, stroke-related morbidity and recurrence rates has been studied in several large clinical trials. While the use of these agents for patients with acute ischemic stroke and transient ischemic attacks continues to be the subject of study, substantial evidence is available from completed studies. Data at this time suggest that antithrombotic therapy should be prescribed at discharge following acute ischemic stroke to reduce stroke mortality and morbidity as long as no contraindications exist. For patients with a stroke due to a cardioembolic source (e.g., atrial fibrillation, mechanical heart valve), warfarin is recommended unless contraindicated. Warfarin is not generally recommended for secondary stroke prevention in patients presumed to have a non-cardioembolic stroke.

Percent of Stroke Patients Prescribed Anticoagulation Therapy for Atrial Fibrillation/Flutter - Ischemic stroke patients with atrial fibrillation/flutter who are prescribed anticoagulation therapy at hospital discharge. Nonvalvular atrial fibrillation (NVAF) is a common arrhythmia and an important risk factor for stroke. It is one of several conditions and lifestyle factors that have been identified as risk factors for stroke. It has been estimated that over 2 million adults in the United States have NVAF. While the median age of patients with atrial fibrillation is 75 years, the incidence increases with advancing age. For example, The Framingham Heart Study noted a dramatic increase in stroke risk associated with atrial fibrillation with advancing age, from 1.5% for those 50 to 59 years of age to 23.5% for those 80 to 89 years of age. Furthermore, a prior stroke or transient ischemic attack(TIA) are among a limited number of predictors of high stroke risk within the population of patients with atrial fibrillation. Therefore, much emphasis has been placed on identifying methods for preventing recurrent ischemic stroke as well as preventing first stroke. Prevention strategies focus on the modifiable risk factors such as hypertension, smoking, and atrial fibrillation. Analysis of five placebo-controlled clinical trials investigating the efficacy of warfarin in the primary prevention of thromboembolic stroke, found the relative risk of thromboembolic stroke was reduced by 68% for atrial fibrillation patients treated with warfarin. The administration of anticoagulation therapy, unless there are contraindications, is an established effective strategy in preventing recurrent stroke in high stroke risk-atrial fibrillation patients with TIA or prior stroke.

Percent of Stroke Patients Receiving Thrombolytic Therapy - Acute ischemic stroke patients who arrive at this hospital within 2 hours of time last known well and for whom IV t-PA was initiated at this hospital within 3 hours of time last known well. The administration of thrombolytic agents to carefully screened, eligible patients with acute ischemic stroke has been shown to be beneficial in several clinical trials. These included two positive randomized controlled trials in the United States; The National Institute of Neurological Disorders and Stroke (NINDS) Studies, Part I and Part II. Based on the results of these studies, the Food and Drug Administration approved the use of intravenous recombinant tissue plasminogen activator (IV r-TPA or t-PA) for the treatment of acute ischemic stroke when given within 3 hours of stroke symptom onset. A large meta-analysis controlling for factors associated with stroke outcome confirmed the benefit of IV t-PA in patients treated within 3 hours of symptom onset. While controversy still exists among some specialists, the major society practice guidelines developed in the United States all recommend the use of IV t-PA for eligible patients. Physicians with experience and skill in stroke management and the interpretation of CT scans should supervise treatment.

Percent of Stroke Patients Receiving Antithrombotic Therapy By End of Hospital Day 2 - Ischemic stroke patients administered antithrombotic therapy by the end of hospital day 2. The effectiveness of antithrombotic agents in reducing stroke mortality, stroke-related morbidity and recurrence rates has been studied in several large clinical trials. While the use of these agents for patients with acute ischemic stroke and transient ischemic attacks continues to be the subject of study, substantial evidence is available from completed studies. Data at this time suggest that antithrombotic therapy should be administered within 2 days of symptom onset in acute ischemic stroke patients to reduce stroke mortality and morbidity as long as no contraindications exist.

Percent of Stroke Patients Discharged on Statin Medication - Ischemic stroke patients with LDL > 100 mg/dL, or LDL not measured, or, who were on a lipid-lowering medication prior to hospital arrival are prescribed statin medication at hospital discharge. It is recommended that all patients with ischemic stroke or TIA with coronary heart disease or symptomatic atherosclerotic disease who have an LDL = 100 mg/dl (or with LDL < 100 mg/dl due to being on lipid lowering therapy prior to admission) should be treated with a statin. The target goal for cholesterol lowering is an LDL-c level of <100 mg/dL. An LDL-c <70 mg/dL is recommended for very high-risk persons with multiple risk factors. For patients with stroke of atherosclerotic origin, intensive lipid lowering therapy with statins should be initiated in those who have an LDL = 100 mg/dl (or with LDL < 100 mg/dl due to being on lipid lowering therapy prior to admission).

Percent of Stroke Patients Receiving Stroke Education - Ischemic or hemorrhagic stroke patients or their caregivers who were given educational materials during the hospital stay addressing all of the following: activation of emergency medical system, need for follow-up after discharge, medications prescribed at discharge, risk factors for stroke, and warning signs and symptoms of stroke. There are many examples of how patient education programs for specific chronic conditions have increased healthful behaviors, improved health status, and/or decreased health care costs of their participants. Clinical practice guidelines include recommendations for patient and family education during hospitalization as well as information about resources for social support services. Some clinical trials have shown measurable benefits in patient and caregiver outcomes with the application of education and support strategies. The type of stroke experienced and the resulting outcomes will play a large role in determining not only the course of treatment but also what education will be required. Patient education should include information about the event (e.g., cause, treatment, and risk factors), the role of various medications or strategies, as well as desirable lifestyle modifications to reduce risk or improve outcomes. Family/caregivers will also need guidance in planning effective and realistic care strategies appropriate to the patient's prognosis and potential for rehabilitation.

Percent of Ischemic Stroke Patients Receiving Stroke Education - Ischemic stroke patients or their caregivers who were given educational materials during the hospital stay addressing all of the following: activation of emergency medical system, need for follow-up after discharge, medications prescribed at discharge, risk factors for stroke, and warning signs and symptoms of stroke. There are many examples of how patient education programs for specific chronic conditions have increased healthful behaviors, improved health status, and/or decreased health care costs of their participants. Clinical practice guidelines include recommendations for patient and family education during hospitalization as well as information about resources for social support services. Some clinical trials have shown measurable benefits in patient and caregiver outcomes with the application of education and support strategies. The type of stroke experienced and the resulting outcomes will play a large role in determining not only the course of treatment but also what education will be required. Patient education should include information about the event (e.g., cause, treatment, and risk factors), the role of various medications or strategies, as well as desirable lifestyle modifications to reduce risk or improve outcomes. Family/caregivers will also need guidance in planning effective and realistic care strategies appropriate to the patient's prognosis and potential for rehabilitation.

Percent of Hemorrhagic Stroke Patients Receiving Stroke Education - Hemorrhagic stroke patients or their caregivers who were given educational materials during the hospital stay addressing all of the following: activation of emergency medical system, need for follow-up after discharge, medications prescribed at discharge, risk factors for stroke, and warning signs and symptoms of stroke. There are many examples of how patient education programs for specific chronic conditions have increased healthful behaviors, improved health status, and/or decreased health care costs of their participants. Clinical practice guidelines include recommendations for patient and family education during hospitalization as well as information about resources for social support services. Some clinical trials have shown measurable benefits in patient and caregiver outcomes with the application of education and support strategies. The type of stroke experienced and the resulting outcomes will play a large role in determining not only the course of treatment but also what education will be required. Patient education should include information about the event (e.g., cause, treatment, and risk factors), the role of various medications or strategies, as well as desirable lifestyle modifications to reduce risk or improve outcomes. Family/caregivers will also need guidance in planning effective and realistic care strategies appropriate to the patient's prognosis and potential for rehabilitation.

Percent of Stroke Patients Assessed for Rehabilitation - Ischemic or hemorrhagic stroke patients who were assessed for rehabilitation services. Each year about 700,000 people experience a new or recurrent stroke, which is the nation's third leading cause of death. Approximately two thirds of these individuals survive and require rehabilitation. Stroke is a leading cause of serious, long-term disability in the United States, with about 4.4 million stroke survivors alive today. Forty percent of stroke patients are left with moderate functional impairment and 15 to 30 percent with severe disability. More than 60% of those who have experienced stroke, serious injury, or a disabling disease have never received rehabilitation. Stroke rehabilitation should begin as soon as the diagnosis of stroke is established and life-threatening problems are under control. Among the high priorities for stroke are to mobilize the patient and encourage resumption of self-care activities as soon as possible. A considerable body of evidence indicates better clinical outcomes when patients with stroke are treated in a setting that provides coordinated, multidisciplinary stroke-related evaluation and services. Effective rehabilitation interventions initiated early following stroke can enhance the recovery process and minimize functional disability. The primary goal of rehabilitation is to prevent complications, minimize impairments, and maximize function.

Percent of Ischemic Stroke Patients Assessed for Rehabilitation - Ischemic stroke patients who were assessed for rehabilitation services. Each year about 700,000 people experience a new or recurrent stroke, which is the nation's third leading cause of death. Approximately two thirds of these individuals survive and require rehabilitation. Stroke is a leading cause of serious, long-term disability in the United States, with about 4.4 million stroke survivors alive today. Forty percent of stroke patients are left with moderate functional impairment and 15 to 30 percent with severe disability. More than 60% of those who have experienced stroke, serious injury, or a disabling disease have never received rehabilitation. Stroke rehabilitation should begin as soon as the diagnosis of stroke is established and life-threatening problems are under control. Among the high priorities for stroke are to mobilize the patient and encourage resumption of self-care activities as soon as possible. A considerable body of evidence indicates better clinical outcomes when patients with stroke are treated in a setting that provides coordinated, multidisciplinary stroke-related evaluation and services. Effective rehabilitation interventions initiated early following stroke can enhance the recovery process and minimize functional disability. The primary goal of rehabilitation is to prevent complications, minimize impairments, and maximize function.

Percent of Hemorrhagic Stroke Patients Assessed for Rehabilitation - Hemorrhagic stroke patients who were assessed for rehabilitation services. Each year about 700,000 people experience a new or recurrent stroke, which is the nation's third leading cause of death. Approximately two thirds of these individuals survive and require rehabilitation. Stroke is a leading cause of serious, long-term disability in the United States, with about 4.4 million stroke survivors alive today. Forty percent of stroke patients are left with moderate functional impairment and 15 to 30 percent with severe disability. More than 60% of those who have experienced stroke, serious injury, or a disabling disease have never received rehabilitation. Stroke rehabilitation should begin as soon as the diagnosis of stroke is established and life-threatening problems are under control. Among the high priorities for stroke are to mobilize the patient and encourage resumption of self-care activities as soon as possible. A considerable body of evidence indicates better clinical outcomes when patients with stroke are treated in a setting that provides coordinated, multidisciplinary stroke-related evaluation and services. Effective rehabilitation interventions initiated early following stroke can enhance the recovery process and minimize functional disability. The primary goal of rehabilitation is to prevent complications, minimize impairments, and maximize function.

Use of Medical Imaging (UMI)

Outpatients with Low Back Pain who had an MRI without Trying Recommended Treatment First - Although MRIs can be helpful for diagnosing low back pain, MRIs can be used too much. Usually, low back pain improves or goes away within six weeks and an MRI is not needed. Process of care say that most patients with low back pain should start with treatment such as physical therapy or chiropractic care, and have an MRI only if the treatment doesn't help. Finding out whether treatment helps before having an MRI is better and safer for most patients because it avoids the stress, risk, and cost of doing MRIs that patients may not need. If a number is high, it may mean that the facility is doing unnecessary MRIs for low back pain. For some patients with certain conditions, getting an MRI right away is appropriate care. Patients with these conditions are not included in this measure.

Outpatients who had a follow-up mammogram or ultrasound within 45 days after a screening mammogram - When a screening mammogram shows signs of possible breast cancer, the patient is asked to come back for a follow-up appointment. A follow-up usually means having more tests (mammograms, an ultrasound, or both). Medical research shows that there may be a problem if a facility has either very low or very high numbers of follow-ups. A number much lower than 8% may mean there's not enough follow-up and it's possible that signs of cancer are being missed. A number much higher than 14% may mean the facility is doing too much unnecessary follow-up.

Outpatient CT scans of the chest that were "combination" (double) scans - Standards of quality care say that most patients who are getting a CT scan of the chest should be given a single CT scan rather than a "combination" CT scan. (Although combination CT scans are appropriate for some parts of the body and some medical conditions, combination scans are usually not appropriate for the chest.) The range for this measure is 0 to 1. If a number is very close to 1, it may mean that the facility is routinely giving patients combination CT scans of the chest when a single scan is all they need.

Outpatient CT scans of the abdomen that were "combination" (double) scans - Combination scans involve additional radiation exposure and risks associated with use of contrast. For this measure, if a number is very close to 1, it may mean that the facility is routinely giving patients combination CT scans of the abdomen when a single scan is all they need.