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Release Notes:
Data Element
Version 2010A1

Data Element Name: Comfort Measures Only
Collected For: AMI-1, AMI-2, AMI-3, AMI-4, AMI-5, AMI-6, AMI-7, AMI-7a, AMI-8, AMI-8a, AMI-9, AMI-T1a, AMI-T2, HF-1, HF-2, HF-3, HF-4, , PN-2, PN-3a, PN-3b, PN-4, PN-5, PN-5a, PN-5b, PN-5c, PN-6, PN-6a, PN-6b, PN-7,
Definition:Physician/advanced practice nurse/physician assistant (physician/APN/PA) documentation of comfort measures only. Commonly referred to as “palliative care” in the medical community and “comfort care” by the general public. Palliative care includes attention to the psychological and spiritual needs of the patient and support for the dying patient and the patient's family. Comfort Measures Only are not equivalent to the following: Do Not Resuscitate (DNR), living will, no code, no heroic measure.
Suggested Data Collection Question:When is the earliest physician/APN/PA documentation of comfort measures only?
Allowable Values:

1   *Day 0 or 1:* The earliest day the physician/APN/PA documented comfort measures only was the day of arrival (Day 0) or day after arrival (Day 1).

2   *Day 2 or after:* The earliest day the physician/APN/PA documented comfort measures only was two or more days after arrival day (Day 2+).

3   *Timing unclear:* There is physician/APN/PA documentation of comfort measures only during this hospital stay, but whether the earliest documentation of comfort measures only was on day 0 or 1 OR after day 1 is unclear.

4   *Not Documented/UTD:* There is no physician/APN/PA documentation of comfort measures only, or unable to determine from medical record documentation if there is physician/APN/PA documentation of comfort measures only during this hospital stay.

Notes for Abstraction:
  • Only accept terms identified in the list of inclusions. No other terminology will be accepted.
  • Determine the earliest day the physician/APN/PA DOCUMENTED comfort measures only. Do not factor in when comfort measures only was actually instituted. E.g., Comfort measures only documentation in a progress note on day 2 which may be linked to day 0 or 1 (e.g., “Discussed comfort care with family on arrival”) – Select “2.”
  • Consider comfort measures only documentation in the discharge summary as documentation on the last day of the hospitalization, regardless of when the summary is dictated.
  • If any of the inclusions are documented, select “1,” “2,” or “3” accordingly, regardless of other documentation.
  • Physician/APN/PA documentation of comfort measures only (hospice, palliative care, etc.) mentioned in the following contexts suffices:
    • Comfort measures only recommendation
    • Order for consultation or evaluation by a hospice/palliative care service
    • Patient or family request for comfort measures only
    • Plan for comfort measures only
    • Referral to hospice/palliative care service
  • If DNR-CC is documented, select “4,” unless there is documented clarification that CC stands for “comfort care.”
Suggested Data Sources:


  • Admitting physician orders
  • Consultation notes
  • Discharge summary
  • Emergency department record
  • History and physical
  • Physician admitting note
  • Physician orders
  • Progress notes
Additional Notes:
Guidelines for Abstraction:
Inclusion Exclusion

  • Allow natural death
  • Comfort care
  • Comfort measures
  • Comfort measures only (CMO)
  • Comfort only
  • End of life care
  • Hospice
  • Hospice care
  • Palliative care
  • Palliative measures
  • Terminal care

  • Chemical code only
  • Do not cardiovert
  • Do not defibrillate
  • Do not intubate (DNI)
  • Do Not Resuscitate (DNR)
  • Keep comfortable
  • Living will
  • No aggressive treatment
  • No antiarrhythmic therapy
  • No artificial respirations
  • No cardiac monitoring
  • No Cardiopulmonary Resuscitation (NCR)
  • No chest compressions
  • No code
  • No Code 99
  • No CPR
  • No heroic or aggressive measures
  • No intubation and/or ventilation
  • No invasive procedures
  • No other protocols associated with advanced cardiac life support
  • No resuscitative medications
  • No resuscitative measures (NRM)
  • No vasopressors
  • Supportive care

Comfort Measures Only
Specifications Manual for Joint Commission National Quality Core Measures (2010A1)
Discharges 04-01-10 (2Q10) through 09-30-10 (3Q10)