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.

Data Element
Incontinence
Description

Lack of voluntary control over urination or defecation
Submitted By: Holly Miller, MD / MedAllies
Data Element Information
Data Element Description Lack of voluntary control over urination or defecation
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.
( mar21_medpac_report_to_the_congress_sec.pdf)
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.
Estimate the breadth of applicability of the use case(s) for this data element 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
Estimate the breadth of applicability of the use case(s) for this data element unknown
Healthcare Aims
  • Improving patient experience of care (quality and/or satisfaction)
  • Improving the health of populations
  • Reducing the cost of care
  • Improving provider experience of care
Maturity of Use and Technical Specifications for Data Element
Applicable Standard(s) LOINC
Additional Specifications N/A
Current Use This data element has been used at scale between multiple different production environments to support the majority of anticipated stakeholders
Supporting Artifacts Level 2 – at scale, or in more widespread production use (routinely collected already) on several different EHR/HIT systems.
Extent of exchange 5 or more. This data element has been tested at scale between multiple different production environments to support the majority of anticipated stakeholders.
Supporting Artifacts 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.
Potential Challenges
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
ASTP Evaluation Details
Each submitted Data Element has been evaluated based on the following criteria. The overall Level classification is a composite of the maturity based on these individual criteria. This information can be used to identify areas that require additional work to raise the overall classification level and consideration for inclusion in future versions of USCDI
Criterion #1
Maturity - Current Standards		 Level 2 - Data element is represented by a terminology standard or SDO-balloted technical specification or implementation guide.
Criterion #2
Maturity - Current Use 		Level 2 - Data element is captured, stored, or accessed in multiple production EHRs or other HIT modules from more than one developer.
Criterion #3
Maturity - Current Exchange		 Level 2 - Data element is electronically exchanged between more than two production EHRs or other HIT modules of different developers using available interoperability standards.
Criterion #4
Use Case(s) - Breadth of Applicability		 Level 0 - Use cases apply to a limited number of care settings or specialties, or data element represents a specialization of other, more general data elements.
Evaluation Comment This data element represents a specific type of existing USCDI data element Health Concern in the Health Status Assessments data class.

Comment

Submitted by rdillaire on

CMS-CCSQ Supports the Advancement of Incontinence to Level 2

Recommendation:  CMS CCSQ recommends the Incontinence element be advanced to Level 2.

Rationale:  Upgrading the Incontinence data element to Level 2 in the USCDI is essential for enhancing care in the long-term post-acute care (LTPAC) setting, where incontinence is a prevalent and significant concern that directly impacts patient quality of life and care planning. Additionally, this data is required by CMS for PAC setting quality reporting programs.

Tracking incontinence, including both bladder and bowel continence, provides vital insights into a patient’s functional status, helping healthcare providers assess care needs, monitor changes in condition, and implement appropriate interventions. This data is already captured in standardized assessments such as Bladder Continence (H0350) and Bowel Continence (H0400) in assessments like the Inpatient Rehabilitation Facility Patient Assessment Instrument (IRF-PAI), Minimum Data Set (MDS), and Long-Term Care Hospital (LTCH) Continuity Assessment Record and Evaluation (CARE) Data Set (LCDS). Upgrading Incontinence to Level 2 will signal the importance of capturing this data element in healthcare IT systems to vendors and may increase its adoption and improve its accessibility and interoperability, enabling better care coordination and facilitating more accurate outcomes tracking across healthcare settings. Additionally, the use of standardized coding systems, such as logical observation identifiers names and codes (LOINC) (Version 2.78), ensures consistency and facilitates seamless data exchange.

Submitted by rdillaire on

CMS-CCSQ Recommends the advancement of Incontinence to Level 2

Recommendation: CMS CCSQ recommends the Incontinence element be advanced to Level 2.

Rationale: Upgrading the Incontinence data element to Level 2 in the USCDI is essential for enhancing care in the long-term post-acute care (LTPAC) setting, where incontinence is a prevalent and significant concern that directly impacts patient quality of life and care planning.

Tracking incontinence, including both bladder and bowel continence, provides vital insights into a patient’s functional status, helping healthcare providers assess care needs, monitor changes in condition, and implement appropriate interventions. This data is already captured in standardized assessments such as Bladder Continence (H0350) and Bowel Continence (H0400) in assessments like the Inpatient Rehabilitation Facility Patient Assessment Instrument (IRF-PAI), Minimum Data Set (MDS), and Long-Term Care Hospital (LTCH) Continuity Assessment Record and Evaluation (CARE) Data Set (LCDS). Upgrading Incontinence to Level 2 will signal the importance of capturing this data element in healthcare IT systems to vendors and may increase its adoption and improve its accessibility and interoperability, enabling better care coordination and facilitating more accurate outcomes tracking across healthcare settings. Additionally, the use of standardized coding systems, such as logical observation identifiers names and codes (LOINC) (Version 2.78), ensures consistency and facilitates seamless data exchange.

Submitted by aphillips@imoh… on

Level 2 Data Element: Incontinence

IMO 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. 

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