ACO-Level Administrative Claims-Based Measure of Days at Home for Patients With Complex Chronic Conditions
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BACKGROUND: Stakeholders have called for measures of how much time patients spend at home and in the community to incentivize coordinated, timely, and primary care-based services and reduce unnecessary acute care. OBJECTIVES: We developed a claims-based "Days at Home" Accountable Care Organization (ACO) measure for Medicare beneficiaries, intended to assess the number of days in a calendar year that adults with complex chronic disease spend at outside acute or postacute inpatient facilities. METHODS: Testing used 2017 and 2018 Medicare claims for fee-for-service patients enrolled in 610 Shared Savings Program ACOs. We used a split-half method for reliability testing, and a survey of technical experts and comparison to related measures for validity. The measure adjusts for 51 clinical and demographic variables and one social determinant of health (Medicaid dual-eligibility). To avoid unintended consequences of discouraging medically appropriate care and excessive reliance on nursing homes, the measure adjusts for mortality and new admissions to long-term nursing home care. RESULTS: The cohort (N=1,154,779) was predominantly White (84.9%) and aged 65 years or older (84.0%), and 22.8% were Medicaid dual-eligible. Mean ACO-level adjusted days at home was 330.4, ranging from 291.0 to 345.9 days (interquartile range: 329.1-332.1). Split-sample reliability was 0.833. External experts rated the measure as having face validity; in assessing external validity the measure generally correlated with related measures. CONCLUSIONS: The Days at Home ACO measure is a reliable and valid measure that can be used to promote coordinated and prevention-focused home-based and community-based care
Chronic disease · Health services research · Measure (data warehouse) · MEDLINE · Chronic Disease Management Strategies · Frailty in Older Adults · Geriatric Care and Nursing Homes
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