Medicare Post-Acute Care: Quality Measurement Final Report. I. PURPOSE


The Office of the Assistant Secretary for Planning and Evaluation (ASPE), within the Department of Health and Human Services (HHS), funded this study to develop quality measures for post-acute care services for similar patients with selected conditions. The conditions targeted in this project were stroke, congestive heart failure (CHF), pneumonia, and back and neck conditions. Under this project, four quality measurement instruments, one for each condition, were developed. Each instrument consists of four parts: a medical and post-acute care chart review, and an initial and follow-up patient survey. The instruments, intended for use in future research, could provide information on the extent of case mix and service overlap across post-acute care settings for patients with one of the four identified conditions and their outcomes following post-acute care.

This report is presented in five chapters. Chapter I, Purpose, provides an overview of the project. Chapter II, Rationale, develops the rationale for conducting this project. This chapter reviews the need to understand post-acute care outcomes in view of the historical trends in post-acute care payment and use, recent changes in post-acute care payment policies and the impact of those changes on quality and access, issues regarding the potential overlap in post-acute care patients and services and the need to understand quality of care across settings if such overlap exists. This chapter also presents what is known about post-acute care quality and outcomes, and concludes with a discussion about why is it important to understand post-acute care quality. Chapter III, Quality Measurement Development, describes how quality measures for selected conditions were identified and selected, and how quality measurement instruments were developed and refined. Chapter IV, Conclusions and Policy Implications, summarizes the quality measures chosen for the selected tracer conditions across post-acute care services and the limitations of existing administrative data (including patient assessment information) in measuring outcomes. The last chapter, Chapter V, Next Steps, briefly describes the next phase of the ASPE research strategy to examine post-acute care quality. In that phase, ASPE is funding a study to examine post-acute care outcomes for stroke patients, which will use the patient assessment instrument developed for stroke under the current project. In addition, Chapter V summarizes work that ASPE is funding to develop a conceptual framework that will specify the objectives of collecting patient health and functional information, review methods used in identifying and collecting patient information, and specify next steps for identifying the patient information needed to achieve objectives and methods for data collection and maintenance. Finally, the Appendices include several background and supporting documents, as referenced throughout this report.