Specifications Manual for Joint Commission National Quality Measures (v2018B)
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Release Notes:
Data Element
Version 2018B

Data Element Name: Discharge Disposition
Collected For: ACHF, ASR-IP-3, CSTK-02, CSTK-10, HBIPS-5, PAL-05, PC-04, PC-05, PC-06, STK-10, STK-2, STK-3, STK-6, STK-8, THKR-IP-2, THKR-IP-3
Definition:The final place or setting to which the patient was discharged on the day of discharge.
Suggested Data Collection Question:What was the patient's discharge disposition on the day of discharge?
Format:
Length:1
Type:Alphanumeric
Occurs:1
Allowable Values:

1 Home

2 Hospice - Home

3 Hospice —- Health Care Facility

4 Acute Care Facility

5 Other Health Care Facility

6 Expired

7 Left Against Medical Advice/AMA

8 Not Documented or Unable to Determine (UTD)

Notes for Abstraction:
  • Only use documentation written on the day prior to discharge through 30 days after discharge when abstracting this data element.
    Example:
    Documentation in the Discharge Planning notes on 04-01-20xx state that the patient will be discharged back home. On 04-06-20xx the physician orders and nursing discharge notes on the day of discharge reflect that the patient was being transferred to skilled care. The documentation from 04-06-20xx would be used to select value “5” (Other Health Care Facility).
  • The medical record must be abstracted as documented (taken at “face value”). Inferences should not be made based on internal knowledge.
  • If there is documentation that further clarifies the level of care that documentation should be used to determine the correct value to abstract. If documentation is contradictory, use the latest documentation.
    Examples:
    • Discharge summary dictated 2 days after discharge states patient went “home”. Physician note on day of discharge further clarifies that the patient will be going home with hospice”. Select value “2” (“Hospice - Home”).
    • Discharge planner note from day before discharge states “XYZ Nursing Home”. Discharge order from day of discharge states “Discharge home”. Contradictory documentation, use latest. Select value “1”" (“Home”).
    • Physician order on discharge states “Discharge to ALF”. Discharge instruction sheet completed after the physician order states patient discharged to “SNF”. Contradictory documentation, use latest. Select value “5” (“Other Health Care Facility”).
  • If documentation is contradictory, and you are unable to determine the latest documentation, select the disposition ranked highest (top to bottom) in the following list. See Inclusion lists for examples.
    • Acute Care Facility
    • Hospice —- Health Care Facility
    • Hospice —- Home
    • Other Health Care Facility
    • Home
  • Hospice (values “2” and “3”) includes discharges with hospice referrals and evaluations.
  • If the medical record states only that the patient is being discharged to another hospital and does not reflect the level of care that the patient will be receiving, select value “4” (“Acute Care Facility”).
  • If the medical record states the patient is being discharged to assisted living care or an assisted living facility (ALF) and the documentation also includes nursing home, intermediate care or skilled nursing facility, select Value “1” (“Home”).
  • If the medical record states the patient is being discharged to nursing home, intermediate care or skilled nursing facility without mention of assisted living care or assisted living facility (ALF), select Value “5” (“Other Health Care Facility”).
  • If the medical record identifies the facility the patient is being discharged to by name only (e.g., “Park Meadows”), and does not reflect the type of facility or level of care, select value “5” (“Other Health Care Facility”).
  • If the medical record states only that the patient is being “discharged” and does not address the place or setting to which the patient was discharged, select value “1” (“Home”).
  • When determining whether to select value “7” (“Left Against Medical Advice/AMA”):
    • Explicit “left against medical advice” documentation is not required. E.g., “Patient is refusing to stay for continued care” —- Select value “7”.
    • Documentation suggesting that the patient left before discharge instructions could be given does not count.
    • A signed AMA form is not required, for the purposes of this data element.
    • Do not consider AMA documentation and other disposition documentation as “contradictory”. If any source states the patient left against medical advice, select value “7”, regardless of whether the AMA documentation was written last. E.g., AMA form signed and discharge instruction sheet states “Discharged home with belongings” -— Select “7”.
Suggested Data Sources:

  • Progress notes
  • Physician orders
  • Discharge summary
  • Discharge instruction sheet
  • Discharge planning notes
  • Nursing discharge notes
  • Social service notes
  • Transfer record

Excluded Data Sources
  • Any documentation prior to the last two days of hospitalization
  • Coding documents
  • UB-04

Additional Notes:
Guidelines for Abstraction:
Inclusion Exclusion
Home (Value 1):
  • Assisted Living Facilities (ALFs) -— Includes ALFs and assisted living care at nursing home, intermediate care, and skilled nursing facilities
  • Court/Law Enforcement -— includes detention facilities, jails, and prison
  • Home -— includes board and care, foster or residential care, group or personal care homes, retirement communities, and homeless shelters
  • Home with Home Health Services
  • Outpatient Services including outpatient procedures at another hospital, Outpatient Chemical Dependency Programs and Partial Hospitalization

Hospice -— Home (Value 2):
  • Hospice in the home (or other “Home” setting as above in Value 1)

Hospice — Health Care Facility (Value 3):
  • Hospice - General Inpatient and Respite
  • Hospice - Residential and Skilled Facilities
  • Hospice - Other Health Care Facilities

Acute Care Facility (Value 4):
  • Acute Short Term General and Critical Access Hospitals
  • Cancer and Children's Hospitals
  • Department of Defense and Veteran's Administration Hospitals

Other Health Care Facility (Value 5):
  • Extended or Intermediate Care Facility (ECF/ICF)
  • Long Term Acute Care Hospital (LTACH)
  • Nursing Home or Facility including Veteran's Administration Nursing Facility
  • Psychiatric Hospital or Psychiatric Unit of a Hospital
  • Rehabilitation Facility including Inpatient Rehabilitation Facility/Hospital or Rehabilitation Unit of a Hospital
  • Skilled Nursing Facility (SNF), Sub-Acute Care or Swing Bed
  • Transitional Care Unit (TCU)
  • Veterans Home
None

Discharge Disposition
Specifications Manual for Joint Commission National Quality Measures (v2018B)
Discharges 01-01-19 (1Q19) through 06-30-19 (2Q19)
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