Hospital Based Inpatient Psychiatric Services (HBIPS)

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Hospital-Based Inpatient Psychiatric Services (HBIPS) Measure Set Initial Patient Population

The HBIPS measure set is unique in that there is one Initial Patient Population within the measure set, event measures (HBIPS-2 and HBIPS-3).

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Initial Patient Population for Event Measures (HBIPS-2 and HBIPS-3)
The population of the HBIPS event measures can be identified by using two data elements that are common to the event performance measures in the HBIPS set:

• Event Date
• Psychiatric Care Setting

The HBIPS Event Topic Population (common to all HBIPS event measures) is defined as patients with an event (Event Date exists) while they are in the hospital with a Patient Age at Time of Event (Event Date -— Birthdate) >= 1 year and the patient was in a Psychiatric Care Setting (='Y') when the event occurred. There are four distinct strata or sub-populations within the HBIPS Event Topic Population, each identified by a specific age range. The patients in each stratum are counted in the HBIPS Initial Patient Population for event measures of multiple measures.

Event Measures	Age Strata	Initial Patient Population definition
HBIPS-2a and 3a (overall measures)	Age greater than and equal to 1 year	The count of all patients in strata 1, 2, 3, and 4
HBIPS-2b and 3b	Age 1 year through 12 years	The count of all patients in stratum 1
HBIPS-2c and 3c	Age 13 years through 17 years	The count of all patients in stratum 2
HBIPS-2d and 3d	Age 18 years through 64 years	The count of all patients in stratum 3
HBIPS-2e and 3e	Age greater than and equal to 65 years	The count of all patients in stratum 4

Patients for which an event occurs (Event Date exists) while in a Psychiatric Care Setting (='Y') in the hospital are included in one of the Strata Initial Populations for the event measures. There is no sampling for the HBIPS event measures. All patients in the Initial Population for HBIPS event measures are automatically sampled.

Event Stratum 1 — Age 1 year through 12 years stratum — A Patient Age at Time of Event (Event Date -— Birthdate) >= 1 year and < 13 years

Event Stratum 2 - Age 13 years through 17 years stratum — A Patient Age at Time of Event (Event Date —- Birthdate) >= 13 years and < 18 years

Event Stratum 3 - Age 18 years through 64 years stratum — A Patient Age at Time of Event (Event Date -— Birthdate) >= 18 years and < 65 years

Event Stratum 4 - Age greater than and equal to 65 years stratum — A Patient Age at Time of Event (Event Date —- Birthdate) >= 65 years

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HBIPS Initial Patient Population Algorithm Narrative

Variable Key: Patient Age at Time of Event, Initial Patient Population Reject Case Flag

1. Start HBIPS Initial Patient Population logic sub-routine. Process all cases that have successfully reached the point in the Data Processing Flow which calls this Initial Patient Population Algorithm. Do not process cases that have been rejected before this point in the Data Processing Flow. Note: Patients that fall into the HBIPS Initial Patient Population are processed as multiple cases. Do not combine multiple events into one case.
2. Event Date:

1. If the Event Date exists, process as an event case, proceed to step 3.
   
2. If an Event Date does not exist, the patient is not in HBIPS Event Topic Population, and the patient is not eligible for any HBIPS Event strata. Set Initial Patient Population Reject Case Flag to equal Yes. Return to Data Processing Flow.
   

Note

Patients for which an event occurred, and the Event Date is not initially captured electronically must be added to the Event Population during manual data abstraction.

3. Calculate Patient Age at Time of Event (in years) = Event Date - Birthdate. Use the month and day portion of event date and birthdate to yield the most accurate age.
4. Check Patient Age at Time of Event:

1. If the Patient Age at Time of Event is equal to zero (0) years, the patient is not in the HBIPS Event Topic Population and patient is not eligible for any HBIPS Event strata. Set Initial Patient Population Reject Case Flag to equal Yes. Return to Data Processing Flow.
   
2. If the Patient Age at Time of Event is greater than or equal to 1 years, proceed to check Psychiatric Care Setting
   

5. Check Psychiatric Care Setting

1. If Psychiatric Care Setting is N , the patient is not in the HBIPS Event Topic Population and patient is not eligible for any HBIPS Event strata. Set Initial Patient Population Reject Case Flag to equal Yes. Return to Data Processing Flow.
   
2. If Psychiatric Care Setting is Y, the patient is in the HBIPS Event Topic Population. Set Initial Patient Population Reject Case Flag to equal No. Proceed to check Patient Age at Time of Event.
   

Note: Initial Patient Population Size – Medicare Only and Non-Medicare Only for HBIPS Event measures are not derived from those cases that pass through the Initial Patient Population algorithm. Instead, these data are derived from the HBIPS census data calculated by (Psychiatric Inpatient Days - Total Leave Days).
6. Check Patient Age at Time of Event:

1. If Patient Age at Time of Event is greater than or equal to 1 years and less than 13 years, the patient is in the 1st HBIPS Event stratum and patient is eligible to be sampled for the 1st HBIPS Event stratum. Include patient in the Initial Patient Population of the appropriate Event measures. Return to Data Processing Flow.
   
2. If Patient Age at Time of Event is greater than 13 years, continue processing and proceed to check Patient Age at Time of Event.
   

7. Check Patient Age at Time of Event:

1. If Patient Age at Time of Event is greater than or equal to 13 years and less than 18 years, the patient is in the 2nd HBIPS Event stratum and patient is eligible to be sampled for the 2nd HBIPS Event stratum. Include patient in the Initial Patient Population of the appropriate Event measures. Return to Data Processing Flow.
   
2. If Patient Age at Time of Event is greater than or equal to 18 years, continue processing and proceed to check Patient Age at Time of Event.
   

8. Check Patient Age at Time of Event:

1. If Patient Age at Time of Event is greater than or equal to 18 years and less than 65 years, the patient is in the 3rd HBIPS Event stratum and patient is eligible to be sampled for the 3rd HBIPS Event stratum. Include patient in the Initial Patient Population of the appropriate Event measures. Return to Data Processing Flow.
   
2. If Patient Age at Time of Event is greater than or equal to 65 years, the patient is in the 4th HBIPS Event stratum and patient is eligible to be sampled for the 4th HBIPS Event stratum. Include patient in the Initial Patient Population of the appropriate Event measures. Return to Data Processing Flow.
   

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/month for the stratum cannot sample that stratum. Regardless of the option used, hospital samples must be monitored to ensure that sampling procedures consistently produce statistically valid and useful data. Because the sample for a measure set will rarely be equal to the effective sample due to exclusions and contraindications, hospitals selecting sample cases MUST submit AT LEAST the minimum required sample size.

For information concerning how to perform sampling, refer to the Population and Sampling Specifications section in this manual.

Sampling Requirements for HBIPS Event Measures (HBIPS-2 and HBIPS-3)
The measures in HBIPS-EVT (HBIPS-2 and HBIPS-3) are not eligible for sampling and will use the entire Initial Patient Population for reporting.