User Guide
Population: All episodes of care included in the registry reflect care given by the CMS-reporting home health agency for more than 14 days.
Data sources: OASIS & patient record
Required Volume: HHCDR will populate with a maximum of twelve (12) randomly selected episode of care per measure (Aspirin, Blood Pressure, Cholesterol, Tobacco Use). Abstractor is encouraged to complete the initial randomly selected episodes shown in registry (12 episodes or less) to increase validity to their monthly report, but this is not a requirement. No matter how many or how few episodes a home health agency abstracts, a report will be generated once ‘Close Out Month’ (see Step 10) has been selected.
Access: Log in to HHQI Data Access account. Then follow ‘HHCDR’ link on brown tool bar at top of page.
Timelines: New episodes of care will be added on the 15th of every month. Reports will be generated for all home health agencies with ‘Close Out Month’ selected by the 14th of every month.
This material was prepared by Quality Insights, the Medicare Quality Innovation Network-Quality Improvement Organization supporting the Home Health Quality Improvement National Campaign, under contract with the Centers for Medicare & Medicaid Services (CMS), an agency of the U.S. Department of Health and Human Services. The views presented do not necessarily reflect CMS policy. Publication number 11SOW-WV-HH-MMD-010815
Step 1: Login with HHQI Data Access account and click ‘HHCDR’ on brown tool bar.
Step 2: Select ‘Year’ & ‘Month’ of discharges to be abstracted. Then click ‘Abstract’ button.
Step 3: Select which ‘measures’ (Aspirin, Blood Pressure, Cholesterol, and/or Tobacco Use) to be abstracted for month by ‘checking’ or ‘unchecking’ box next to measure. Click ‘Save Settings’.
Note: This selection will be available each month, but once this step is completed, it cannot be altered until the next month.
Step 4: Select episode of care to be abstracted by clicking ‘Edit’ on left side of listed episode.
Step 5: Confirm patient identity from record matches prepopulated demographic information (currently hidden in example at right).
Note: The only pre-populated information available for editing is ‘Patient Race / Ethnicity’. If errors are found after ensuring correct record is selected, please proceed with your home health agency’s policy for notifying CMS with transmitted OASIS changes.
Step 6: Answer first question: ‘Did the patient have BOTH a Medicare AND a Medicaid identification number listed in the record?’
Step 7: Answer measure-specific questions. Questions will differ dependent on response in Step 3.
Aspirin (1 question)
This question will only display for patients with IVD (ischemic vascular disease) diagnosis age 18 and older: Did the patient take aspirin or other antithrombotic (i.e., clopidogrel, prasugrel, or ticlopidine) during this episode of care?’
Note: In order to accurately select ‘Contraindicated’, documentation in record must be present. Conclusions are not to be drawn by abstractor.
Blood Pressure Control (2 questions)
These questions will only display for patients with hypertension diagnosis (per OASIS transmission)age 18-85: 1) What was the last blood pressure recorded during this episode of care? 2) Was a follow-up plan to obtain better blood pressure control included in the record during this episode of care?
Cholesterol Management (maximum 3 questions)
These questions will only display for patients with either IVD or diabetes diagnosis age 18-75 years: 1) Is there documentation in the medical record that the patient received a cholesterol screening within the past 12-months prior to this discharge date? 2) If yes, then please indicate which test results were documented in the patient’s record. 3) If LDL selected, then please enter LDL-C value and date.
Tobacco Use (maximum 3 questions)
These questions will display for every patient 18 years and older: 1) During this episode of care, was the patient screened for tobacco use by the home health agency? 2) If yes, then was the patient identified as a current tobacco user? 3) If yes, then did the patient receive tobacco cessation counseling / intervention by the home health agency?
Note: In order to accurately select ‘Not Applicable’, documentation in record must be present. Conclusions are not to be drawn by abstractor.
Step 8 (optional): Enter additional comments as needed (e.g., ‘patient’s birthdate was really 1936 instead of 1963’).
Note: Entering changes in this text box will not change formal OASIS transmissions to CMS. Please proceed with home health agency’s policy for notifying CMS with transmitted OASIS changes.
Step 9: Save information by clicking ‘Save’.
Step 10: Repeat Steps 4-9 until all required randomly selected episodes have been completed. Once final randomly selected episode has been completed, abstractor will see the note below in red.
At this time, registry will populate with ALL episodes of care discharged during the selected month meeting the requirements for the selected measures. At this time, the required number of episodes of care have been completed, but the abstractor may continue to abstract additional episodes of care to create a more robust report.
Once abstractor has decided to end the abstraction process for the month, click ‘Close Out Month’. All home health agencies’ registries ‘Closed’ by the 14th of the month will receive an agency-specific HHCDR Report around the 23rd of the same month.
Note: Once ‘Close Out Month’ has been selected, it cannot be reopened. If ‘Close Out Month’ has not been selected, no report will be generated.
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