Testing Transfer of Health Information Quality Measures Mandated By the Improving Medicare Post‐Acute Care Transformation Act of 2014
Authors: Tyler D. , Byrne C. , McMullen T. 
Published: August 2020

Research Objective

The Improving Post‐Acute Care Transformation Act of 2014 mandated the creation of quality measures related to the transfer of health information and patient care preferences between post‐acute care (PAC) and other settings. The measures were required to be cross‐setting, meaning the measures should be developed for use across four specific PAC settings. Based on input from a technical expert panel and other stakeholders, the measures developed focus on the transfer of medication information at PAC discharge. One measure assesses the transfer of medication information to the subsequent provider (TOH‐Provider measure) and one measure assesses the transfer of medication information to the patient, family, and/or caregiver (TOH‐Patient measure). The purpose of this study was to examine inter‐rater reliability, face validity, feasibility, and the overall experience of collecting and submitting data for these quality measures. We also examined consumer reaction to the measures.

Study Design

Pilot sites, including home health agencies (HHAs), inpatient rehabilitation facilities (IRFs), long‐term care hospitals (LTCHs), and skilled nursing facilities (SNFs), used pairs of data collectors to independently complete assessments for recently discharged patients. We used these data to determine inter‐rater reliability. We conducted telephone interviews with the sites to gather data about face validity, feasibility, and other experiences collecting and submitting data for the measures. We also conducted interviews with recent PAC patients and caregivers to gauge their reactions to the measures, especially their opinions of the measures’ usefulness in selecting a PAC provider.

Population Studied

Twenty‐four PAC sites, including seven HHAs, five IRFs, six LTCHs, and six SNFs, submitted assessments for 801 recently discharged PAC patients. We also interviewed six recent (ie, within the past 6 months) PAC patients and six caregivers of recent PAC patients.

Principal Findings

Inter‐rater reliability was 86.7% for the TOH‐Provider measure and 93.2% for the TOH‐Patient measure. Most sites reported that the measures would distinguish between providers with better and poorer transfer of information processes. They also reported that the data were feasible to collect. Most patients and caregivers stated that data about the transfer of medication information by PAC providers would be important to their future PAC selection and said that these measures would tell them about the quality of PAC providers.

Conclusions

The transfer of health information measures showed very good inter‐rater reliability, and the data were feasible for sites to collect. Patients and caregivers also reported that this information is important to them.

Implications for Policy or Practice

The Centers for Medicare & Medicaid Services (CMS) has set important policy goals related to improving information sharing between health care providers. These measures will support that goal by assessing the transfer of medication information at PAC discharge. These measures may also be helpful to patients in their selection of a PAC provider. Future research should examine the relationship between these process measures and measures of patient outcomes.

Primary Funding Source

Centers for Medicare and Medicaid Services.