mmalik15
asked on
how to extract unique values from a string node
I have nodes like this
<?xml version="1.0" encoding="UTF-8"?>
<Records>
<record> Heart Failure; Patient Readmission; Risk Assessment; Time Factors; Heart failure; Risk assessment</record>
</Records>
From the stirng "Heart Failure; Patient Readmission; Risk Assessment; Time Factors; Heart failure; Risk assessment"
I need to remove the duplicates and my output string should be like
Heart Failure; Patient Readmission; Risk Assessment; Time Factors
<?xml version="1.0" encoding="UTF-8"?>
<Records>
<record> Heart Failure; Patient Readmission; Risk Assessment; Time Factors; Heart failure; Risk assessment</record>
</Records>
From the stirng "Heart Failure; Patient Readmission; Risk Assessment; Time Factors; Heart failure; Risk assessment"
I need to remove the duplicates and my output string should be like
Heart Failure; Patient Readmission; Risk Assessment; Time Factors
Gertone (Geert Bormans)
You have the code for that in my answer to your previous question
ASKER
i have slightly modified your xslt but unable to get the desired result. The output is coming liket this
"Heart Failure; Patient Readmission; Risk Assessment; Time Factors; Heart failure; Risk assessment"
"Heart Failure; Patient Readmission; Risk Assessment; Time Factors; Heart failure; Risk assessment"
<?xml version="1.0" encoding="UTF-8"?>
<xsl:stylesheet version="1.0" xmlns:xsl="http://www.w3.org/1999/XSL/Transform">
<xsl:output method="xml" version="1.0" encoding="UTF-8" indent="yes"/>
<xsl:variable name="lc" select="'azertyuiopqsdfghjklmwxcvbn'"/>
<xsl:variable name="uc" select="'AZERTYUIOPQSDFGHJKLMWXCVBN'"/>
<xsl:template match="/">
<Records>
<xsl:for-each select="/documents/document">
<record>
<xsl:variable name="mylist">
<xsl:call-template name="strip-tags">
<xsl:with-param name="text" select="concat(substring-after(element[@name='MSHValues']/value,':'),';',substring-after(element[@name='MTHValues']/value,':'),';',substring-after(element[@name='SNOMEDCTValues']/value, ':'))"/>
</xsl:call-template>
</xsl:variable>
<xsl:variable name="mylist">
<xsl:call-template name="process-values">
<xsl:with-param name="list" select="';'"/>
<xsl:with-param name="remaining" select="$firstlist"/>
</xsl:call-template>
</xsl:variable>
</record>
</xsl:for-each>
</Records>
</xsl:template>
<xsl:template name="process-values">
<xsl:param name="list"/>
<xsl:param name="remaining"/>
<xsl:choose>
<xsl:when test="contains($remaining, ';')">
<xsl:variable name="new-list">
<xsl:call-template name="filter-and-add">
<xsl:with-param name="list" select="$list"/>
<xsl:with-param name="term" select="substring-before($remaining, ';')"/>
</xsl:call-template>
</xsl:variable>
<xsl:call-template name="process-values">
<xsl:with-param name="list" select="$new-list"/>
<xsl:with-param name="remaining" select="substring-after($remaining, ';')"/>
</xsl:call-template>
</xsl:when>
<xsl:otherwise>
<xsl:variable name="new-list">
<xsl:call-template name="filter-and-add">
<xsl:with-param name="list" select="$list"/>
<xsl:with-param name="term" select="$remaining"/>
</xsl:call-template>
</xsl:variable>
<xsl:value-of select="substring($new-list, 3)"/>
</xsl:otherwise>
</xsl:choose>
</xsl:template>
<xsl:template name="filter-and-add">
<xsl:param name="list"/>
<xsl:param name="term"/>
<xsl:param name="norm-term" select="normalize-space(translate($term, '()1234567890', ''))"/>
<xsl:choose>
<xsl:when test="not(contains(concat($list, '; '), concat('; ', $norm-term, '; ')))">
<xsl:value-of select="concat($list, '; ', $norm-term)"/>
</xsl:when>
<xsl:otherwise>
<xsl:value-of select="$list"/>
</xsl:otherwise>
</xsl:choose>
</xsl:template>
<xsl:template name="strip-tags">
<xsl:param name="text"/>
<xsl:choose>
<xsl:when test="contains($text, '<')">
<xsl:value-of select="substring-before($text, '<')"/>
<xsl:call-template name="strip-tags">
<xsl:with-param name="text" select="substring-after($text, '>')"/>
</xsl:call-template>
</xsl:when>
<xsl:otherwise>
<xsl:value-of select="$text"/>
</xsl:otherwise>
</xsl:choose>
</xsl:template>
</xsl:stylesheet><?xml version="1.0" encoding="utf-8"?>
<documents><document id="http://www.qualitymeasures.ahrq.gov/content.aspx?id=27444"><element name="MSHValues"><value>:
<a href='/search/search.aspx?term=Heart+Failure &umls=1'>Heart Failure</a>; <a href='/search/search.aspx?term=Patient+Readmission &umls=1'>Patient Readmission</a>; <a href='/search/search.aspx?term=Risk+Assessment &umls=1'>Risk Assessment</a>; <a href='/search/search.aspx?term=Time+Factors &umls=1'>Time Factors</a>
</value></element><element name="MTHValues"><value>:
<a href='/search/search.aspx?term=Heart+failure &umls=1'>Heart failure</a>
</value></element><element name="SNOMEDCTValues"><value>:
<a href='/search/search.aspx?term=Heart+failure &umls=1'>Heart failure</a> (84114007); <a href='/search/search.aspx?term=Risk+assessment &umls=1'>Risk assessment</a> (225338004)
</value></element><element name="body"><value><p>This measure* is a hospital-specific, risk-standardized, all-cause 30-day readmission (defined as readmission for any cause within 30 days from the date of discharge of the index admission) for patients discharged from the hospital with a principal discharge diagnosis of heart failure (HF).</p>
<p class="Note">*This is a Centers for Medicare &amp; Medicaid Services (CMS) only measure.</p></value></element><element name="html"><value><html><head><meta name="keywords" content="insert keywords here" /><meta name="description" content="Heart failure (HF): hospital 30-day, all-cause, risk-standardized readmission rate (RSRR) following HF hospitalization." /><title>
National Quality Measures Clearinghouse | Heart failure (HF): hospital 30-day, all-cause, risk-standardized readmission rate (RSRR) following HF hospitalization.
</title></head><body><div class="padding content_page">
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<span id="ctl00_ContentPlaceHolder1_dlXML_ctl00_rptField_ctl00_rptValues_ctl00_Value"><div class="content_title">Heart failure (HF): hospital 30-day, all-cause, risk-standardized readmission rate (RSRR) following HF hospitalization.</div></span>
</div>
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<a id='Field1'></a>
<div class="fieldName">
<span id="ctl00_ContentPlaceHolder1_dlXML_ctl00_rptField_ctl01_FieldName">Source(s)</span>
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<span id="ctl00_ContentPlaceHolder1_dlXML_ctl00_rptField_ctl01_nofieldtext"></span>
<span id="ctl00_ContentPlaceHolder1_dlXML_ctl00_rptField_ctl01_rptValues_ctl00_Value"><table><tr><td>Specifications manual for national hospital inpatient quality measures, version 3.1a. Centers for Medicare & Medicaid Services (CMS), The Joint Commission; 2010 Apr 1. various p. </td></tr></table></span>
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<a href="#Section605" id="ctl00_ContentPlaceHolder1_dlXML_ctl00_dlBookmarks2_ctl02_aBookmark2" class="content_jumplink">Computation of the Measure</a>
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<a href="#Section615" id="ctl00_ContentPlaceHolder1_dlXML_ctl00_dlBookmarks2_ctl03_aBookmark2" class="content_jumplink">Identifying Information</a>
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Developer: <span id="ctl00_ContentPlaceHolder1_dlXML_ctl00_lblDevs"><a href="/browse/by-organization.aspx?orgid=11">Centers for Medicare & Medicaid Services</a>; <a href="/browse/by-organization.aspx?orgid=2183">Yale-New Haven Health Services Corporation/Center for Outcomes Research and Evaluation under contract to Centers for Medicare & Medicaid Services</a></span><br />
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<span id="ctl00_ContentPlaceHolder1_dlXML_ctl00_lblAgeNQMC">Target Population Age:</span>
<a href='/search/results.aspx?94=102'>Adult: 80 years old and older</a>; <a href='/search/results.aspx?94=101'>Adult: 65-79 years old</a><br />
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Endorser:
<a id="ctl00_ContentPlaceHolder1_dlXML_ctl00_rptEndorser_ctl00_hlEndorser" href="/browse/nqf-endorsed.aspx">National Quality Forum</a>
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<span id="ctl00_ContentPlaceHolder1_dlXML_ctl00_lblClickToView">Click to view all measure(s) indexed with these concepts</span><br/>
<div style="padding:10px;" id="divUMLSSummary">
<span id="ctl00_ContentPlaceHolder1_dlXML_ctl00_rptUMLSSummary_ctl00_lblSab" class="content_umls_sab">ICD9CM</span>:
<a href='/search/search.aspx?term=Heart+failure%2c+unspecified&vocab=ICD9CM&code= (428.9)&umls=1'>Heart failure, unspecified</a> (428.9)
<br />
<span id="ctl00_ContentPlaceHolder1_dlXML_ctl00_rptUMLSSummary_ctl02_lblSab" class="content_umls_sab">MSH</span>:
<a href='/search/search.aspx?term=Heart+Failure&vocab=MSH&code=&umls=1'>Heart Failure</a>; <a href='/search/search.aspx?term=Risk+Assessment&vocab=MSH&code=&umls=1'>Risk Assessment</a>; <a href='/search/search.aspx?term=Time+Factors&vocab=MSH&code=&umls=1'>Time Factors</a>
<br />
<span id="ctl00_ContentPlaceHolder1_dlXML_ctl00_rptUMLSSummary_ctl04_lblSab" class="content_umls_sab">MTH</span>:
<a href='/search/search.aspx?term=Heart+failure&vocab=MTH&code=&umls=1'>Heart failure</a>
<br />
<span id="ctl00_ContentPlaceHolder1_dlXML_ctl00_rptUMLSSummary_ctl06_lblSab" class="content_umls_sab">SNOMEDCT</span>:
<a href='/search/search.aspx?term=Heart+failure&vocab=SNOMEDCT&code= (84114007)&umls=1'>Heart failure</a> (84114007); <a href='/search/search.aspx?term=Risk+assessment&vocab=SNOMEDCT&code= (225338004)&umls=1'>Risk assessment</a> (225338004)
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<span id="ctl00_ContentPlaceHolder1_dlXML_ctl00_rptUMLSAll_ctl00_lblSab" class="content_umls_sab">ICD9CM</span>:
<a href='/search/search.aspx?term=Heart+failure%2c+unspecified &umls=1'>Heart failure, unspecified</a> (428.9)
<br />
<span id="ctl00_ContentPlaceHolder1_dlXML_ctl00_rptUMLSAll_ctl02_lblSab" class="content_umls_sab">MSH</span>:
<a href='/search/search.aspx?term=Heart+Failure &umls=1'>Heart Failure</a>; <a href='/search/search.aspx?term=Patient+Readmission &umls=1'>Patient Readmission</a>; <a href='/search/search.aspx?term=Risk+Assessment &umls=1'>Risk Assessment</a>; <a href='/search/search.aspx?term=Time+Factors &umls=1'>Time Factors</a>
<br />
<span id="ctl00_ContentPlaceHolder1_dlXML_ctl00_rptUMLSAll_ctl04_lblSab" class="content_umls_sab">MTH</span>:
<a href='/search/search.aspx?term=Heart+failure &umls=1'>Heart failure</a>
<br />
<span id="ctl00_ContentPlaceHolder1_dlXML_ctl00_rptUMLSAll_ctl06_lblSab" class="content_umls_sab">SNOMEDCT</span>:
<a href='/search/search.aspx?term=Heart+failure &umls=1'>Heart failure</a> (84114007); <a href='/search/search.aspx?term=Risk+assessment &umls=1'>Risk assessment</a> (225338004)
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<div class="SectionTitle"><h2><span id="ctl00_ContentPlaceHolder1_dlXML_ctl01_SectionName">Measure Domain</span></h2></div>
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<a id='Field3025'></a>
<div class="fieldName">
<span id="ctl00_ContentPlaceHolder1_dlXML_ctl01_rptField_ctl00_FieldName">Primary Measure Domain</span>
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<span id="ctl00_ContentPlaceHolder1_dlXML_ctl01_rptField_ctl00_rptValues_ctl00_Value">Clinical Quality Measures: Outcome</span>
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<span id="ctl00_ContentPlaceHolder1_dlXML_ctl01_rptField_ctl01_FieldName">Secondary Measure Domain</span>
</div>
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<div class="SectionTitle"><h2><span id="ctl00_ContentPlaceHolder1_dlXML_ctl02_SectionName">Brief Abstract</span></h2></div>
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<div id="ctl00_ContentPlaceHolder1_dlXML_ctl02_rptField_ctl00_divOuter">
<a id='Field34'></a>
<div class="fieldName">
<span id="ctl00_ContentPlaceHolder1_dlXML_ctl02_rptField_ctl00_FieldName">Description</span>
</div>
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<span id="ctl00_ContentPlaceHolder1_dlXML_ctl02_rptField_ctl00_nofieldtext"></span>
<span id="ctl00_ContentPlaceHolder1_dlXML_ctl02_rptField_ctl00_rptValues_ctl00_Value"><div class="content_para"><p>This measure* is a hospital-specific, risk-standardized, all-cause 30-day readmission (defined as readmission for any cause within 30 days from the date of discharge of the index admission) for patients discharged from the hospital with a principal discharge diagnosis of heart failure (HF).</p>
<p class="Note">*This is a Centers for Medicare &amp; Medicaid Services (CMS) only measure.</p></div></span>
</div>
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<div id="ctl00_ContentPlaceHolder1_dlXML_ctl02_rptField_ctl01_divOuter">
<a id='Field21'></a>
<div class="fieldName">
<span id="ctl00_ContentPlaceHolder1_dlXML_ctl02_rptField_ctl01_FieldName">Rationale</span>
</div>
<div class="fieldData">
<span id="ctl00_ContentPlaceHolder1_dlXML_ctl02_rptField_ctl01_nofieldtext"></span>
<span id="ctl00_ContentPlaceHolder1_dlXML_ctl02_rptField_ctl01_rptValues_ctl00_Value"><div class="content_para"><p>Centers for Medicare &amp; Medicaid Services (CMS) developed the heart failure (HF) 30-day readmission measure to complement the existing HF process-of-care and mortality measures. Risk-standardized readmission rates (RSRRs) can provide important additional information about quality of care that is currently not captured by the process and mortality measures and is currently unavailable to hospitals. Variation in readmission, after adjusting for case mix, may reflect differences in hospitals' general environments (such as coordination of care, patient safety policies, and staffing) or variation in care processes not measured in the current core measure set. Outcome measures can focus attention on a broader set of healthcare activities that affect patients' well-being. Moreover, improving outcomes is the ultimate goal of quality improvement, and thus the inclusion of outcomes measures assists in attaining improvement goals.</p>
<p>Readmission of patients who were recently discharged after hospitalization with HF represents an important, expensive and often preventable, adverse outcome. The risk of readmission can be modified by the quality and type of care provided to these patients. Improving readmission rates is the joint responsibility of hospitals and clinicians. Measuring readmission will create incentives to invest in interventions to improve hospital care, better assess the readiness of patients for discharge, and facilitate transitions to outpatient status. This measure is also responsive to the recent call by the Medicare Payment Advisory Commission (MedPAC) to develop readmission measures, with HF highlighted as one of seven conditions that account for nearly 30% of potentially preventable readmissions in the 15-day window after initial hospital discharge (MedPAC, 2007).</p></div></span>
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<div id="ctl00_ContentPlaceHolder1_dlXML_ctl02_rptField_ctl02_divOuter">
<a id='Field3500'></a>
<div class="fieldName">
<span id="ctl00_ContentPlaceHolder1_dlXML_ctl02_rptField_ctl02_FieldName">Evidence for Rationale</span>
</div>
<div class="fieldData">
<span id="ctl00_ContentPlaceHolder1_dlXML_ctl02_rptField_ctl02_nofieldtext"></span>
<span id="ctl00_ContentPlaceHolder1_dlXML_ctl02_rptField_ctl02_rptValues_ctl00_Value"><table><tr><td>Medicare Payment Advisory Commission (MeDPAC). Report to congress: promoting greater efficiency in Medicare. Medicare Payment Advisory Commission (MeDPAC); 2007. </td></tr></table><br /></span>
<span id="ctl00_ContentPlaceHolder1_dlXML_ctl02_rptField_ctl02_rptValues_ctl01_Value"><table><tr><td>Specifications manual for national hospital inpatient quality measures, version 3.1a. Centers for Medicare & Medicaid Services (CMS), The Joint Commission; 2010 Apr 1. various p. </td></tr></table></span>
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<a id='Field3022'></a>
<div class="fieldName">
<span id="ctl00_ContentPlaceHolder1_dlXML_ctl02_rptField_ctl03_FieldName">Primary Health Components</span>
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<div class="fieldData">
<span id="ctl00_ContentPlaceHolder1_dlXML_ctl02_rptField_ctl03_nofieldtext"></span>
<span id="ctl00_ContentPlaceHolder1_dlXML_ctl02_rptField_ctl03_rptValues_ctl00_Value"><div class="content_para"><p>Heart failure (HF); 30-day all-cause readmission rate</p></div></span>
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<div id="ctl00_ContentPlaceHolder1_dlXML_ctl02_rptField_ctl04_divOuter">
<a id='Field23'></a>
<div class="fieldName">
<span id="ctl00_ContentPlaceHolder1_dlXML_ctl02_rptField_ctl04_FieldName">Denominator Description</span>
</div>
<div class="fieldData">
<span id="ctl00_ContentPlaceHolder1_dlXML_ctl02_rptField_ctl04_nofieldtext"></span>
<span id="ctl00_ContentPlaceHolder1_dlXML_ctl02_rptField_ctl04_rptValues_ctl00_Value"><div class="content_para"><p>This cohort includes admissions for Medicare fee-for-service beneficiaries aged greater than or equal to 65 years with a principal discharge diagnosis of heart failure (HF) and with a complete claims history for 12 months prior to admission (see the related "Denominator Inclusions/Exclusions" field)</p>
<p class="Note"><strong>Note</strong>: This outcome measure does not have a traditional numerator and denominator like a core process measure; thus, we are using this field to define our statistically-adjusted outcome measure.</p>
<p class="Note">Hierarchical logistic regression modeling is used to calculate a hospital-specific risk-standardized readmission rate (RSRR). The RSRR is calculated as the ratio of the number of "predicted" to the number of "expected" readmissions, multiplied by the national unadjusted readmission rate. For each hospital, the "numerator" of the ratio is the number of readmissions within 30 days predicted on the basis of the hospital's performance with its observed case mix, and the "denominator" is the number of readmissions expected on the basis of the nation's performance with that hospital's case mix. This approach is analogous to a ratio of "observed" to "expected" used in other types of statistical analyses. It conceptually allows for a comparison of a particular hospital's performance given its case-mix to an average hospital's performance with the same case mix. Thus a lower ratio indicates lower-than-expected readmission or better quality and a higher ratio indicates higher-than-expected readmission or worse quality.</p>
<p class="Note">The predicted hospital outcome (the numerator) is calculated by regressing the risk factors and the hospital-specific intercept on the risk of readmission, multiplying the estimated regression coefficients by the patient characteristics in the hospital, transforming, and then summing over all patients attributed to the hospital to get a value. The expected number of readmissions (the denominator) is obtained by regressing the risk factors and a common intercept on the readmission outcome using all hospitals in our sample, multiplying the subsequent estimated regression coefficients by the patient characteristics observed in the hospital, transforming, and then summing over all patients in the hospital to get a value.</p>
<p class="Note">To assess hospital performance in any reporting period, the model coefficients are re-estimated using the years of data in that period. See the <a href="disclaimer.aspx?redirect=http://www.qualitynet.org/dcs/ContentServer?c=Page&amp;pagename=QnetPublic%2FPage%2FQnetTier3&amp;cid=1219069855841" title="QualityNet Web site">2010 Measures Maintenance Technical Report: Acute Myocardial Infarction, Heart Failure, and Pneumonia 30-Day Risk-standardized Readmission Measures</a>&nbsp;<img alt="External Web Site Policy" src="/images/icon_externallink.gif" /> for more details.</p></div></span>
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<a id='Field24'></a>
<div class="fieldName">
<span id="ctl00_ContentPlaceHolder1_dlXML_ctl02_rptField_ctl05_FieldName">Numerator Description</span>
</div>
<div class="fieldData">
<span id="ctl00_ContentPlaceHolder1_dlXML_ctl02_rptField_ctl05_nofieldtext"></span>
<span id="ctl00_ContentPlaceHolder1_dlXML_ctl02_rptField_ctl05_rptValues_ctl00_Value"><div class="content_para"><p>The hospital-specific risk-standardized readmission rate (RSRR) is calculated as the ratio of predicted to expected readmissions, multiplied by the national unadjusted rate. The "numerator" of the ratio component is the predicted number of readmissions for each hospital within 30 days given the hospital's performance with its observed case mix.</p>
<p class="Note"><strong>Note</strong>: This outcome measure does not have a traditional numerator and denominator like a core process measure (e.g., percentage of adult patients with diabetes aged 18-75 years receiving one or more hemoglobin A1c tests per year); thus, we are using this field to define our statistically-adjusted outcome measure.</p>
<p class="Note">Hierarchical logistic regression modeling is used to calculate a hospital-specific RSRR. The RSRR is calculated as the ratio of the number of "predicted" to the number of "expected" readmissions, multiplied by the national unadjusted readmission rate. For each hospital, the "numerator" of the ratio is the number of readmissions within 30 days predicted on the basis of the hospital's performance with its observed case mix, and the "denominator" is the number of readmissions expected on the basis of the nation's performance with that hospital's case mix. This approach is analogous to a ratio of "observed" to "expected" used in other types of statistical analyses. It conceptually allows for a comparison of a particular hospital's performance given its case-mix to an average hospital's performance with the same case mix. Thus a lower ratio indicates lower-than-expected readmission or better quality and a higher ratio indicates higher-than-expected readmission or worse quality.</p>
<p class="Note">The predicted hospital outcome (the numerator) is calculated by regressing the risk factors and the hospital-specific intercept on the risk of readmission, multiplying the estimated regression coefficients by the patient characteristics in the hospital, transforming, and then summing over all patients attributed to the hospital to get a value. The expected number of readmissions (the denominator) is obtained by regressing the risk factors and a common intercept on the readmission outcome using all hospitals in our sample, multiplying the subsequent estimated regression coefficients by the patient characteristics observed in the hospital, transforming, and then summing over all patients in the hospital to get a value.</p>
<p class="Note">To assess hospital performance in any reporting period, the model coefficients are re-estimated using the years of data in that period. See the "Description of Allowance for Patient Factors" field for risk adjustment details. See the <a href="disclaimer.aspx?redirect=http://www.qualitynet.org/dcs/ContentServer?c=Page&amp;pagename=QnetPublic%2FPage%2FQnetTier3&amp;cid=1219069855841" title="QualityNet Web site">2010 Measures Maintenance Technical Report: Acute Myocardial Infarction, Heart Failure, and Pneumonia 30-Day Risk-standardized Readmission Measures</a>&nbsp;<img alt="External Web Site Policy" src="/images/icon_externallink.gif" /> for more details.</p></div></span>
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<div class="SectionTitle"><h2><span id="ctl00_ContentPlaceHolder1_dlXML_ctl03_SectionName">Evidence Supporting the Measure</span></h2></div>
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<span id="ctl00_ContentPlaceHolder1_dlXML_ctl03_rptField_ctl00_FieldName">Type of Evidence Supporting the Criterion of Quality for the Measure</span>
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<span id="ctl00_ContentPlaceHolder1_dlXML_ctl03_rptField_ctl00_rptValues_ctl00_Value"><ul><li>One or more research studies published in a National Library of Medicine (NLM) indexed, peer-reviewed journal</li></ul></span>
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<div class="fieldName">
<span id="ctl00_ContentPlaceHolder1_dlXML_ctl03_rptField_ctl01_FieldName">Other Characteristics Concerning the Measure</span>
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<span id="ctl00_ContentPlaceHolder1_dlXML_ctl03_rptField_ctl01_nofieldtext"></span>
<span id="ctl00_ContentPlaceHolder1_dlXML_ctl03_rptField_ctl01_rptValues_ctl00_Value"><ul style="list-style-type: disc;">
<li>Heart failure (HF) is the most common principal hospital discharge diagnosis among Medicare beneficiaries, and is among the most expensive conditions billed to Medicare (Andrews and Elixhauser, 2007). Readmission rates following discharge for HF are high. All-cause 30-day readmission rates per thousand patients discharged with HF increased by 11 percent between 1992 and 2001 (CMS/MQMS, 2006). </li>
<li>HF is the most common principal hospital discharge diagnosis among Medicare beneficiaries, and is among the most expensive conditions billed to Medicare (Andrews and Elixhauser, 2007). Readmission rates following discharge for HF are high. All-cause 30-day readmission rates per thousand patients discharged with HF increased by 11 percent between 1992 and 2001 (Centers for Medicare &amp; Medicaid Services [CMS]/Medicare Quality Monitoring System [MQMS], 2006). </li>
<li>Readmission rates are influenced by the quality of inpatient and outpatient care, the availability and use of effective disease management programs, and the bed capacity of the local health care system. Some of the variation in readmissions may be attributable to delivery system characteristics (Fisher et al., 1994). Also, interventions during and after a hospitalization can be effective in reducing readmission rates in geriatric populations generally (Benbassat and Taragin, 2000; Naylor et al., 1999; Coleman et al., 2006) and for elderly HF patients specifically (Phillips et al., 2004; Naylor et al., 2004; Koelling, 2005; Krumholz et al., 2002; Nohria et al., 2002; Rich et al., 1995). Moreover, such interventions can be cost saving (Coleman et al., 2006; Naylor et al., 1999; Krumholz et al., 2002; Naylor et al., 2004; Rich et al., 1995; Koelling, 2005; Phillips et al., 2004). Tracking readmissions also emphasizes improvement in care transitions and care coordination. Although discharge planning is required by Medicare as a condition of participation for hospitals, transitional care focuses more broadly on "hand-offs" of care from one setting to another, and may have implications for quality and costs (Coleman, 2005). Despite positive results in disease management studies, many post-hospital HF management programs have been discontinued, most often due to financial considerations (Seow et al., 2006). </li>
<li>The Medicare Payment Advisory Commission (MedPAC) has called for hospital-specific public reporting of readmission rates, identifying HF as one of seven conditions that account for nearly 30% of potentially preventable readmissions in the 15-day window after initial hospital discharge (MedPAC, 2007). MedPAC finds that readmissions are common, costly, and often preventable. Based on 2005 Medicare data, MedPAC estimates that about 12.5% of Medicare HF admissions were followed by a potentially preventable readmission within 15 days, accounting for more than 90,000 admissions at a cost of $590 million. </li>
</ul></span>
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<div class="fieldName">
<span id="ctl00_ContentPlaceHolder1_dlXML_ctl03_rptField_ctl02_FieldName">Evidence for Other Characteristics Concerning the Measure</span>
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<span id="ctl00_ContentPlaceHolder1_dlXML_ctl03_rptField_ctl02_nofieldtext"></span>
<span id="ctl00_ContentPlaceHolder1_dlXML_ctl03_rptField_ctl02_rptValues_ctl00_Value"><table><tr><td>Andrews RM, Elixhauser A. The national hospital bill: growth trends and 2005 update on the most expensive conditions by payer. Rockville (MD): Agency for Healthcare Research and Quality (AHRQ); 2007 Dec. &nbsp;(HCUP statistical brief; no. 42).</td></tr></table><br /></span>
<span id="ctl00_ContentPlaceHolder1_dlXML_ctl03_rptField_ctl02_rptValues_ctl01_Value"><table><tr><td>Benbassat J, Taragin M. Hospital readmissions as a measure of quality of health care: advantages and limitations. Arch Intern Med&nbsp;2000 Apr 24;160(8):1074-81. <a href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=10789599" target="_blank">PubMed</a> <img alt="External Web Site Policy" src="/images/icon_externallink.gif" /></td></tr></table><br /></span>
<span id="ctl00_ContentPlaceHolder1_dlXML_ctl03_rptField_ctl02_rptValues_ctl02_Value"><table><tr><td>Centers for Medicare & Medicaid Services (CMS). Medicare quality monitoring system (MQMS). Available at: http://www.cms.hhs.gov/QualityInitiativesGenInfo/15_MQMS.asp..</td></tr></table><br /></span>
<span id="ctl00_ContentPlaceHolder1_dlXML_ctl03_rptField_ctl02_rptValues_ctl03_Value"><table><tr><td>Coleman EA, Parry C, Chalmers S, Min SJ. The care transitions intervention: results of a randomized controlled trial. Arch Intern Med&nbsp;2006 Sep 25;166(17):1822-8. <a href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=17000937" target="_blank">PubMed</a> <img alt="External Web Site Policy" src="/images/icon_externallink.gif" /></td></tr></table><br /></span>
<span id="ctl00_ContentPlaceHolder1_dlXML_ctl03_rptField_ctl02_rptValues_ctl04_Value"><table><tr><td>Coleman EA. Background paper on transitional care performance measurement. Appendix I. In: Institute of Medicine, performance measurement: accelerating improvement. Washington (DC): National Academy Press; 2005. </td></tr></table><br /></span>
<span id="ctl00_ContentPlaceHolder1_dlXML_ctl03_rptField_ctl02_rptValues_ctl05_Value"><table><tr><td>Fisher ES, Wennberg JE, Stukel TA, Sharp SM. Hospital readmission rates for cohorts of Medicare beneficiaries in Boston and New Haven. N Engl J Med&nbsp;1994 Oct 13;331(15):989-95. <a href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=8084356" target="_blank">PubMed</a> <img alt="External Web Site Policy" src="/images/icon_externallink.gif" /></td></tr></table><br /></span>
<span id="ctl00_ContentPlaceHolder1_dlXML_ctl03_rptField_ctl02_rptValues_ctl06_Value"><table><tr><td>Koelling TM. Multifaceted outpatient support can improve outcomes for people with heart failure. Commentary. Evid Based Cardiovasc Med&nbsp;2005 Jun;9(2):138-41. <a href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=16380013" target="_blank">PubMed</a> <img alt="External Web Site Policy" src="/images/icon_externallink.gif" /></td></tr></table><br /></span>
<span id="ctl00_ContentPlaceHolder1_dlXML_ctl03_rptField_ctl02_rptValues_ctl07_Value"><table><tr><td>Krumholz HM, Amatruda J, Smith GL, Mattera JA, Roumanis SA, Radford MJ, Crombie P, Vaccarino V. Randomized trial of an education and support intervention to prevent readmission of patients with heart failure. J Am Coll Cardiol&nbsp;2002 Jan 2;39(1):83-9. <a href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=11755291" target="_blank">PubMed</a> <img alt="External Web Site Policy" src="/images/icon_externallink.gif" /></td></tr></table><br /></span>
<span id="ctl00_ContentPlaceHolder1_dlXML_ctl03_rptField_ctl02_rptValues_ctl08_Value"><table><tr><td>Medicare Payment Advisory Commission (MeDPAC). Report to congress: promoting greater efficiency in Medicare. Medicare Payment Advisory Commission (MeDPAC); 2007. </td></tr></table><br /></span>
<span id="ctl00_ContentPlaceHolder1_dlXML_ctl03_rptField_ctl02_rptValues_ctl09_Value"><table><tr><td>Naylor MD, Brooten D, Campbell R, Jacobsen BS, Mezey MD, Pauly MV, Schwartz JS. Comprehensive discharge planning and home follow-up of hospitalized elders: a randomized clinical trial. JAMA&nbsp;1999 Feb 17;281(7):613-20. <a href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=10029122" target="_blank">PubMed</a> <img alt="External Web Site Policy" src="/images/icon_externallink.gif" /></td></tr></table><br /></span>
<span id="ctl00_ContentPlaceHolder1_dlXML_ctl03_rptField_ctl02_rptValues_ctl10_Value"><table><tr><td>Naylor MD, Brooten DA, Campbell RL, Maislin G, McCauley KM, Schwartz JS. Transitional care of older adults hospitalized with heart failure: a randomized, controlled trial. J Am Geriatr Soc&nbsp;2004 May;52(5):675-84. <a href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=15086645" target="_blank">PubMed</a> <img alt="External Web Site Policy" src="/images/icon_externallink.gif" /></td></tr></table><br /></span>
<span id="ctl00_ContentPlaceHolder1_dlXML_ctl03_rptField_ctl02_rptValues_ctl11_Value"><table><tr><td>Nohria A, Lewis E, Stevenson LW. Medical management of advanced heart failure. JAMA&nbsp;2002 Feb 6;287(5):628-40. [99 references] <a href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=11829703" target="_blank">PubMed</a> <img alt="External Web Site Policy" src="/images/icon_externallink.gif" /></td></tr></table><br /></span>
<span id="ctl00_ContentPlaceHolder1_dlXML_ctl03_rptField_ctl02_rptValues_ctl12_Value"><table><tr><td>Phillips CO, Wright SM, Kern DE, Singa RM, Shepperd S, Rubin HR. Comprehensive discharge planning with postdischarge support for older patients with congestive heart failure: a meta-analysis. JAMA&nbsp;2004 Mar 17;291(11):1358-67. <a href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=15026403" target="_blank">PubMed</a> <img alt="External Web Site Policy" src="/images/icon_externallink.gif" /></td></tr></table><br /></span>
<span id="ctl00_ContentPlaceHolder1_dlXML_ctl03_rptField_ctl02_rptValues_ctl13_Value"><table><tr><td>Rich MW, Beckham V, Wittenberg C, Leven CL, Freedland KE, Carney RM. A multidisciplinary intervention to prevent the readmission of elderly patients with congestive heart failure. N Engl J Med&nbsp;1995;333(18):1190-5. <a href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=7565975" target="_blank">PubMed</a> <img alt="External Web Site Policy" src="/images/icon_externallink.gif" /></td></tr></table><br /></span>
<span id="ctl00_ContentPlaceHolder1_dlXML_ctl03_rptField_ctl02_rptValues_ctl14_Value"><table><tr><td>Seow H, Phillips CO, Rich MW, Spertus JA, Krumholz HM, Lynn J. Isolation of health services research from practice and policy: the example of chronic heart failure management. J Am Geriatr Soc&nbsp;2006 Mar;54(3):535-40. <a href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=16551325" target="_blank">PubMed</a> <img alt="External Web Site Policy" src="/images/icon_externallink.gif" /></td></tr></table></span>
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<div id="ctl00_ContentPlaceHolder1_dlXML_ctl03_rptField_ctl03_divOuter">
<a id='Field3072'></a>
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<span id="ctl00_ContentPlaceHolder1_dlXML_ctl03_rptField_ctl03_FieldName">Extent of Measure Testing</span>
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<span id="ctl00_ContentPlaceHolder1_dlXML_ctl03_rptField_ctl03_nofieldtext"></span>
<span id="ctl00_ContentPlaceHolder1_dlXML_ctl03_rptField_ctl03_rptValues_ctl00_Value"><div class="content_para"><p>To evaluate the performance of the model used for 2010 public reporting, we fit the condition-specific risk standardized readmission model to three single-year datasets (2006, 2007, and 2008) and to the combined three-year 2006-2008 calendar year dataset. We re-estimated the model variable coefficients and examined the model performance in each of these datasets. We also examined trends in the frequency of patient risk factors.</p>
<p>Specifically, we:</p>
<ul style="list-style-type: disc;">
<li>Assessed model hierarchical generalized linear model (HGLM) performance in terms of discriminant and predictive ability and overall fit for each of the single-year datasets (2006, 2007, and 2008) and for the combined 2006-2008 calendar year dataset. </li>
<li>Fitted HGLMs for the same datasets and compared both fixed-effect estimates and hospital-level covariance estimates across the different time periods. </li>
</ul>
<p>We additionally assessed the performance of the measure using preliminary public reporting data for admissions with discharges between July 1, 2006, and June 30, 2009. The results were substantively similar to those for the 2006-2008 calendar year dataset (data not shown). </p>
<p>We computed a summary statistic for assessing model performance: the area under the receiver operating characteristic (ROC) curve (c-statistic), which is an indicator of the model's discriminant ability or ability to correctly classify those who are and are not readmitted within 30 days (values range from 0.5 meaning no better than chance to 1.0 meaning perfect discrimination). The area under the ROC curve (c-statistic) remained constant at 0.60. For the model using the 2006-2008 calendar year dataset, the observed readmission rate was 16.0% among patients in the lowest predicted decile and 38.7% among patients in the highest predicted decile, a range of 22.7%.</p>
<p>Examining the overall distribution of the cause risk-standardized readmission rate (RSRR) based on the 2006-2008 calendar year dataset, the 25th and 75th percentiles were 23.5% and 25.7%, respectively. The odds of all-cause readmission if treated at a hospital one standard deviation above the national average was 1.37 times higher than the odds of all-cause readmission if treated at a hospital one standard deviation below the national average. If there were no systematic differences between hospitals, the between-hospital variance would be zero and the odds ratio would be 1.0.</p></div></span>
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<a id='Field3007'></a>
<div class="fieldName">
<span id="ctl00_ContentPlaceHolder1_dlXML_ctl03_rptField_ctl04_FieldName">Evidence for Extent of Measure Testing</span>
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<span id="ctl00_ContentPlaceHolder1_dlXML_ctl03_rptField_ctl04_nofieldtext"></span>
<span id="ctl00_ContentPlaceHolder1_dlXML_ctl03_rptField_ctl04_rptValues_ctl00_Value"><table><tr><td>Bernheim SM, Lin Z, Bhat KR, Savage SV, Wang Y, Grady JN, Desai MM, Wang Y, Wang C, Gao J, Normand SL, Drye EE, Krumholz HM. 2010 measures maintenance technical report: acute myocardial infarction, heart failure, and pneumonia 30-day risk-standardized readmission measures. Baltimore (MD): Centers for Medicare & Medicaid Services; 2010 Mar 31. 52 p. </td></tr></table></span>
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<div class="SectionTitle"><h2><span id="ctl00_ContentPlaceHolder1_dlXML_ctl04_SectionName">State of Use of the Measure</span></h2></div>
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<a id='Field3029'></a>
<div class="fieldName">
<span id="ctl00_ContentPlaceHolder1_dlXML_ctl04_rptField_ctl00_FieldName">State of Use</span>
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<div class="fieldData">
<span id="ctl00_ContentPlaceHolder1_dlXML_ctl04_rptField_ctl00_nofieldtext"></span>
<span id="ctl00_ContentPlaceHolder1_dlXML_ctl04_rptField_ctl00_rptValues_ctl00_Value">Current routine use</span>
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<a id='Field3030'></a>
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<span id="ctl00_ContentPlaceHolder1_dlXML_ctl04_rptField_ctl01_FieldName">Current Use</span>
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<span id="ctl00_ContentPlaceHolder1_dlXML_ctl04_rptField_ctl01_nofieldtext"></span>
<span id="ctl00_ContentPlaceHolder1_dlXML_ctl04_rptField_ctl01_rptValues_ctl00_Value">Collaborative inter-organizational quality improvement<br /></span>
<span id="ctl00_ContentPlaceHolder1_dlXML_ctl04_rptField_ctl01_rptValues_ctl01_Value">External oversight/Medicare <br /></span>
<span id="ctl00_ContentPlaceHolder1_dlXML_ctl04_rptField_ctl01_rptValues_ctl02_Value">Internal quality improvement<br /></span>
<span id="ctl00_ContentPlaceHolder1_dlXML_ctl04_rptField_ctl01_rptValues_ctl03_Value">National reporting<br /></span>
<span id="ctl00_ContentPlaceHolder1_dlXML_ctl04_rptField_ctl01_rptValues_ctl04_Value">Pay-for-reporting</span>
</div>
</div>
</div>
</td>
</tr><tr>
<td>
<div id="ctl00_ContentPlaceHolder1_dlXML_ctl05_divSectionName" class="SectionLbl">
<a id='Section583'></a>
<div class="SectionBackToTop"><a href="#top">Back to top</a></div>
<div class="SectionTitle"><h2><span id="ctl00_ContentPlaceHolder1_dlXML_ctl05_SectionName">Application of the Measure in its Current Use</span></h2></div>
</div>
<div>
<div id="ctl00_ContentPlaceHolder1_dlXML_ctl05_rptField_ctl00_divOuter">
<a id='Field3031'></a>
<div class="fieldName">
<span id="ctl00_ContentPlaceHolder1_dlXML_ctl05_rptField_ctl00_FieldName">Measurement Setting</span>
</div>
<div class="fieldData">
<span id="ctl00_ContentPlaceHolder1_dlXML_ctl05_rptField_ctl00_nofieldtext"></span>
<span id="ctl00_ContentPlaceHolder1_dlXML_ctl05_rptField_ctl00_rptValues_ctl00_Value">Hospitals</span>
</div>
</div>
<div id="ctl00_ContentPlaceHolder1_dlXML_ctl05_rptField_ctl01_divOuter">
<a id='Field3032'></a>
<div class="fieldName">
<span id="ctl00_ContentPlaceHolder1_dlXML_ctl05_rptField_ctl01_FieldName">Professionals Involved in Delivery of Health Services</span>
</div>
<div class="fieldData">
<span id="ctl00_ContentPlaceHolder1_dlXML_ctl05_rptField_ctl01_nofieldtext"></span>
<span id="ctl00_ContentPlaceHolder1_dlXML_ctl05_rptField_ctl01_rptValues_ctl00_Value">Does not apply to this measure (e.g., measure is not provider specific)</span>
</div>
</div>
<div id="ctl00_ContentPlaceHolder1_dlXML_ctl05_rptField_ctl02_divOuter">
<a id='Field3033'></a>
<div class="fieldName">
<span id="ctl00_ContentPlaceHolder1_dlXML_ctl05_rptField_ctl02_FieldName">Least Aggregated Level of Services Delivery Addressed</span>
</div>
<div class="fieldData">
<span id="ctl00_ContentPlaceHolder1_dlXML_ctl05_rptField_ctl02_nofieldtext"></span>
<span id="ctl00_ContentPlaceHolder1_dlXML_ctl05_rptField_ctl02_rptValues_ctl00_Value">Single Health Care Delivery or Public Health Organizations</span>
</div>
</div>
<div id="ctl00_ContentPlaceHolder1_dlXML_ctl05_rptField_ctl03_divOuter">
<a id='Field3505'></a>
<div class="fieldName">
<span id="ctl00_ContentPlaceHolder1_dlXML_ctl05_rptField_ctl03_FieldName">Statement of Acceptable Minimum Sample Size</span>
</div>
<div class="fieldData">
<span id="ctl00_ContentPlaceHolder1_dlXML_ctl05_rptField_ctl03_nofieldtext"></span>
<span id="ctl00_ContentPlaceHolder1_dlXML_ctl05_rptField_ctl03_rptValues_ctl00_Value">Unspecified</span>
</div>
</div>
<div id="ctl00_ContentPlaceHolder1_dlXML_ctl05_rptField_ctl04_divOuter">
<a id='Field41'></a>
<div class="fieldName">
<span id="ctl00_ContentPlaceHolder1_dlXML_ctl05_rptField_ctl04_FieldName">Target Population Age</span>
</div>
<div class="fieldData">
<span id="ctl00_ContentPlaceHolder1_dlXML_ctl05_rptField_ctl04_nofieldtext"></span>
<span id="ctl00_ContentPlaceHolder1_dlXML_ctl05_rptField_ctl04_rptValues_ctl00_Value"><div class="content_para"><p>Age greater than or equal to 65 years</p></div></span>
</div>
</div>
<div id="ctl00_ContentPlaceHolder1_dlXML_ctl05_rptField_ctl05_divOuter">
<a id='Field42'></a>
<div class="fieldName">
<span id="ctl00_ContentPlaceHolder1_dlXML_ctl05_rptField_ctl05_FieldName">Target Population Gender</span>
</div>
<div class="fieldData">
<span id="ctl00_ContentPlaceHolder1_dlXML_ctl05_rptField_ctl05_nofieldtext"></span>
<span id="ctl00_ContentPlaceHolder1_dlXML_ctl05_rptField_ctl05_rptValues_ctl00_Value">Either male or female</span>
</div>
</div>
</div>
</td>
</tr><tr>
<td>
<div id="ctl00_ContentPlaceHolder1_dlXML_ctl06_divSectionName" class="SectionLbl">
<a id='Section590'></a>
<div class="SectionBackToTop"><a href="#top">Back to top</a></div>
<div class="SectionTitle"><h2><span id="ctl00_ContentPlaceHolder1_dlXML_ctl06_SectionName">Institute of Medicine (IOM) National Health Care Quality Report Categories</span></h2></div>
</div>
<div>
<div id="ctl00_ContentPlaceHolder1_dlXML_ctl06_rptField_ctl00_divOuter">
<a id='Field3163'></a>
<div class="fieldName">
<span id="ctl00_ContentPlaceHolder1_dlXML_ctl06_rptField_ctl00_FieldName">IOM Care Need</span>
</div>
<div class="fieldData">
<span id="ctl00_ContentPlaceHolder1_dlXML_ctl06_rptField_ctl00_nofieldtext"></span>
<span id="ctl00_ContentPlaceHolder1_dlXML_ctl06_rptField_ctl00_rptValues_ctl00_Value">Getting Better</span>
</div>
</div>
<div id="ctl00_ContentPlaceHolder1_dlXML_ctl06_rptField_ctl01_divOuter">
<a id='Field3164'></a>
<div class="fieldName">
<span id="ctl00_ContentPlaceHolder1_dlXML_ctl06_rptField_ctl01_FieldName">IOM Domain</span>
</div>
<div class="fieldData">
<span id="ctl00_ContentPlaceHolder1_dlXML_ctl06_rptField_ctl01_nofieldtext"></span>
<span id="ctl00_ContentPlaceHolder1_dlXML_ctl06_rptField_ctl01_rptValues_ctl00_Value">Effectiveness</span>
</div>
</div>
</div>
</td>
</tr><tr>
<td>
<div id="ctl00_ContentPlaceHolder1_dlXML_ctl07_divSectionName" class="SectionLbl">
<a id='Section593'></a>
<div class="SectionBackToTop"><a href="#top">Back to top</a></div>
<div class="SectionTitle"><h2><span id="ctl00_ContentPlaceHolder1_dlXML_ctl07_SectionName">Data Collection for the Measure</span></h2></div>
</div>
<div>
<div id="ctl00_ContentPlaceHolder1_dlXML_ctl07_rptField_ctl00_divOuter">
<a id='Field3506'></a>
<div class="fieldName">
<span id="ctl00_ContentPlaceHolder1_dlXML_ctl07_rptField_ctl00_FieldName">Case Finding Period</span>
</div>
<div class="fieldData">
<span id="ctl00_ContentPlaceHolder1_dlXML_ctl07_rptField_ctl00_nofieldtext"></span>
<span id="ctl00_ContentPlaceHolder1_dlXML_ctl07_rptField_ctl00_rptValues_ctl00_Value"><div class="content_para"><p>3 years</p></div></span>
</div>
</div>
<div id="ctl00_ContentPlaceHolder1_dlXML_ctl07_rptField_ctl01_divOuter">
<a id='Field3054'></a>
<div class="fieldName">
<span id="ctl00_ContentPlaceHolder1_dlXML_ctl07_rptField_ctl01_FieldName">Denominator Sampling Frame</span>
</div>
<div class="fieldData">
<span id="ctl00_ContentPlaceHolder1_dlXML_ctl07_rptField_ctl01_nofieldtext"></span>
<span id="ctl00_ContentPlaceHolder1_dlXML_ctl07_rptField_ctl01_rptValues_ctl00_Value">Patients associated with provider</span>
</div>
</div>
<div id="ctl00_ContentPlaceHolder1_dlXML_ctl07_rptField_ctl02_divOuter">
<a id='Field55'></a>
<div class="fieldName">
<span id="ctl00_ContentPlaceHolder1_dlXML_ctl07_rptField_ctl02_FieldName">Denominator Inclusions/Exclusions</span>
</div>
<div class="fieldData">
<span id="ctl00_ContentPlaceHolder1_dlXML_ctl07_rptField_ctl02_nofieldtext"></span>
<span id="ctl00_ContentPlaceHolder1_dlXML_ctl07_rptField_ctl02_rptValues_ctl00_Value"><div class="content_para"><p><strong>Inclusions</strong><br />
This cohort includes admissions for Medicare fee-for-service beneficiaries aged greater than or equal to 65 years with a principal discharge diagnosis of heart failure (HF)* and with a complete claims history for 12 months prior to admission</p>
<p class="Note">*International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) codes that define the patient cohort:</p>
<ul style="list-style-type: disc;" class="Note">
<li>402.01: Hypertensive heart disease, malignant, with heart failure </li>
<li>402.11: Hypertensive heart disease, benign, with heart failure </li>
<li>402.91: Hypertensive heart disease, unspecified, with heart failure </li>
<li>404.01: Hypertensive heart and chronic kidney disease, malignant, with heart failure and with chronic kidney disease stage I through stage IV, or unspecified </li>
<li>404.03: Hypertensive heart and chronic kidney disease, malignant, with heart failure and with chronic kidney disease stage V or end stage renal disease </li>
<li>404.11: Hypertensive heart and chronic kidney disease, benign, with heart failure and with chronic kidney disease stage I through stage IV, or unspecified </li>
<li>404.13: Hypertensive heart and chronic kidney disease, benign, with heart failure and chronic kidney disease stage V or end stage renal disease </li>
<li>404.91: Hypertensive heart and chronic kidney disease, unspecified, with heart failure and with chronic kidney disease stage I through stage IV, or unspecified </li>
<li>404.93: Hypertensive heart and chronic kidney disease, unspecified, with heart failure and chronic kidney disease stage V or end stage renal disease </li>
<li>428.xx: Heart Failure </li>
</ul>
<p><strong>Exclusions</strong><br />
Cohort exclusions (excluded admissions):</p>
<ul style="list-style-type: disc;">
<li>Admissions for patients with an in-hospital death (because they are not eligible for readmission). </li>
<li>Admissions for patients having a principal diagnosis of HF during the index hospitalization and subsequently transferred to another acute care facility are excluded (because we are focusing on discharges to non-acute care settings). </li>
<li>Admissions for patients who are discharged against medical advice (AMA) (because providers did not have the opportunity to deliver full care and prepare the patient for discharge). </li>
<li>Admissions for patients without at least 30 days post-discharge enrollment in fee-for-service Medicare (because the 30-day readmission outcome cannot be assessed in this group). </li>
</ul>
<p>In addition, if a patient has one or more additional HF admissions within 30 days of discharge from an index HF admission, we do not consider the additional HF admissions as index admissions (they are considered as potential readmissions). Thus, any HF admission is either an index admission or a potential readmission, but not both.</p></div></span>
</div>
</div>
<div id="ctl00_ContentPlaceHolder1_dlXML_ctl07_rptField_ctl03_divOuter">
<a id='Field3507'></a>
<div class="fieldName">
<span id="ctl00_ContentPlaceHolder1_dlXML_ctl07_rptField_ctl03_FieldName">Exclusions/Exceptions</span>
</div>
<div class="fieldData">
<span id="ctl00_ContentPlaceHolder1_dlXML_ctl07_rptField_ctl03_nofieldtext"></span>
<span id="ctl00_ContentPlaceHolder1_dlXML_ctl07_rptField_ctl03_rptValues_ctl00_Value">Patient factors addressed</span>
</div>
</div>
<div id="ctl00_ContentPlaceHolder1_dlXML_ctl07_rptField_ctl04_divOuter">
<a id='Field3057'></a>
<div class="fieldName">
<span id="ctl00_ContentPlaceHolder1_dlXML_ctl07_rptField_ctl04_FieldName">Denominator (Index) Event or Characteristic</span>
</div>
<div class="fieldData">
<span id="ctl00_ContentPlaceHolder1_dlXML_ctl07_rptField_ctl04_nofieldtext"></span>
<span id="ctl00_ContentPlaceHolder1_dlXML_ctl07_rptField_ctl04_rptValues_ctl00_Value">Clinical Condition<br /></span>
<span id="ctl00_ContentPlaceHolder1_dlXML_ctl07_rptField_ctl04_rptValues_ctl01_Value">Institutionalization<br /></span>
<span id="ctl00_ContentPlaceHolder1_dlXML_ctl07_rptField_ctl04_rptValues_ctl02_Value">Patient/Individual (Consumer) Characteristic</span>
</div>
</div>
<div id="ctl00_ContentPlaceHolder1_dlXML_ctl07_rptField_ctl05_divOuter">
<a id='Field3058'></a>
<div class="fieldName">
<span id="ctl00_ContentPlaceHolder1_dlXML_ctl07_rptField_ctl05_FieldName">Denominator Time Window</span>
</div>
<div class="fieldData">
<span id="ctl00_ContentPlaceHolder1_dlXML_ctl07_rptField_ctl05_nofieldtext"></span>
<span id="ctl00_ContentPlaceHolder1_dlXML_ctl07_rptField_ctl05_rptValues_ctl00_Value">Time window precedes index event</span>
</div>
</div>
<div id="ctl00_ContentPlaceHolder1_dlXML_ctl07_rptField_ctl06_divOuter">
<a id='Field59'></a>
<div class="fieldName">
<span id="ctl00_ContentPlaceHolder1_dlXML_ctl07_rptField_ctl06_FieldName">Numerator Inclusions/Exclusions</span>
</div>
<div class="fieldData">
<span id="ctl00_ContentPlaceHolder1_dlXML_ctl07_rptField_ctl06_nofieldtext"></span>
<span id="ctl00_ContentPlaceHolder1_dlXML_ctl07_rptField_ctl06_rptValues_ctl00_Value"><div class="content_para"><p><strong>Inclusions</strong><br />
The hospital-specific risk-standardized readmission rate (RSRR) is calculated as the ratio of predicted to expected readmissions, multiplied by the national unadjusted rate. The "numerator" of the ratio component is the predicted number of readmissions for each hospital within 30 days given the hospital's performance with its observed case mix.</p>
<p class="Note"><strong>Note</strong>: This outcome measure does not have a traditional numerator and denominator like a core process measure (e.g., percentage of adult patients with diabetes aged 18-75 years receiving one or more hemoglobin A1c tests per year); thus, we are using this field to define our statistically-adjusted outcome measure.</p>
<p class="Note">Hierarchical logistic regression modeling is used to calculate a hospital-specific RSRR. The RSRR is calculated as the ratio of the number of "predicted" to the number of "expected" readmissions, multiplied by the national unadjusted readmission rate. For each hospital, the "numerator" of the ratio is the number of readmissions within 30 days predicted on the basis of the hospital's performance with its observed case mix, and the "denominator" is the number of readmissions expected on the basis of the nation's performance with that hospital's case mix. This approach is analogous to a ratio of "observed" to "expected" used in other types of statistical analyses. It conceptually allows for a comparison of a particular hospital's performance given its case-mix to an average hospital's performance with the same case mix. Thus a lower ratio indicates lower-than-expected readmission or better quality and a higher ratio indicates higher-than-expected readmission or worse quality.</p>
<p class="Note">The predicted hospital outcome (the numerator) is calculated by regressing the risk factors and the hospital-specific intercept on the risk of readmission, multiplying the estimated regression coefficients by the patient characteristics in the hospital, transforming, and then summing over all patients attributed to the hospital to get a value. The expected number of readmissions (the denominator) is obtained by regressing the risk factors and a common intercept on the readmission outcome using all hospitals in our sample, multiplying the subsequent estimated regression coefficients by the patient characteristics observed in the hospital, transforming, and then summing over all patients in the hospital to get a value.</p>
<p class="Note">To assess hospital performance in any reporting period, the model coefficients are re-estimated using the years of data in that period. See the "Description of Allowance for Patient Factors" field for risk adjustment details. See the <a href="disclaimer.aspx?redirect=http://www.qualitynet.org/dcs/ContentServer?c=Page&amp;pagename=QnetPublic%2FPage%2FQnetTier3&amp;cid=1219069855841" title="QualityNet Web site">2010 Measures Maintenance Technical Report: Acute Myocardial Infarction, Heart Failure, and Pneumonia 30-Day Risk-standardized Readmission Measures</a>&nbsp;<img alt="External Web Site Policy" src="/images/icon_externallink.gif" /> for more details.</p>
<p><strong>Exclusions</strong><br />
Unspecified</p></div></span>
</div>
</div>
<div id="ctl00_ContentPlaceHolder1_dlXML_ctl07_rptField_ctl07_divOuter">
<a id='Field3061'></a>
<div class="fieldName">
<span id="ctl00_ContentPlaceHolder1_dlXML_ctl07_rptField_ctl07_FieldName">Numerator Search Strategy</span>
</div>
<div class="fieldData">
<span id="ctl00_ContentPlaceHolder1_dlXML_ctl07_rptField_ctl07_nofieldtext"></span>
<span id="ctl00_ContentPlaceHolder1_dlXML_ctl07_rptField_ctl07_rptValues_ctl00_Value">Fixed time period</span>
</div>
</div>
<div id="ctl00_ContentPlaceHolder1_dlXML_ctl07_rptField_ctl08_divOuter">
<a id='Field3062'></a>
<div class="fieldName">
<span id="ctl00_ContentPlaceHolder1_dlXML_ctl07_rptField_ctl08_FieldName">Data Source</span>
</div>
<div class="fieldData">
<span id="ctl00_ContentPlaceHolder1_dlXML_ctl07_rptField_ctl08_nofieldtext"></span>
<span id="ctl00_ContentPlaceHolder1_dlXML_ctl07_rptField_ctl08_rptValues_ctl00_Value">Administrative clinical data</span>
</div>
</div>
<div id="ctl00_ContentPlaceHolder1_dlXML_ctl07_rptField_ctl09_divOuter">
<a id='Field3065'></a>
<div class="fieldName">
<span id="ctl00_ContentPlaceHolder1_dlXML_ctl07_rptField_ctl09_FieldName">Type of Health State</span>
</div>
<div class="fieldData">
<span id="ctl00_ContentPlaceHolder1_dlXML_ctl07_rptField_ctl09_nofieldtext"></span>
<span id="ctl00_ContentPlaceHolder1_dlXML_ctl07_rptField_ctl09_rptValues_ctl00_Value">Adverse Health State</span>
</div>
</div>
<div id="ctl00_ContentPlaceHolder1_dlXML_ctl07_rptField_ctl10_divOuter">
<a id='Field3066'></a>
<div class="fieldName">
<span id="ctl00_ContentPlaceHolder1_dlXML_ctl07_rptField_ctl10_FieldName">Instruments Used and/or Associated with the Measure</span>
</div>
<div class="fieldData">
<span id="ctl00_ContentPlaceHolder1_dlXML_ctl07_rptField_ctl10_nofieldtext"></span>
<span id="ctl00_ContentPlaceHolder1_dlXML_ctl07_rptField_ctl10_rptValues_ctl00_Value"><div class="content_para"><p>None</p></div></span>
</div>
</div>
</div>
</td>
</tr><tr>
<td>
<div id="ctl00_ContentPlaceHolder1_dlXML_ctl08_divSectionName" class="SectionLbl">
<a id='Section605'></a>
<div class="SectionBackToTop"><a href="#top">Back to top</a></div>
<div class="SectionTitle"><h2><span id="ctl00_ContentPlaceHolder1_dlXML_ctl08_SectionName">Computation of the Measure</span></h2></div>
</div>
<div>
<div id="ctl00_ContentPlaceHolder1_dlXML_ctl08_rptField_ctl00_divOuter">
<a id='Field3508'></a>
<div class="fieldName">
<span id="ctl00_ContentPlaceHolder1_dlXML_ctl08_rptField_ctl00_FieldName">Measure Specifies Disaggregation</span>
</div>
<div class="fieldData">
<span id="ctl00_ContentPlaceHolder1_dlXML_ctl08_rptField_ctl00_nofieldtext"></span>
<span id="ctl00_ContentPlaceHolder1_dlXML_ctl08_rptField_ctl00_rptValues_ctl00_Value">Does not apply to this measure</span>
</div>
</div>
<div id="ctl00_ContentPlaceHolder1_dlXML_ctl08_rptField_ctl01_divOuter">
<a id='Field3067'></a>
<div class="fieldName">
<span id="ctl00_ContentPlaceHolder1_dlXML_ctl08_rptField_ctl01_FieldName">Scoring</span>
</div>
<div class="fieldData">
<span id="ctl00_ContentPlaceHolder1_dlXML_ctl08_rptField_ctl01_nofieldtext"></span>
<span id="ctl00_ContentPlaceHolder1_dlXML_ctl08_rptField_ctl01_rptValues_ctl00_Value">Rate/Proportion</span>
</div>
</div>
<div id="ctl00_ContentPlaceHolder1_dlXML_ctl08_rptField_ctl02_divOuter">
<a id='Field3068'></a>
<div class="fieldName">
<span id="ctl00_ContentPlaceHolder1_dlXML_ctl08_rptField_ctl02_FieldName">Interpretation of Score</span>
</div>
<div class="fieldData">
<span id="ctl00_ContentPlaceHolder1_dlXML_ctl08_rptField_ctl02_nofieldtext"></span>
<span id="ctl00_ContentPlaceHolder1_dlXML_ctl08_rptField_ctl02_rptValues_ctl00_Value">Desired value is a lower score</span>
</div>
</div>
<div id="ctl00_ContentPlaceHolder1_dlXML_ctl08_rptField_ctl03_divOuter">
<a id='Field3090'></a>
<div class="fieldName">
<span id="ctl00_ContentPlaceHolder1_dlXML_ctl08_rptField_ctl03_FieldName">Allowance for Patient or Population Factors</span>
</div>
<div class="fieldData">
<span id="ctl00_ContentPlaceHolder1_dlXML_ctl08_rptField_ctl03_nofieldtext"></span>
<span id="ctl00_ContentPlaceHolder1_dlXML_ctl08_rptField_ctl03_rptValues_ctl00_Value">Risk adjustment devised specifically for this measure/condition</span>
</div>
</div>
<div id="ctl00_ContentPlaceHolder1_dlXML_ctl08_rptField_ctl04_divOuter">
<a id='Field3069'></a>
<div class="fieldName">
<span id="ctl00_ContentPlaceHolder1_dlXML_ctl08_rptField_ctl04_FieldName">Description of Allowance for Patient or Population Factors</span>
</div>
<div class="fieldData">
<span id="ctl00_ContentPlaceHolder1_dlXML_ctl08_rptField_ctl04_nofieldtext"></span>
<span id="ctl00_ContentPlaceHolder1_dlXML_ctl08_rptField_ctl04_rptValues_ctl00_Value"><div class="content_para"><p>Our approach to risk adjustment was tailored to and appropriate for a publicly reported outcome measure, as articulated in the American Heart Association (AHA) Scientific Statement, "Standards for Statistical Models Used for Public Reporting of Health Outcomes" (Krumholz et al., 2006).</p>
<p>The measure employs a hierarchical logistic regression model (a form of hierarchical generalized linear model [HGLM]) to create a hospital level 30-day risk-standardized readmission rate (RSRR). This approach to modeling appropriately accounts for the structure of the data (patients clustered within hospitals), the underlying risk due to patients' comorbidities, and sample size at a given hospital when estimating hospital readmission rates. In brief, the approach simultaneously models two levels (patient and hospital) to account for the variance in patient outcomes within and between hospitals (Normand et al., 2007). At the patient level, each model adjusts the log-odds of readmission within 30-days of admission for age, sex, selected clinical covariates and a hospital-specific intercept. The second level models the hospital-specific intercepts as arising from a normal distribution. The hospital intercept, or hospital specific effect, represents the hospital contribution to the risk of readmission, after accounting for patient risk and sample size, and can be inferred as a measure of quality. The hospital-specific intercepts are given a distribution in order to account for the clustering (non-independence) of patients within the same hospital. If there were no differences among hospitals, then after adjusting for patient risk, the hospital intercepts should be identical across all hospitals.</p>
<p>Refer to the original measure documentation for the final set of risk-adjustment variables included.</p>
<p>Candidate and Final Risk-adjustment Variables: Candidate variables were patient-level risk-adjustors that are expected to be predictive of readmission, based on empirical analysis, prior literature, and clinical judgment, including demographic factors (age, sex) and indicators of comorbidity and disease severity. For each patient, covariates were obtained from Medicare claims extending 12 months prior to and including the index admission. The model adjusted for case differences based on the clinical status of the patient at the time of admission. We used condition categories (CCs), which are clinically meaningful groupings of more than 15,000 International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) diagnosis codes. We did not risk-adjust for CCs that were possible adverse events of care and that were only recorded in the index admission. In addition, only comorbidities that conveyed information about the patient at that time or in the 12-months prior, and not complications that arose during the course of the hospitalization were included in the risk-adjustment.</p>
<p>The final set of risk-adjustment variables included:</p>
<table border="1" cellspacing="0" summary="Final Set of Risk-adjustment Variables" cellpadding="0">
<tbody>
<tr>
<th valign="top" scope="row">Demographic</th>
<td valign="top">
<ul style="list-style-type: disc;">
<li>Age-65 (years above 65, continuous) </li>
<li>Male </li>
</ul>
</td>
</tr>
<tr>
<th valign="top" scope="row">Cardiovascular</th>
<td valign="top">
<ul style="list-style-type: disc;">
<li>History of coronary artery bypass grafting (CABG) surgery </li>
<li>Congestive heart failure </li>
<li>Acute coronary syndrome </li>
<li>Arrhythmias </li>
<li>Cardio-respiratory failure and shock </li>
<li>Valvular and rheumatic heart disease </li>
<li>Vascular or circulatory disease </li>
<li>Chronic atherosclerosis </li>
<li>Other and unspecified heart disease </li>
</ul>
</td>
</tr>
<tr>
<th valign="top" scope="row">Comorbidity</th>
<td valign="top">
<ul style="list-style-type: disc;">
<li>Hemiplegia, paraplegia, paralysis, functional disability </li>
<li>Stroke </li>
<li>Renal failure </li>
<li>Chronic obstructive pulmonary disease (COPD) </li>
<li>Diabetes mellitus (DM) and DM complications </li>
<li>Disorders of fluid/electrolyte/acid-base </li>
<li>Other urinary tract disorders </li>
<li>Decubitus ulcer or chronic skin ulcer </li>
<li>Other gastrointestinal disorders </li>
<li>Peptic ulcer, hemorrhage, other specified gastrointestinal disorders </li>
<li>Severe hematological disorders </li>
<li>Nephritis </li>
<li>Dementia and senility </li>
<li>Metastatic cancer and acute leukemia </li>
<li>Cancer </li>
<li>Liver and biliary disease </li>
<li>End-stage renal disease or dialysis </li>
<li>Asthma </li>
<li>Iron deficiency and other/unspecified anemias and blood disease </li>
<li>Pneumonia </li>
<li>Drug/alcohol abuse/dependence/psychosis </li>
<li>Major psychiatric disorders </li>
<li>Depression </li>
<li>Other psychiatric disorders </li>
<li>Fibrosis of lung and other chronic lung disorders </li>
<li>Protein-calorie malnutrition </li>
</ul>
</td>
</tr>
</tbody>
</table>
<p>Full details of the development of the risk-standardization model for this measure are available at <a href="disclaimer.aspx?redirect=http://www.qualitynet.org" title="QualityNet Web site">www.qualitynet.org</a>&nbsp;<img alt="External Web Site Policy" src="/images/icon_externallink.gif" />.</p></div></span>
</div>
</div>
<div id="ctl00_ContentPlaceHolder1_dlXML_ctl08_rptField_ctl05_divOuter">
<a id='Field3070'></a>
<div class="fieldName">
<span id="ctl00_ContentPlaceHolder1_dlXML_ctl08_rptField_ctl05_FieldName">Standard of Comparison</span>
</div>
<div class="fieldData">
<span id="ctl00_ContentPlaceHolder1_dlXML_ctl08_rptField_ctl05_nofieldtext"></span>
<span id="ctl00_ContentPlaceHolder1_dlXML_ctl08_rptField_ctl05_rptValues_ctl00_Value">External comparison at a point in, or interval of, time<br /></span>
<span id="ctl00_ContentPlaceHolder1_dlXML_ctl08_rptField_ctl05_rptValues_ctl01_Value">External comparison of time trends<br /></span>
<span id="ctl00_ContentPlaceHolder1_dlXML_ctl08_rptField_ctl05_rptValues_ctl02_Value">Internal time comparison</span>
</div>
</div>
</div>
</td>
</tr><tr>
<td>
<div id="ctl00_ContentPlaceHolder1_dlXML_ctl09_divSectionName" class="SectionLbl">
<a id='Section615'></a>
<div class="SectionBackToTop"><a href="#top">Back to top</a></div>
<div class="SectionTitle"><h2><span id="ctl00_ContentPlaceHolder1_dlXML_ctl09_SectionName">Identifying Information</span></h2></div>
</div>
<div>
<div id="ctl00_ContentPlaceHolder1_dlXML_ctl09_rptField_ctl00_divOuter">
<a id='Field73'></a>
<div class="fieldName">
<span id="ctl00_ContentPlaceHolder1_dlXML_ctl09_rptField_ctl00_FieldName">Original Title</span>
</div>
<div class="fieldData">
<span id="ctl00_ContentPlaceHolder1_dlXML_ctl09_rptField_ctl00_nofieldtext"></span>
<span id="ctl00_ContentPlaceHolder1_dlXML_ctl09_rptField_ctl00_rptValues_ctl00_Value"><div class="content_para"><p>READM-30-HF: thirty-day all-cause risk standardized readmission rate following heart failure (HF) hospitalization.</p></div></span>
</div>
</div>
<div id="ctl00_ContentPlaceHolder1_dlXML_ctl09_rptField_ctl01_divOuter">
<a id='Field74'></a>
<div class="fieldName">
<span id="ctl00_ContentPlaceHolder1_dlXML_ctl09_rptField_ctl01_FieldName">Measure Collection Name</span>
</div>
<div class="fieldData">
<span id="ctl00_ContentPlaceHolder1_dlXML_ctl09_rptField_ctl01_nofieldtext"></span>
<span id="ctl00_ContentPlaceHolder1_dlXML_ctl09_rptField_ctl01_rptValues_ctl00_Value"><a href="/browse/by-organization-indiv.aspx?objid=25813">National Hospital Inpatient Quality Measures</a></span>
</div>
</div>
<div id="ctl00_ContentPlaceHolder1_dlXML_ctl09_rptField_ctl02_divOuter">
<a id='Field75'></a>
<div class="fieldName">
<span id="ctl00_ContentPlaceHolder1_dlXML_ctl09_rptField_ctl02_FieldName">Measure Set Name</span>
</div>
<div class="fieldData">
<span id="ctl00_ContentPlaceHolder1_dlXML_ctl09_rptField_ctl02_nofieldtext"></span>
<span id="ctl00_ContentPlaceHolder1_dlXML_ctl09_rptField_ctl02_rptValues_ctl00_Value"><a href="/browse/by-organization-indiv.aspx?objid=26098">CMS Readmission Measures</a></span>
</div>
</div>
<div id="ctl00_ContentPlaceHolder1_dlXML_ctl09_rptField_ctl03_divOuter">
<a id='Field16'></a>
<div class="fieldName">
<span id="ctl00_ContentPlaceHolder1_dlXML_ctl09_rptField_ctl03_FieldName">Submitter</span>
</div>
<div class="fieldData">
<span id="ctl00_ContentPlaceHolder1_dlXML_ctl09_rptField_ctl03_nofieldtext"></span>
<span id="ctl00_ContentPlaceHolder1_dlXML_ctl09_rptField_ctl03_rptValues_ctl00_Value">Centers for Medicare & Medicaid Services/The Joint Commission</span>
</div>
</div>
<div id="ctl00_ContentPlaceHolder1_dlXML_ctl09_rptField_ctl04_divOuter">
<a id='Field17'></a>
<div class="fieldName">
<span id="ctl00_ContentPlaceHolder1_dlXML_ctl09_rptField_ctl04_FieldName">Developer</span>
</div>
<div class="fieldData">
<span id="ctl00_ContentPlaceHolder1_dlXML_ctl09_rptField_ctl04_nofieldtext"></span>
<span id="ctl00_ContentPlaceHolder1_dlXML_ctl09_rptField_ctl04_rptValues_ctl00_Value">Centers for Medicare & Medicaid Services - Federal Government Agency [U.S.]<br /></span>
<span id="ctl00_ContentPlaceHolder1_dlXML_ctl09_rptField_ctl04_rptValues_ctl01_Value">Yale-New Haven Health Services Corporation/Center for Outcomes Research and Evaluation under contract to Centers for Medicare & Medicaid Services - Academic Affiliated Research Institute</span>
</div>
</div>
<div id="ctl00_ContentPlaceHolder1_dlXML_ctl09_rptField_ctl05_divOuter">
<a id='Field79'></a>
<div class="fieldName">
<span id="ctl00_ContentPlaceHolder1_dlXML_ctl09_rptField_ctl05_FieldName">Funding Source(s)</span>
</div>
<div class="fieldData">
<span id="ctl00_ContentPlaceHolder1_dlXML_ctl09_rptField_ctl05_nofieldtext"></span>
<span id="ctl00_ContentPlaceHolder1_dlXML_ctl09_rptField_ctl05_rptValues_ctl00_Value"><div class="content_para"><p>Centers for Medicare & Medicaid Services (CMS)</p></div></span>
</div>
</div>
<div id="ctl00_ContentPlaceHolder1_dlXML_ctl09_rptField_ctl06_divOuter">
<a id='Field80'></a>
<div class="fieldName">
<span id="ctl00_ContentPlaceHolder1_dlXML_ctl09_rptField_ctl06_FieldName">Composition of the Group that Developed the Measure</span>
</div>
<div class="fieldData">
<span id="ctl00_ContentPlaceHolder1_dlXML_ctl09_rptField_ctl06_nofieldtext"></span>
<span id="ctl00_ContentPlaceHolder1_dlXML_ctl09_rptField_ctl06_rptValues_ctl00_Value"><div class="content_para"><p>This measure was developed by a team of clinical and statistical experts from Yale University/Yale-New Haven Hospital Center for Outcomes Research and Evaluation (Yale-CORE) and Harvard University, through a Centers for Medicare & Medicaid Services (CMS) contract with the Colorado Foundation for Medicare Care (CFMC).</p></div></span>
</div>
</div>
<div id="ctl00_ContentPlaceHolder1_dlXML_ctl09_rptField_ctl07_divOuter">
<a id='Field81'></a>
<div class="fieldName">
<span id="ctl00_ContentPlaceHolder1_dlXML_ctl09_rptField_ctl07_FieldName">Financial Disclosures/Other Potential Conflicts of Interest</span>
</div>
<div class="fieldData">
<span id="ctl00_ContentPlaceHolder1_dlXML_ctl09_rptField_ctl07_nofieldtext"></span>
<span id="ctl00_ContentPlaceHolder1_dlXML_ctl09_rptField_ctl07_rptValues_ctl00_Value"><div class="content_para"><p>Unspecified</p></div></span>
</div>
</div>
<div id="ctl00_ContentPlaceHolder1_dlXML_ctl09_rptField_ctl08_divOuter">
<a id='Field82'></a>
<div class="fieldName">
<span id="ctl00_ContentPlaceHolder1_dlXML_ctl09_rptField_ctl08_FieldName">Endorser</span>
</div>
<div class="fieldData">
<span id="ctl00_ContentPlaceHolder1_dlXML_ctl09_rptField_ctl08_nofieldtext"></span>
<span id="ctl00_ContentPlaceHolder1_dlXML_ctl09_rptField_ctl08_rptValues_ctl00_Value">National Quality Forum</span>
</div>
</div>
<div id="ctl00_ContentPlaceHolder1_dlXML_ctl09_rptField_ctl09_divOuter">
<a id='Field3510'></a>
<div class="fieldName">
<span id="ctl00_ContentPlaceHolder1_dlXML_ctl09_rptField_ctl09_FieldName">Date of Endorsement</span>
</div>
<div class="fieldData">
<span id="ctl00_ContentPlaceHolder1_dlXML_ctl09_rptField_ctl09_nofieldtext"></span>
<span id="ctl00_ContentPlaceHolder1_dlXML_ctl09_rptField_ctl09_rptValues_ctl00_Value"><div class="content_para"><p>2010 Sep 12</p></div></span>
</div>
</div>
<div id="ctl00_ContentPlaceHolder1_dlXML_ctl09_rptField_ctl10_divOuter">
<a id='Field3083'></a>
<div class="fieldName">
<span id="ctl00_ContentPlaceHolder1_dlXML_ctl09_rptField_ctl10_FieldName">Measure Initiative(s)</span>
</div>
<div class="fieldData">
<span id="ctl00_ContentPlaceHolder1_dlXML_ctl09_rptField_ctl10_nofieldtext"></span>
<span id="ctl00_ContentPlaceHolder1_dlXML_ctl09_rptField_ctl10_rptValues_ctl00_Value">Hospital Compare<br /></span>
<span id="ctl00_ContentPlaceHolder1_dlXML_ctl09_rptField_ctl10_rptValues_ctl01_Value">Hospital Quality Alliance (HQA)<br /></span>
<span id="ctl00_ContentPlaceHolder1_dlXML_ctl09_rptField_ctl10_rptValues_ctl02_Value">Hospital Inpatient Quality Reporting Program</span>
</div>
</div>
<div id="ctl00_ContentPlaceHolder1_dlXML_ctl09_rptField_ctl11_divOuter">
<a id='Field19'></a>
<div class="fieldName">
<span id="ctl00_ContentPlaceHolder1_dlXML_ctl09_rptField_ctl11_FieldName">Adaptation</span>
</div>
<div class="fieldData">
<span id="ctl00_ContentPlaceHolder1_dlXML_ctl09_rptField_ctl11_nofieldtext"></span>
<span id="ctl00_ContentPlaceHolder1_dlXML_ctl09_rptField_ctl11_rptValues_ctl00_Value"><div class="content_para"><p>This measure was not adapted from another source.</p></div></span>
</div>
</div>
<div id="ctl00_ContentPlaceHolder1_dlXML_ctl09_rptField_ctl12_divOuter">
<a id='Field3086'></a>
<div class="fieldName">
<span id="ctl00_ContentPlaceHolder1_dlXML_ctl09_rptField_ctl12_FieldName">Date of Most Current Version in NQMC</span>
</div>
<div class="fieldData">
<span id="ctl00_ContentPlaceHolder1_dlXML_ctl09_rptField_ctl12_nofieldtext"></span>
<span id="ctl00_ContentPlaceHolder1_dlXML_ctl09_rptField_ctl12_rptValues_ctl00_Value">2010 Apr</span>
</div>
</div>
<div id="ctl00_ContentPlaceHolder1_dlXML_ctl09_rptField_ctl13_divOuter">
<a id='Field3511'></a>
<div class="fieldName">
<span id="ctl00_ContentPlaceHolder1_dlXML_ctl09_rptField_ctl13_FieldName">Measure Maintenance</span>
</div>
<div class="fieldData">
<span id="ctl00_ContentPlaceHolder1_dlXML_ctl09_rptField_ctl13_nofieldtext"></span>
<span id="ctl00_ContentPlaceHolder1_dlXML_ctl09_rptField_ctl13_rptValues_ctl00_Value"><div class="content_para"><p>Unspecified</p></div></span>
</div>
</div>
<div id="ctl00_ContentPlaceHolder1_dlXML_ctl09_rptField_ctl14_divOuter">
<a id='Field3512'></a>
<div class="fieldName">
<span id="ctl00_ContentPlaceHolder1_dlXML_ctl09_rptField_ctl14_FieldName">Date of Next Anticipated Revision</span>
</div>
<div class="fieldData">
<span id="ctl00_ContentPlaceHolder1_dlXML_ctl09_rptField_ctl14_nofieldtext"></span>
<span id="ctl00_ContentPlaceHolder1_dlXML_ctl09_rptField_ctl14_rptValues_ctl00_Value"><div class="content_para"><p>Unspecified</p></div></span>
</div>
</div>
<div id="ctl00_ContentPlaceHolder1_dlXML_ctl09_rptField_ctl15_divOuter">
<a id='Field20'></a>
<div class="fieldName">
<span id="ctl00_ContentPlaceHolder1_dlXML_ctl09_rptField_ctl15_FieldName">Measure Status</span>
</div>
<div class="fieldData">
<span id="ctl00_ContentPlaceHolder1_dlXML_ctl09_rptField_ctl15_nofieldtext"></span>
<span id="ctl00_ContentPlaceHolder1_dlXML_ctl09_rptField_ctl15_rptValues_ctl00_Value"><div class="content_para"><p>This is the current release of the measure.</p>
<p>This measure updates a previous version: Specifications manual for national hospital inpatient quality measures, version 3.0b. Centers for Medicare &amp; Medicaid Services (CMS), The Joint Commission; 2009 Oct. various p.</p></div></span>
</div>
</div>
<div id="ctl00_ContentPlaceHolder1_dlXML_ctl09_rptField_ctl16_divOuter">
<a id='Field1'></a>
<div class="fieldName">
<span id="ctl00_ContentPlaceHolder1_dlXML_ctl09_rptField_ctl16_FieldName">Source(s)</span>
</div>
<div class="fieldData">
<span id="ctl00_ContentPlaceHolder1_dlXML_ctl09_rptField_ctl16_nofieldtext"></span>
<span id="ctl00_ContentPlaceHolder1_dlXML_ctl09_rptField_ctl16_rptValues_ctl00_Value"><table><tr><td>Specifications manual for national hospital inpatient quality measures, version 3.1a. Centers for Medicare & Medicaid Services (CMS), The Joint Commission; 2010 Apr 1. various p. </td></tr></table></span>
</div>
</div>
<div id="ctl00_ContentPlaceHolder1_dlXML_ctl09_rptField_ctl17_divOuter">
<a id='Field14'></a>
<div class="fieldName">
<span id="ctl00_ContentPlaceHolder1_dlXML_ctl09_rptField_ctl17_FieldName">Measure Availability</span>
</div>
<div class="fieldData">
<span id="ctl00_ContentPlaceHolder1_dlXML_ctl09_rptField_ctl17_nofieldtext"></span>
<span id="ctl00_ContentPlaceHolder1_dlXML_ctl09_rptField_ctl17_rptValues_ctl00_Value"><div class="content_para"><p>The individual measure, "READM-30-HF: Thirty-day All-cause Risk Standardized Readmission Rate Following Heart Failure (HF) Hospitalization," is published in "Specifications Manual for National Hospital Inpatient Quality Measures." This document is available from <a href="disclaimer.aspx?redirect=http://www.jointcommission.org/specifications_manual_for_national_hospital_inpatient_quality_measures/" title="The Joint Commission Web site">The Joint Commission Web site</a>&nbsp;<img alt="External Web Site Policy" src="/images/icon_externallink.gif" />. Information is also available from the <a href="disclaimer.aspx?redirect=http://www.qualitynet.org/dcs/ContentServer?c=Page&amp;pagename=QnetPublic%2FPage%2FQnetTier2&amp;cid=1141662756099" title="QualityNet Web site">QualityNet Web site</a>&nbsp;<img alt="External Web Site Policy" src="/images/icon_externallink.gif" />. Check The Joint Commission Web site and QualityNet Web site regularly for the most recent version of the specifications manual and for the applicable dates of discharge.</p></div></span>
</div>
</div>
<div id="ctl00_ContentPlaceHolder1_dlXML_ctl09_rptField_ctl18_divOuter">
<a id='Field87'></a>
<div class="fieldName">
<span id="ctl00_ContentPlaceHolder1_dlXML_ctl09_rptField_ctl18_FieldName">NQMC Status</span>
</div>
<div class="fieldData">
<span id="ctl00_ContentPlaceHolder1_dlXML_ctl09_rptField_ctl18_nofieldtext"></span>
<span id="ctl00_ContentPlaceHolder1_dlXML_ctl09_rptField_ctl18_rptValues_ctl00_Value"><div class="content_para"><p>This NQMC summary was completed by ECRI Institute on July 13, 2009. This information was verified by the measure developer on December 29, 2009. This NQMC summary was updated by ECRI Institute on November 8, 2010. This information was verified by the measure developer on December 17, 2010. This NQMC summary was retrofitted into the new template on May 19, 2011.</p></div></span>
</div>
</div>
<div id="ctl00_ContentPlaceHolder1_dlXML_ctl09_rptField_ctl19_divOuter">
<a id='Field88'></a>
<div class="fieldName">
<span id="ctl00_ContentPlaceHolder1_dlXML_ctl09_rptField_ctl19_FieldName">Copyright Statement</span>
</div>
<div class="fieldData">
<span id="ctl00_ContentPlaceHolder1_dlXML_ctl09_rptField_ctl19_nofieldtext"></span>
<span id="ctl00_ContentPlaceHolder1_dlXML_ctl09_rptField_ctl19_rptValues_ctl00_Value"><div class="content_para"><p>The Specifications Manual for National Hospital Inpatient Quality Measures [Version 3.1a, April, 2010] is the collaborative work of the Centers for Medicare &amp; Medicaid Services and The Joint Commission. The Specifications Manual is periodically updated by the Centers for Medicare &amp; Medicaid Services and The Joint Commission. Users of the Specifications Manual for National Hospital Quality Measures should periodically verify that the most up-to-date version is being utilized.</p></div></span>
</div>
</div>
</div>
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</tr><tr>
<td>
<div id="ctl00_ContentPlaceHolder1_dlXML_ctl10_divSectionName" class="SectionLbl">
<a id='Section99999'></a>
<div class="SectionBackToTop"><a href="#top">Back to top</a></div>
<div class="SectionTitle"><h2><span id="ctl00_ContentPlaceHolder1_dlXML_ctl10_SectionName">Disclaimer</span></h2></div>
</div>
<div>
<div id="ctl00_ContentPlaceHolder1_dlXML_ctl10_rptField_ctl00_divOuter">
<a id='Field99999'></a>
<div class="fieldName">
<span id="ctl00_ContentPlaceHolder1_dlXML_ctl10_rptField_ctl00_FieldName">NQMC Disclaimer</span>
</div>
<div class="fieldData">
<span id="ctl00_ContentPlaceHolder1_dlXML_ctl10_rptField_ctl00_nofieldtext"></span>
<span id="ctl00_ContentPlaceHolder1_dlXML_ctl10_rptField_ctl00_rptValues_ctl00_Value"><div id="divDisclaimerShort"><p>The National Quality Measures Clearinghouseâ„¢ (NQMC) does not develop, produce, approve, or endorse the measures represented on this site.</p><a id="aShowDisc" class="javascriptLink" onclick="showDisclaimer();"><b>Read full disclaimer...</b></a></div><div style="display:none;" id="divDisclaimerAll"><p>The National Quality Measures Clearinghouseâ„¢ (NQMC) does not develop, produce, approve, or endorse the measures represented on this site.</p> <p>All measures summarized by NQMC and hosted on our site are produced under the auspices of medical specialty societies, relevant professional associations, public and private organizations, other government agencies, health care organizations or plans, individuals, and similar entities.</p> <p>Measures represented on the NQMC Web site are submitted by measure developers, and are screened solely to determine that they meet the NQMC Inclusion Criteria which may be found at <a href="../about/inclusion-criteria.aspx">http://www.qualitymeasures.ahrq.gov/about/inclusion-criteria.aspx</a>&nbsp;<img alt="External Web Site Policy" src="/images/icon_externallink.gif" />.</p> <p>NQMC, AHRQ, and its contractor ECRI Institute make no warranties concerning the content or its reliability and/or validity of the quality measures and related materials represented on this site. Moreover, the views and opinions of developers or authors of measures represented on this site do not necessarily state or reflect those of NQMC, AHRQ, or its contractor, ECRI Institute, and inclusion or hosting of measures in NQMC may not be used for advertising or commercial endorsement purposes.</p> <p>Readers with questions regarding measure content are directed to contact the measure developer.</p><a id="aHideDisc" onclick="hideDisclaimer();" class="javascriptLink"><b>Hide...</b></a></div></span>
</div>
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</body></html></value></element><element name="languages"><value>English</value></element><element name="mauthentication"><value>No log-in required</value></element><element name="mauthororganisations"><value>Centers for Medicare & Medicaid Services - Federal Government Agency [U.S.]<br /></value></element><element name="mavailability"><value>General public</value></element><element name="mdbid"><value>http://www.qualitymeasures.ahrq.gov/content.aspx?id=27444</value></element><element name="mpublisher"><value>National Quality Measures Clearinghouse</value></element><element name="mrtype"><value>Measure</value></element><element name="msourcename"><value>Agency for Healthcare Research and Quality</value></element><element name="teaser"><value><p>This measure* is a hospital-specific, risk-standardized, all-cause 30-day readmission (defined as readmission for any cause within 30 days from the date of discharge of the index admission) for patients discharged from the hospital with a principal discharge diagnosis of heart failure (HF).</p>
<p class="Note">*This is a Centers for Medicare &amp; Medicaid Services (CMS) only measure.</p></value></element><element name="title"><value>Heart failure (HF): hospital 30-day, all-cause, risk-standardized readmission rate (RSRR) following HF hospitalization.</value></element><element name="url"><value>http://www.qualitymeasures.ahrq.gov/content.aspx?id=27444</value></element></document></documents>ASKER
sorry below is the modified xslt
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<xsl:with-param name="remaining" select="substring-after($remaining, ';')"/>
</xsl:call-template>
</xsl:when>
<xsl:otherwise>
<xsl:variable name="new-list">
<xsl:call-template name="filter-and-add">
<xsl:with-param name="list" select="$list"/>
<xsl:with-param name="term" select="$remaining"/>
</xsl:call-template>
</xsl:variable>
<xsl:value-of select="substring($new-list, 3)"/>
</xsl:otherwise>
</xsl:choose>
</xsl:template>
<xsl:template name="filter-and-add">
<xsl:param name="list"/>
<xsl:param name="term"/>
<xsl:param name="norm-term" select="normalize-space(translate($term, '()1234567890', ''))"/>
<xsl:choose>
<xsl:when test="not(contains(concat($list, '; '), concat('; ', $norm-term, '; ')))">
<xsl:value-of select="concat($list, '; ', $norm-term)"/>
</xsl:when>
<xsl:otherwise>
<xsl:value-of select="$list"/>
</xsl:otherwise>
</xsl:choose>
</xsl:template>
<xsl:template name="strip-tags">
<xsl:param name="text"/>
<xsl:choose>
<xsl:when test="contains($text, '<')">
<xsl:value-of select="substring-before($text, '<')"/>
<xsl:call-template name="strip-tags">
<xsl:with-param name="text" select="substring-after($text, '>')"/>
</xsl:call-template>
</xsl:when>
<xsl:otherwise>
<xsl:value-of select="$text"/>
</xsl:otherwise>
</xsl:choose>
</xsl:template>
</xsl:stylesheet>
If you pass the string to this function, like this
<xsl:call-template name="process-values">
<xsl:with-param name="list" select="';'"/>
<xsl:with-param name="remaining" select="/Records/record"/>
</xsl:call-template>
It should work, no?
<xsl:call-template name="process-values">
<xsl:with-param name="list" select="';'"/>
<xsl:with-param name="remaining" select="/Records/record"/>
</xsl:call-template>
It should work, no?
ASKER
I m stripping out html tags, concatenating the values i need and then passing the xml to the process-values templates which for some reason is not returning me the desired output
thanks
thanks
ASKER CERTIFIED SOLUTION
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it is the lower-case that you need to get it working, in your sample Heart Failure and Heart failure are cased differently
ASKER
sorry for late reply got busy in some priority work.
It looks good except one little problem i m getting a leading space in the output
<msubjectgen> heart failure; patient readmission; risk assessment; time factors</msubjectgen>
Tried normalise space but it did not work
It looks good except one little problem i m getting a leading space in the output
<msubjectgen> heart failure; patient readmission; risk assessment; time factors</msubjectgen>
Tried normalise space but it did not work
if you simply do a normamlize-space on the result it will strip it out
(could be that you need to store the result in a variable first and do a normalize-space on the variable)
(could be that you need to store the result in a variable first and do a normalize-space on the variable)
ASKER
The variable thing worked. Many thanks
cheers