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Missing Data Chapter
Version 2010A1

Missing and Invalid Data

Introduction

Missing data refers to data elements, required for calculating a national hospital quality measure, that have no values present for one or more episodes of care (EOC) records. Invalid data refers to data element values, required for calculating a national hospital quality measure, that fall outside of the range of allowable values defined by The Joint Commission and Centers for Medicare & Medicaid Services (CMS) for that data element.

Reducing missing and invalid data minimizes the bias to a measure rate, because episodes of care with missing or invalid data cannot be included in the calculation of the observed measure rate. A measure’s observed rate may not accurately reflect the patient population, if the excluded EOC records differ significantly from the EOCs with no missing data that were included in the measure calculation.

Data Collection and the Unable to be Determined (UTD) Allowable Value

Abstractors must ‘touch’ and provide an answer to every data element that is applicable per the combined skip logic of all of the measures in a topic. While there is an expectation that all data elements are collected, it is recognized that in certain situations information may not be available (dates, times, codes, etc.). If, after due diligence, the abstractor determines that a value is not documented or is not able to determine the answer value, the abstractor must select “Unable to Determine (UTD)” as the answer. The “UTD” allowable value is used as follows:

  • Admission Date, Antibiotic Name, Birthdate, Discharge Date, ICD-9-CM Principal and Other Diagnosis Codes, and ICD-9-CM Principal and Other Procedure Codes do not have an “UTD” allowable value for transmission to CMS and The Joint Commission. EOC records containing “UTD” for any of these data elements are rejected when submitted to the QIO Clinical Warehouse and the Joint Commission’s Data Warehouse.
  • Date, time, and numeric data elements, other than Admission Date, Birthdate, and Discharge Date, have an “UTD” allowable value option.
    • Rate-based algorithms evaluate EOC records to a Measure Category Assignment = “D” (failed) when a date, time, or numeric data element containing an allowable value of “UTD” is evaluated.
    • Continuous variable algorithms evaluate EOC records to a Measure Category Assignment = “Y” (UTD value exists) when a date, time, or numeric data element containing an allowable value of “UTD” is evaluated.
    • The method by which data collection software collects “UTD’ information is determined by each software vendor; except the software cannot automatically default an “UTD” answer. The decision to enter an “UTD” for each data element is up to the abstractor, not the software.
    • There are specific requirements pertaining to the transmission of this value. Refer to the Transmission section in this manual for more information.
  • Yes/No data elements: The allowable value “No” incorporates “UTD” into the definition. Refer to the measure algorithms in which each Yes/No data element is used to determine how the EOC record is treated.
  • Data elements containing two or more categorical values: The “UTD” value is either classified as a separate allowable value (e.g., ICU Transfer or Admission Within First 24 Hours) or included in the same category as “None of the above/Not documented” (e.g., Influenza Vaccination Status). Refer to the measure algorithms in which each categorical data element is used to determine how the EOC record is treated.

Missing and Invalid Episode of Care (EOC) Data

The QIO Clinical Warehouse and the Joint Commission’s Data Warehouse evaluates patient data using the same missing, invalid and data integrity edits. Differences in the acceptance and rejection of patient data may occur due to differences in hospitals measure selections with the two organizations and how CMS only and Joint Commission only data elements evaluate. Refer to the Alphabetical Data Element List in the Data Dictionary for information concerning which data elements are CMS or Joint Commission only. Rejected data must be corrected and resubmitted before the transmission deadline in order for it to be accepted by either warehouse.

  • The majority of general data elements that are missing data* cause the EOC record to be rejected. These data elements include Admission Date, Birthdate, Discharge Date, ICD-9-CM Principal Diagnosis Codes. Refer to the Introduction to the Data Dictionary in this manual for the complete list of general data elements.
    • Not all patients have an ICD-9-CM Other Diagnosis Code or an ICD-9-CM Principal and Other Procedure Codes. Records will be accepted missing data* for these general data elements.
  • Measure-specific data elements that are missing data* cause the EOC record to be rejected if any measure algorithm results in a Measure Category Assignment = “X” (missing data). If no measure evaluates to a category assignment of “X”, the EOC record will be accepted.
  • General and measure specific data elements that contain invalid data cause the EOC record to be rejected.
  • All cases submitted with data related to Antibiotic Administration, VTE Prophylaxis and Procedure Codes are required to be complete when submitted to the QIO Clinical Warehouse or the Joint Commission Data Warehouse. If the abstractor, after due diligence, is not able to determine an answer, a value of “UTD” may be selected for the applicable data element. This includes:
    • Cases related to the patient’s receipt of antibiotics. Antibiotic Administration Name, Antibiotic Administration Date, Antibiotic Administration Time and Antibiotic Administration Route must be complete for each dose of antibiotics submitted. A dose is considered any row of antibiotics that contain all allowable answer values for the above listed data elements. If a case is submitted to the QIO Clinical Warehouse or the Joint Commission Data Warehouse with missing data for any dose of antibiotics, the case will be rejected.
    • For the data element VTE Prophylaxis allowable values 1 - 7 are required to include a corresponding answer to the data element VTE Timely. Please see the data element definitions for further details on allowable values. If the VTE Prophylaxis field is populated with an allowable value of 1 – 7 and the corresponding VTE Timely field is missing, the entire case will be rejected. If the VTE Prophylaxis field is populated with an allowable value of A, then the VTE Timely element is not required to be submitted.
    • ICD-9-CM Principle Procedure Codes and ICD-9-CM Other Procedure Codes require the data element ICD-9-CM Principle Procedure Date and ICD-9-CM Other Procedure Date to be submitted with the case. Please see the data element definitions for further details on allowable values. If the case is missing the corresponding allowable answer value, the case will be rejected from the QIO Clinical Warehouse and the Joint Commission Warehouse.

Abstraction Software Skip Logic and Missing Data

Skip logic allows hospitals and vendors to minimize abstraction burden by using vendor software edit logic to bypass abstraction of data elements not utilized in the measure algorithm. However, these bypassed elements also negatively impact data quality and the hospital’s CMS chart audit validation results when elements are incorrectly abstracted and subsequent data elements are bypassed and left blank.

The use of skip logic by hospitals and ORYX vendors is optional and not required by CMS and The Joint Commission. Hospitals should be aware the potential impact of skip logic on data quality, abstraction burden, and CMS chart audit validation scores. Vendors and hospitals utilizing skip logic should closely monitor the accuracy rate of abstracted data elements, particularly data elements placed higher in the algorithm flow (e.g., Comfort Measures data element).

Historically, CMS chart audit validation results have been used in previous payment years as one of many requirements in the Reporting Hospital Quality for Annual Payment Update (RHQDAPU) program. Please refer to the Federal Register and the QualityNet website for the current payment year’s proposed and final requirements for acute care Inpatient Prospective Payment System (IPPS) hospitals.

Note:
*A missing value occurs when the abstractor does not select an answer for a data element (leaves it blank) or the software incorrectly transmits a “null” instead of the correct value for a data element. An “UTD” allowable value is not considered missing data.

Missing, Invalid, UTD Data Summary:

Missing Data Invalid Data UTD
No data element value is present. (blank or “null”) The data element value falls outside of the range of defined allowable values. The allowable value of “UTD” is present for the data element.


Related Topics

Related Topics
a. Table of Contents

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