Global is an umbrella name for four measure sets, Emergency Department (ED), Immunization (IMM), Substance Use (SUB) and Tobacco Treatment (TOB). The purpose of defining an umbrella name was to apply one population flow and one sampling on the Global population and reduce the burden of sampling for four measure sets or any number of these four measure sets that are selected. Therefore, if only two of the Global measure sets are selected and reported, the process would only apply for those two measure sets.

The Global Initial Patient Population is defined by two data elements:

• Admission Date
• Discharge Date

All patients discharged from acute inpatient care with Length of Stay (Discharge Date minus Admission Date) less than or equal to 120 days are included in the Global Initial Population and are eligible for sampling.

The cases that are accepted into the Global Initial patient population and are sampled would be selected for the specific measure set and return to the Clinical Data Processing Flow in the Data Processing section.

For The Joint Commission, hospitals must submit the same case for all applicable measure sets elected by the hospital (i.e., ED, IMM, SUB and TOB) under the Global Initial Patient Population.
Example:
If a hospital has elected to submit ED, TOB and IMM to The Joint Commission, for every ED case that is submitted the same case must also be submitted as a TOB case and an IMM case to The Joint Commission.

The Global Initial Patient Population only contains the population information and flow. There is no measure associated to Global; therefore there is no measure flow or MIF for Global.

For Emergency Department (ED), Immunization (IMM), Substance Use (SUB) and Tobacco Treatment (TOB) Initial Patient Population definitions and algorithms, please refer to the Global Initial Patient Population.

Initial Patient Population Algorithm

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Global Sample Size Requirements

Hospitals that choose to sample have the option of sampling quarterly or sampling monthly. A hospital may choose to use a larger sample size than is required. Hospitals whose Initial Patient Population size is less than the minimum number of cases per quarter for the measure set cannot sample.

Regardless of the option used, hospital samples must be monitored to ensure that sampling procedures consistently produce statistically valid and useful data. Due to exclusions, hospitals selecting sample cases MUST submit AT LEAST the minimum required sample size.

To reduce the burden of multiple sampling for different measure sets, those hospitals that are submitting any of the measure sets under the Global Initial Patient Population, the pulled sample must be used to identify the data for all measure sets or stratum that are submitted to The Joint Commission. For more information concerning how to perform sampling and using the Global sample size for other measure sets, please refer to the Population and Sampling Specifications section in this manual.

The following sample size tables for each option automatically build in the number of cases needed to obtain the required sample sizes for the measure sets under the Global initial patient population.

Quarterly Sampling

Hospitals performing quarterly sampling for Global must ensure that its Initial Patient Population and sample size meet the following conditions:

Quarterly Sample Size
Based on Hospital’s Initial Patient Population Size for the Global Measures

Average Quarterly Initial Patient Population Size “N”	Minimum Required Sample Size “n”
≥ 1530	306
765 – 1529	20% of Initial Patient Population size
153 — 764	153
6 – 152	No sampling; 100% Initial Patient Population required
0-5	Submission of patient level data is encouraged but not required: if submission occurs, 100% Initial Patient Population required

Monthly Sampling

Hospitals performing monthly sampling for Global must ensure that its Initial Patient Population and sample size meet the following conditions:

Monthly Sample Size
Based on Hospital’s Global Initial Patient Population Size Measures

Average Monthly Initial Patient Population Size “N”	Minimum Required Sample Size “n”
≥ 510	102
255 - 509	20% of Initial Patient Population size
51 - 254	51
< 51	No sampling; 100% Initial Patient Population required

Sample Size Examples

• Quarterly sampling:
  
  • A hospital’s Global Initial Patient Population size is 3000 patients during the fourth quarter. The required sample size is seen to be a minimum of 306 Global patients for this quarter.
    
  • A hospital’s Global Initial Patient Population size 803 patients during the third quarter. The required sample size is 20% of the patient population or 161cases for the quarter (twenty percent of 803 equals 160.6 rounded to the next highest whole number equals 161).
    
  • A hospital’s Global Initial Patient Population size is 4 patients during the first quarter. Submission of patient level data is not required. If the hospital chooses to submit patient level data, the required quarterly sample size would be 100% of the patient population or 4 cases for the quarter.

• Monthly sampling:
  
  • A hospital’s Global Initial Patient Population size is 600 patients during March. The required sample size is 102 cases from the patient population.
    
  • A hospital’s Global Initial Patient Population size is 303 patients during July. The required sample size is 20% of the patient population or 61 cases for the month (twenty percent of 303 equals 60.6 rounded to the next highest whole number equals 61).