Transcript Hospital based inpatient psychiatric services

Hospital Based
Inpatient
Psychiatric
Services
3Q FY2014
Objectives

 The purpose of this presentation is to provide an
overview of
 HBIPS instrument questions and definition/decision
rules
 HBIPS exit report and scoring
 This presentation is provided as a reference to use in
conjunction with the training call
HBIPS

 HBIPS looks at care provided to veterans during an
inpatient psychiatric hospitalization
 Cases were selected for review from ICD-9-CM
codes indicating a mental disorder was the principal
diagnosis or a secondary diagnosis
 Joint Commission Table 10.01 in Appendix A contains
a list of applicable codes
Sample

 There are three HBIPS pull lists per quarter
 Two lists come with the first pull of the quarter and the
third list comes with the 2nd pull list of the quarter
 For example, in 3QFY2014
 April 14
 One pull list with study interval January 2014
 One pull list (dated 4/15) with study interval February 2014
 May 12
 One pull list with study interval March 2014
 May 27: No HBIPS pull list
Measures

 The Joint Commission measures look at
 Required components of admission screening
 Patients discharged on multiple antipsychotic medications
 Patients discharged on multiple antipsychotic medications
with appropriate justification
 Post-discharge continuing care plan
 Post-discharge continuing care plan transmitted to next
level of care provider
 The measures will be discussed in more detail later in
the presentation
Questions

 Let’s take a look at the questions and important
points in the definition/decision rules
 We will review the questions on the training call, but
please read the definition/decision rules thoroughly
Admission Date and Time

 The first few data elements are familiar to you
 Date and time of admission to inpatient care
 These are auto-filled but can be modified if incorrect
 Date of admission to inpatient psychiatric care
 This element is also auto-filled with the ability to modify
 This date may be different from the original hospital
admission date if the patient was initially admitted to a
unit other than psych then transferred to a psychiatric
unit
 If the patient had multiple admissions to the psychiatric
unit during their hospitalization, enter the date of the
first admission to a psychiatric unit
Discharge Date and Time

 In questions 4 and 5 you will enter the date and time
of discharge from inpatient psychiatric care
 This may also be the date/time the patient was
discharged from acute care, or it could be different if
the patient was transferred to a different unit (not
acute psych)
 If the patient left AMA or expired, use the date of
occurrence
Discharge Date and Time

 Questions 6 and 7 ask for the date of discharge from
the hospital
 The discharge date is auto-filled and cannot be
changed
 May be the same as or different from the date and time
used for questions 4 and 5
 If the patient expired or left AMA, use the date/time
of occurrence
 Review suggested data sources
Pop Quiz #1

 If the patient was in an acute-care hospital and had
multiple admissions to the psychiatric unit during
their hospitalization, which date will you enter to
answer the question psyadmdt (date of admission
to inpatient psychiatric care)?
 A. first admission to the psychiatric unit
 B. last admission to the psychiatric unit
 C. just pick one, it doesn’t matter
The answer is

 A. the first admission to inpatient psychiatric care
Diagnosis Codes

 The ICD-9 principal and other diagnosis codes are
auto-filled in the software
 The codes can be changed but should only be changed
if a code does not match what is in the medical record
 If the principal diagnosis code or one of the other
diagnosis codes is not a code from Table 10.01, the
case is excluded
Discharge Disposition

 Question 10 is the discharge disposition question
that is found in other inpatient instruments
 Answer options and rules are the same
 Note an important change for 3QFY14
 Discharge disposition documentation in the discharge
summary, post-discharge addendum, or a late entry,
may be considered if written within 30 days after
discharge date and prior to pull list date
Inpatient Psychiatric Care

 Q11: Did the patient receive care in an inpatient
psychiatric care setting?
 Answer “yes” if there is documentation in the record
that the patient was receiving care primarily for a
psychiatric diagnosis in an inpatient psychiatric setting
 Psychiatric unit of an acute care hospital
 Free-standing psychiatric hospital
 Psychiatric units that treat patients with both substance
use disorders and psychiatric diagnoses are included in
the HBIPS measures (dual diagnosis patients)
Inpatient Psychiatric Care

 Answer “no” to q11 if the patient with a psychiatric
diagnosis received care in an inpatient unit OTHER than
a psychiatric unit within an acute-care hospital or free
standing psychiatric hospital
 Chemical dependency units that treat patients primarily
for substance use disorders and occasionally psychiatric
diagnoses are excluded from HBIPS measures
 Cases with no documentation that the patient was
receiving care in an inpatient psychiatric setting are
excluded from HBIPS quality measures (go to end)
Pop Quiz #2

 A patient on your pull list was admitted to acute care
on 3/10/2014. His diagnoses include COPD,
Schizophrenia, Alcohol Dependence, BPH, and
Hypokalemia. He was treated on the
medical/surgical floor during his entire stay.
 What is the answer to psycare (Did the patient
receive care in an inpatient psychiatric care setting?)
 1. yes
 2. no
The answer is

 2. No The patient did not receive care in an
inpatient psychiatric setting
 Even if the patient has a psychiatric diagnosis, if
he/she was not treated in an inpatient psychiatric
setting during the stay under review, the case will be
excluded
Admission Screening

 Questions 12 through 17 are questions about admission
screening
 You will be looking for documentation of 5 components
 Two patient strengths
 Psychological trauma history
 Alcohol and substance abuse which occurred in the past
12 months
 Violence risk to others over the past 6 months
 Violence risk to self over the past 6 months
General Notes for Admission
Screening

 Documentation must be by a Psychiatrist,
Psychologist, APN, PA, Master of Social Work
(MSW), or Registered Nurse only
 If a patient had multiple admissions to a psychiatric
unit during their acute hospitalization select the first
admission for abstraction
General Notes for Admission
Screening

 Admission screening must be done within the first 3
days of admission
 The day after admission is considered the first day
 An admission screen performed in an ambulatory
setting, i.e. emergency department, crisis center
which results in an admission to an inpatient
psychiatric care setting, can be used if the screen is
documented in the medical record
Suggested Data Sources for Admission
Screening
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
biopsychological assessment
ED record
functional skills assessment
history and physical
interdisciplinary plan of
care
initial assessment form
nursing notes
physician progress notes
psychiatrist admission form
referral packet
social work assessment
 It is quite likely that
you will not find all the
components in one note
 Be sure to look
carefully at all notes in
the time period and
remember that note
titles can be misleading
Answer Options

 The questions for admission screening components
have these answer options
 1. Yes
 2. No
 X. Unable to complete admission screening
 In order to choose option X there must be
documentation in the medical record that screening for
the component (e.g psychological trauma) cannot be
completed due to the patient’s inability or
unwillingness to answer screening questions within
the first 3 days of admission
Patient Strengths

 Q 12 Is there documentation in the medical record
that the patient was screened for at least two patient
strengths within the first three days of admission?
 Strengths must be identified as such in the
documentation
 You should not interpret something as a patient
strength unless the documentation reflects that
Patient Strengths

 There are several examples of adult and older patient
strengths in the definition/decision rules including:
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Access to housing/residential stability
Steady employment
Financial stability
Awareness of substance use issues
Knowledge of medications
 Patient strengths are not limited to those on the list
Psychological Trauma History

 Q13 Is there documentation in the medical record
that the patient was screened for a psychological
trauma history within the first three days of
admission?
 Traumatic life experiences are defined as those that
result in responses to life stressors characterized by
significant fear, anxiety, panic, terror, dissociation,
feelings of complete powerless or strong emotions
that have long term effects on behaviors and
coping skills
Psychological Trauma History

 Examples of psychological trauma
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Physical, sexual or emotional abuse
victimization, e.g. disasters, criminal activities, identify theft
combat experiences
witnessing others being harmed or victimized
any significant injury or life-threatening disease
significant psycho-social loss, e.g. bankruptcy, traumatic
family loss
 Psychological trauma is not limited to the examples in the
definition/decision rules
Alcohol or Substance Abuse

 Q14 Within the first 3 days of admission, is there
documentation in the medical record that the patient
was screened for alcohol and substance use which
occurred over the past 12 months?
 Substance abuse is defined as the use of psychoactive or mood altering
substances, i.e. prescription medications, over the counter medications,
inhalants, organic substances, illegal substances, and street drugs.
 In order to select “1” (yes) there must be documentation
in the medical record by one of the qualified psychiatric
practitioners that the initial assessment contained a
screening for the use of alcohol and substance abuse
which occurred over the past twelve (12) months.
Alcohol or Substance Abuse

 Documentation of a past history of substance use
must at a minimum state over the past 12 months or
over a longer period of time, i.e., life time history
 Documentation of "no history" cannot be used,
unless the minimum timeframe of 12 months or
longer is specified
Risk of Violence to Others

 Q15 Is there documentation in the medical record
that the patient was screened for violence risk to
others over the past 6 months within the first 3 days
of admission?
 Examples:
 Thoughts of harm to others
 Intentional infliction of harm on someone else by the
patient
 Homicidal thoughts by the patient
Risk of Violence to Self

 Q16 Is there documentation in the medical record that the
patient was screened for violence risk to self over the past
6 months within the first 3 days of admission?
 Examples of violence risk to self
 Past suicide attempts by the patient
 Intentional cutting, burning, bruising or damaging of self by
the patient
 Inappropriate substance use
 Suicidal thoughts in the past six months by the patient
 Specific suicide plan in the past six months by the patient
 Past suicide attempts by anyone in the patient’s family
Date Screening Completed

 Q 17 Enter the date the admission screening was
completed (all components must be included)
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Two patient strengths
Psychological trauma
Alcohol/substance use
Risk of violence to self
Risk of violence to others
 You may find components documented by different
providers in different notes, so enter the date the last
component was completed
 If any component was not found, the screening was not
complete and the date will be auto-filled as 99/99/9999
Pop Quiz #3

 True or False: All five components of admission
screening must be documented within the first three
days of admission but may be in different notes and
by different providers.
 The correct answer is
 True
Admission Screening Measure

 Ips1: Admission Screening - violence risk to self or
others, substance use, psychological trauma history,
and patient strengths completed
 Ips1a: overall rate
 Ips1b: Adult (18-64 years)
 Ips1c: Older Adult (>= 65 years)
Ips1 Denominator

 All cases are included except:
 The length of stay is <= 3 or >365 days
 The patient did not receive care in an inpatient psychiatric
setting
 Patients for whom there is inability to complete screening
within the first three days of admission for all of the following:
 Two patient strengths
 Psychological trauma history
 Alcohol and substance abuse that occurred over the past 12
months
 Violence risk to others over the past 6 months
 Violence risk to self over the past 6 months
 Patients age <18 and>64 are excluded from ips1b
 Patients age <65 are excluded from ips1c
ips1Numerator

 A case will pass if:
 There is documentation that the patient was screened
within 3 days of admission for at least one of the 5
components
AND
 There is documentation that the patient was screened
or was unable to complete admission screening within
3 days of admission for the remaining components
Next…..

 After you have entered the date the admission
screening was completed, if the patient expired
(dcdispo=6) the review will end.
 Otherwise, on to question 18
Referral to Next Level of Care
Provider

 Q18 Please read this question, the answer options and
the rules very carefully
 Is there documentation in the medical record that the
patient was referred to the next level of care provider
upon discharge from a hospital based inpatient
psychiatric setting? Select one option
 The intent of this question is to determine whether the
patient was referred to the next level of care provider upon
discharge from the hospital based inpatient psychiatric
setting
 If the patient was in an acute care hospital and had multiple
admissions to the psychiatric unit during the
hospitalization, only abstract this information at the time of
discharge from the hospital
Option 1 Referred to Next Level of Care Provider

 Select option 1 if the medical record contains documentation that the
patient was referred to the next level of care provider upon discharge
from the inpatient psych setting
 The next level of care providers include:
 Prescribing inpatient or outpatient clinician: the clinician who is
responsible for managing the patient’s medication regime after hospital
discharge
 Prescribing inpatient or outpatient entity: the hospital or clinic that is
responsible for managing the patient’s medication regime after hospital
discharge
 Treating inpatient or outpatient clinician: the clinician who is responsible
for the primary treatment of the patient in the absence of medications
 Treating inpatient or outpatient entity: the hospital or clinic that is
responsible for the primary treatment of the patient in the absence of
medications
Clinicians

 Examples of inpatient and outpatient clinicians
include but are not limited to:
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primary care physician
psychiatrist
advanced practice nurse (APN)
physician assistant (PA)
Master of Social Work (MSW)
psychologist
Option 2: Refusal of Referral

 If the patient or guardian refuses a referral to the
next level of care provider or refuses to authorize
release of information select answer option 2
 Note: if a patient signs out against medical advice
(AMA) the patient should still be offered a referral to
the next level of care provider
Refrnext option 3

 Select option 3 when
 The medical record contains documentation that the
patient eloped OR failed to return from leave and was
discharged OR was discharged from the hospital from
a setting other than a Psychiatric Care setting to
another level of care outside of the hospital system.
 Note that signing out AMA is not the same as an
elopement
 There is documentation a patient is released from a
psychiatric inpatient stay directly after a court hearing
Refrnext option 4

 Select option 4 when:
 The medical record contains documentation that the
patient was NOT referred to the next level of care
provider upon discharge from a hospital based
inpatient psychiatric setting for a reason other than
options 1 – 3.
 If the patient was not referred to the next level of
care provider upon discharge, review the
documentation to determine if there is
documentation of a reason why the patient was not
referred
Refrnext option 5

 Use option 5 when
 The medical record does not contain documentation
that the patient was referred to the next level of care
provider upon discharge from a hospital based
inpatient psychiatric setting OR unable to determine
from the medical record
 If the patient checks out AMA and is not offered a
referral to next level of care provider, select “5.”
Pop Quiz # 4

 The patient signed out AMA. There is no
documentation in the medical record that indicates
the patient was offered a referral to the next level of
care provider. What is the correct answer to
refrnext?
 Option 2
 Option 3
 Option 5
The answer is

 Option 5
 If the patient checks out AMA and is not offered a
referral to next level of care provider, select “5.”
Scheduled Antipsychotics at Discharge

 Q19 asks for the documented number of scheduled
antipsychotic medications prescribed for the patient
at discharge
 If the patient was in an acute-care hospital and had
multiple admissions to the psychiatric unit during
the hospitalization, only abstract this information
at the time of discharge from the hospital.
 Do not include prn antipsychotic medications
Antipsychotic Medications

 An antipsychotic medication is defined as any group
of drugs, such as the phenothiazines,
butyrophenones, or serotonin-dopamine antagonists,
which are used to treat psychosis.
 An antipsychotic medication is also called a
neuroleptic.
Antipsychotic Medications

 Refer to Joint Commission Appendix B Table 10.0
for a list of antipsychotic medications
 Some examples of antipsychotics:
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aripiprazole (Abilify)
haldol (Haloperidol)
thioridazine (Mellaril)
thiothixene (Navane)
olanzapine (Zyprexa)
risperidone (Risperdal)
trifluoperazine (Stelazine)
Number of scheduled antipsychotic meds

 If the patient is on two forms of the same medication (i.e.,
PO and IM) this would be counted as one antipsychotic
medication.
 If unable to determine the number of scheduled
antipsychotic medications that were prescribed for the
patient at discharge, enter default zz.
 Exclude:
 PRN antipsychotic medications
 short acting intramuscular antipsychotic medications such
as haldol injectable short acting
 Refer to JC Appendix B, Table 10.1 for short acting IM
antipsychotics
ONLY Acceptable Sources

 The following are the only acceptable sources for
documentation of number of scheduled antipsychotic
medications prescribed at discharge
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aftercare discharge plan
continuing care plan
discharge plan
final discharge summary
interim discharge summary
physician discharge orders
physician progress notes
referral form
More than one antipsychotic

 If the patient was discharged on two or more
antipsychotic medications you will go to question 20
 Is there documentation in the medical record of
appropriate justification for discharging the patient
on two or more routine antipsychotic medications?
 If the patient was in an acute-care hospital and had
multiple admissions to the psychiatric unit during
their hospitalization, only abstract this information
at the time of discharge from the hospital.
Q20 Justification for two or more

 Answer option 1:
 The medical record contains documentation of a
history of a minimum of three failed multiple trials of
monotherapy
 Failed multiple trials of antipsychotic monotherapy is
defined as a history of three or more failed trials in
which there was a lack of sufficient improvement in
symptoms or functioning
 The documentation should include at a minimum the
names of the antipsychotic medications that previously
failed
Q20 Justification for two or
more
 Answer option 2

 The medical record contains documentation of a
recommended plan to taper to monotherapy due to
previous use of multiple antipsychotic medications OR
documentation of a cross-taper in progress at the time of
discharge
 A cross-taper plan is defined as a plan to decrease the
dosage of one or more antipsychotic medication while
increasing the dosage of another antipsychotic medication
to a level which results in controlling the patient’s
symptoms with one antipsychotic medication
 The cross-taper plan must list the name(s) of the
medications intended to increase and the name(s) of the
medications to be tapered
Plan to Taper

 The recommended plan to taper to monotherapy
must appear in the continuing care plan
transmitted to the next level of care provider
 If an addendum about the recommended plan to
taper to monotherapy is added to the continuing care
plan in the medical record, it must occur within 5
days after discharge or prior to transmission of the
continuing care plan
Q20 Justification for two or more

 Answer option 3
 The medical record contains documentation of
augmentation of Clozapine
 Augmentation of Clozapine = adding another
antipsychotic medication in addition to the clozapine.
Usually done when the patient is still experiencing
disabling psychiatric symptoms despite use of clozapine.
Q20 Justification for two or more

 Answer option 4: Documentation of another
justification other than option 1 – 3
 Answer option 5: The medical record does not
contain documentation supporting the reason for
being discharged on two or more antipsychotic
medications OR unable to determine from medical
record documentation
Q20 Justification for two or more

 All justifications other
than the recommended
plan to taper
monotherapy may be
documented anywhere
in the medical record
 Suggested data sources:
Aftercare discharge plan
continuing care plan
discharge plan
final discharge summary
history and physical
interim discharge summary
medication reconciliation
form
 physician discharge orders
 physician progress notes
 referral form
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Pop Quiz #5
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 The discharge summary lists the following
medications at discharge:
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Quetiapine tablets 1 daily
Clozapine tablets 1 daily at bedtime
Haldol short-acting IM once weekly
Tenazepam daily
Pop Quiz #5
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 How many scheduled antipsychotic medications was
the patient prescribed at discharge?
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0
1
2
3
4
 The answer is 2 (quetiapine and clozapine)
ips4

 Ips4: discharged on multiple antipsychotic
medications
 Ips4a: overall rate
 Ips4b: Adult (18-64 years)
 Ips4c: Older Adult (>= 65 years)
 This is a “lower is better” measure
ips4 Denominator

 All cases are included in the denominator except:
 Patients who expired
 Patients who did not receive care in an inpatient
psychiatric setting
 Patients who eloped or failed to return from leave and
were discharged
 The number of antipsychotic medications is 0
 Patients age <18 and>64 are excluded from ips4b
 Patients age <65 are excluded from ips4c
ips4 Numerator

 Cases included in the numerator:
 Those cases with documentation that the patient was
prescribed >=2 antipsychotic medications at discharge
OR
 The number of antipsychotic medications prescribed
at discharge was unable to be determined (zz)
 Remember: Lower is better for this measure!!
ips6

 Multiple antipsychotic medications at discharge with
appropriate justification
 Ips6a: overall rate
 Ips6b: Adult (18-64 years)
 Ips6c: Older Adult (>= 65 years)
ips6 Denominator

 The denominator includes all cases except:
 The length of stay for this admission is <=3 days
 Patient who did not receive care in an inpatient
psychiatric setting
 Patients who expired
 Patient who eloped or failed to return from leave and
was discharged
 The number of antipsychotic medications is <2
 Patients age <18 and>64 are excluded from ips6b
 Patients age <65 are excluded from ips6c
Ips6 Numerator

 Cases will be included in the numerator if:
 The number of antipsychotics prescribed at
discharge is documented and is >=2 and one of the
following
 There is documentation of a history of a minimum of 3
failed multiple trials of monotherapy OR
 There is documentation of a recommended plan to
taper to monotherapy due to previous use of multiple
antipsychotic medications or documentation of a cross
taper in progress at the time of discharge OR
 There is documentation of augmentation of clozapine
Next……

 If the patient refused the next level of care provider
or refused to authorize release of information (i.e
refrnext=2), abstraction is complete and you go to
the end of the instrument
 Otherwise, you will go on to questions about the
continuing care plan
Continuing Care Plan

 For questions 21-32 you will abstract information about
the continuing care plan
 A continuing care plan may consist of one document or
several documents which could be considered a
continuing care packet
 If the patient was in an acute care hospital and had
multiple admissions to the psychiatric unit during the
hospitalization, only abstract this information at the
time of discharge from the hospital or at the time of
final discharge from the psychiatric unit.
Continuing Care Plan

 The VAMC must be able to identify which document(s)
make up the continuing care plan and the hospital must
identify what specific documents are transmitted to the
next level of care provider within the required timeframe
 If the continuing care plan is not titled as such,
please ask the liaison to identify which documents
make up the continuing care plan
Required Timeframe

 The required timeframe for transmitting the
continuing care plan to the next level of care
provider is no later than the fifth post-discharge
day
 The first post-discharge day is defined as the day
after discharge
 If an addendum about any of the components is
added to the continuing care plan in the medical
record, it must occur within 5 days after discharge
or prior to transmission of the continuing care plan.
Methods for Transmitting

 Methods for transmitting the post-discharge
continuing care plan include, but are not limited to:
FedEx, CPRS access, ambulance transport
personnel
 If the next level of care provider has access to the
complete electronic medical record (i.e. CPRS), that
is considered transmission of the continuing care
plan
 Giving a copy of the continuing care plan to the
patient does not comprise transmission.
Follow up with more than one
clinician

 If the patient has referrals to more than one clinician or
entity for follow-up, the order of precedence for
transmission of the continuing care plan is listed below:
 Follow-up prescribing inpatient or outpatient clinician or
entity: the clinician, hospital, or clinic that is responsible for
managing the patient’s medication regime after hospital
discharge.
 Treating inpatient or outpatient clinician or entity: the
clinician, hospital, or clinic that is responsible for the
primary treatment of the patient in the absence of
medications.
Four Parts of Continuing Care
Plan

 You will look for 4 parts of the continuing care plan
and whether each was transmitted to the next level
of care provider no later than the 5th post-discharge
day
 You will also enter the date that the continuing care
plan containing each component was transmitted to
the next level of care provider
 Q21-23 ask about the principal discharge diagnosis
Reason for Hospitalization

 Q24-26 ask about the reason for hospitalization
 The reason for hospitalization should be a short
synopsis describing the events the patient experienced
prior to this hospitalization.
 The reason for hospitalization may be listed as the
triggering or precipitating event.
Discharge Medications

 Q27-29 ask about discharge medications
 All medications must have the names, dosage and indications
for use listed in the continuing care plan
 The indications for use can be as short as one or two words,
but must be present for all medications, not just psychotropic
medications
 Include routinely scheduled medications and PRN
medications
 Medications include prescription medications, sample
medications, herbal remedies, vitamins, nutriceuticals, and
over the counter drugs and any product designated by the
FDA as a drug
 If no medications were prescribed at discharge, the
continuing care plan should state that
Next level of care recommendations

 Next level of care recommendations may include,
but are not limited to:
 appointment with next level of care clinician or clinic
 Axis III follow-up
 Axis III of DSM IV is for medical and neurological
conditions that may influence a psychiatric problem
 social work and benefits follow-up
 pending legal issues
 peer support, i.e. Alcoholics Anonymous, Narcotics
Anonymous
 home-based services
Pop Quiz #6

 Which of the following is not a required component
of the continuing care plan
 Discharge medications with dosage and indications
for use or states no discharge medication
 Risk of harm to self or others
 Principal diagnosis
 The reason for hospitalization
 The answer is: Risk of harm to self or others
Ips7

 Post discharge continuing care plan documented
 Ips7a: overall rate
 Ips7b: Adult (18-64 years)
 Ips7c: Older Adult (>= 65 years)
ips7 Denominator

 All cases are included in the denominator except:
 Patients who expired
 Patients who did not receive care in an inpatient
psychiatric setting
 Patients who eloped or failed to return from leave and
was discharged OR
 The patient or guardian refused the next level of care
provider upon discharge, or refused to authorize
release of information
 Patients age <18 and>64 are excluded from ips7b
 Patients age <65 are excluded from ips7c
ips7 Numerator

 Cases will pass if:
 All of the following
 The medical record contains a continuing care plan which
includes the principal discharge diagnosis
 The medical record contains a continuing care plan which
includes the reason for hospitalization
 The medical record contains a continuing care plan which
includes the discharge medications with dosage and
indications for use OR states no medication were prescribed
at discharge
 The medical record contains a continuing care plan which
includes next level of care recommendations
ips5

 Post discharge continuing care plan transmitted to
next level of care provider
 Ips5a: overall rate
 Ips5b: Adult (18-64 years)
 Ips5c: Older Adult (>= 65 years)
ips5 Denominator

 Includes all cases except:
 Discharge date is prior to 01/01/2013
 Patients who expired
 Patients who did not receive care in an inpatient psychiatric
setting
 Patients who eloped or failed to return from leave and was
discharged OR
 The patient or guardian refused the next level of care
provider upon discharge, or refused to authorize release of
information
 Patients age <18 and>64 are excluded from ips5b
 Patients age <65 are excluded from ips5c
ips5 Numerator

 Cases that will pass:
 All of the following:
 There is documentation the continuing care plan included the
principal diagnosis and was transmitted to the next level of care
provider no later than the 5th post-discharge day
 There is documentation the continuing care plan included the
reason for hospitalization and was transmitted to the next level of
care provider no later than the 5th post-discharge day
 There is documentation the continuing care plan included the
discharge medications with indications and dosage or states no
medications were prescribed at discharge and was transmitted to
the next level of care provider no later than the 5th post-discharge
day
 There is documentation the continuing care plan included next
level of care recommendations and was transmitted to the next
level of care provider no later than the 5th post-discharge day
cod9

 Coded mental disorder with documentation in the
record to support the diagnosis code as related to
the PM system
 Denominator includes all cases with discharge dates
>= 1/1/2014
 Numerator includes cases with principal diagnosis
code from Table 10.01 or other diagnosis code from
Table 10.01
Ask questions!

 An exit report guide is provided each quarter to help
you understand the exit report
 Please be sure to ask questions as needed about the
instrument or the exit report
 HBIPS is part of inter-rate reliability assessment
 We will provide feedback about areas that may need
clarification based on IRR scores
 Please remember that an accurate review helps the
facility know where improvements/changes are
needed