|Submitted By: Holly Miller, MD / MedAllies|
|Data Element Information|
|Use Case Description(s)|
|Use Case Description||In community dwelling individuals: Risk assessment for: skin breakdown/pressure ulcers. falls, institutionalization, social isolation. Quantify extent of services needed to remain safely at home. This data element is routinely captured by PCPs, home care nurses, HCBS service providers, and by case managers. It is part of the OASIS assessment instrument required by CMS for payment and quality measurement of home care services. 25% of women over age 35 have varying degrees of urinary incontinence (The True Impact Of Incontinence - NAFC) and it has a significant impact on the quality of life (The Impact of Urinary Incontinence on Quality of Life in Those Receiving Home Care Services - Mahcube Cubukcu, 2019 (sagepub.com). The additional burden on caregivers due to incontinence is a significant factor in long term institutionalization.
In institutionalized individuals: estimate staff time required, risk of skin breakdown/pressure ulcers, falls. This assessment is part of the federally mandated assessment instruments used in Skilled Nursing Facilities (SNFs), Long Term Care Hospitals (LTCHs), Inpatient Rehabilitation Facilities (IRFs) and Hospice. This data element is routinely collected on all admissions and during periodic evaluations. MedPAC reported LTPAC (Long-Term and Post-Acute Care) providers collectively provided care to over 7 million Medicare Beneficiaries per year. Because these assessments are required for payment and quality reporting, they are collected by the more than 15,000 Skilled Nursing Facilities (SNFs), 11,000 Home Health Agencies (HHAs), 4,600 Hospice Care agencies, 1,100 Inpatient Rehabilitation Facilities (IRFs), and 400 Long-Term Care Hospitals (LTCHs). These standardized data are collected and submitted to CMS as required by these entities.
This data element is also included in the transitions of care data sent when an individual moves from one site of care or care team to another. Care transitions are a frequent occurrence for the LTPAC population, occurring millions of times per year.
Given the universality of incontinence, this data element is collected in a variety of settings, exchanged with a variety of settings, and used in different EHR/HIT systems.
Fecal incontinence, although less prevalent at about 8% of the non-institutionalized population (Fecal incontinence in US adults: epidemiology and risk factors - PubMed (nih.gov), presents the same issues and impact. It, too, is part of the federally mandated LTPAC assessment instruments and used similarly to urinary incontinence data.
Although LTPAC data is cited as the specific use case, these data elements apply to the population as a whole and are not limited to LTPAC.
|Estimated number of stakeholders capturing, accessing using or exchanging||Level 2 – These elements pertain to most or all patients, providers or requestors.
|Link to use case project page||https://del.cms.gov/DELWeb/pubHome there are 9 relevant incontinence data elements in the DEL.|
|Use Case Description||Use in research
Patient reported data
|Estimated number of stakeholders capturing, accessing using or exchanging||unknown|
|Maturity of Use and Technical Specifications for Data Element|
|Current Use||This data element has been used at scale between multiple different production environments to support the majority of anticipated stakeholders|
Level 2 – at scale, or in more widespread production use (routinely collected already) on several different EHR/HIT systems.
|Number of organizations/individuals with which this data element has been electronically exchanged||5 or more. This data element has been tested at scale between multiple different production environments to support the majority of anticipated stakeholders.|
Level 2 – exchanged between 4 or more different EHR/HIT systems. More routinely exchanged between multiple different systems can justify adding to next draft version.
|Restrictions on Standardization (e.g. proprietary code)||None|
|Restrictions on Use (e.g. licensing, user fees)||None|
|Privacy and Security Concerns||None|
|Estimate of Overall Burden||Low|
Assessments of a health-related matter of interest, importance, or worry to a patient, patient’s family, or patient’s healthcare provider that could identify a need, problem, or condition.
Information from the submission form
Lack of voluntary control over urination or defecation
Submitted by aphillips@imoh… on 2022-04-28
Level 2 Data Element: IncontinenceIMO supports the inclusion of Incontinence as a Level 2 data element in the Assessment and Plan of Treatment Data Class in USCDI V3. IMO agrees with the submitter that assessment of incontinence is important to the quality of patient care, structured documentation is well supported by established CMS assessment instruments with associated HIT standards and can be easily implemented in ONC Certified HIT.