10432 Web-based Measure Online Data Entry Tool Content

Inpatient Psychiatric Facility Quality Reporting Program

Data collection

Inpatient Psychiatric Facility Quality Reporting Program

OMB: 0938-1171

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Inpatient Psychiatric Facility Quality Reporting (IPFQR) Program

Web-based Measure

Online Data Entry Tool Content


HBIPS-2 Hours of Physical Restraint Use

NShape2 Shape1 UMERATOR Q4 2012 Q1 2013

PShape4 Shape3 lease enter the total number of hours that all psychiatric 1-12 years old

pShape6 Shape5 atients were in physical restraints for each age group. 13-17 years old

Shape8 Shape7 18-64 years old

65 and over



DShape10 Shape9 ENOMINATOR Q4 2012 Q1 2013

PShape12 Shape11 lease enter the number of inpatient psychiatric days 1-12 years old

fShape14 Shape13 or each age group. 13-17 years old

(Shape16 Shape15 convert days to hours) 18-64 years old

65 and over

NOTE: Denominator basis is per 1,000 hours.

Shape18 Shape17 Q4 2012 Q1 2013

Shape20 Shape19 Measure rates of physical restraint use per inpatient 1-12 years old

pShape22 Shape21 sychiatric day for each age group. 13-17 years old

Shape24 Shape23 18-64 years old

Shape26 Shape25 65 and over

Overall

NOTE: Measure rates will be auto calculated from above entries.









HBIPS-3 Hours of Seclusion Use

NShape28 Shape27 UMERATOR Q4 2012 Q1 2013

PShape30 Shape29 lease enter the total number of hours that all psychiatric 1-12 years old

pShape32 Shape31 atients were in seclusion for each age group. 13-17 years old

Shape34 Shape33 18-64 years old

65 and over



DShape36 Shape35 ENOMINATOR Q4 2012 Q1 2013

PShape38 Shape37 lease enter the number of inpatient psychiatric days 1-12 years old

fShape40 Shape39 or each age group. 13-17 years old

Shape42 Shape41 18-64 years old

65 and over



Shape44 Shape43 Q4 2012 Q1 2013

MShape46 Shape45 easure rates of seclusion use per inpatient psychiatric day 1-12 years old

fShape48 Shape47 or each age group. 13-17 years old

Shape50 Shape49 18-64 years old

Shape52 Shape51 65 and over

Overall

NOTE: Measure rates will be auto calculated from above entries.











HBIPS-4 Patients Discharged on Multiple Antipsychotic Medications

NShape54 Shape53 UMERATOR Q4 2012 Q1 2013

PShape56 Shape55 lease enter the number of psychiatric patients discharged 1-12 years old

oShape58 Shape57 n multiple antipsychotic medications for each age group. 13-17 years old

Shape60 Shape59 18-64 years old

65 and over



DShape62 Shape61 ENOMINATOR Q4 2012 Q1 2013

PShape64 Shape63 lease enter the total number of psychiatric patients 1-12 years old

dShape66 Shape65 ischarged for each age group. 13-17 years old

Shape68 Shape67 18-64 years old

65 and over



Shape70 Shape69 Q4 2012 Q1 2013

MShape72 Shape71 easure rates of psychiatric patients who were discharged 1-12 years old

oShape74 Shape73 n multiple antipsychotic medications for each age group. 13-17 years old

Shape76 Shape75 18-64 years old

Shape78 Shape77 65 and over

Overall

NOTE: Measure rates will be auto calculated from above entries.













HBIPS-5 Patients Discharged on Multiple Antipsychotic Medications with Appropriate Justification

NShape80 Shape79 UMERATOR Q4 2012 Q1 2013

PShape82 Shape81 lease enter the number of psychiatric patients discharged 1-12 years old

oShape84 Shape83 n two or more multiple antipsychotic medications 13-17 years old

for each age group. Shape86 Shape85 18-64 years old

65 and over



DShape88 Shape87 ENOMINATOR Q4 2012 Q1 2013

PShape90 Shape89 lease enter the total number of psychiatric patients 1-12 years old

dShape92 Shape91 ischarged for each age group. 13-17 years old

Shape94 Shape93 18-64 years old

65 and over



Shape96 Shape95 Q4 2012 Q1 2013

MShape98 Shape97 easure rates of psychiatric patients who were discharged 1-12 years old

oShape100 Shape99 n multiple antipsychotic medications with appropriate 13-17 years old

jShape102 Shape101 ustification for each age group. 18-64 years old

Shape104 Shape103 65 and over

Overall

NOTE: Measure rates will be auto calculated from above entries.







HBIPS-6 Patients Discharged from a Hospital-based Inpatient Psychiatric Setting with a Continuing Care Plan Created

NShape106 Shape105 UMERATOR Q4 2012 Q1 2013

PShape108 Shape107 lease enter the number of psychiatric patients for whom 1-12 years old

tShape110 Shape109 he post discharge continuing care plan is created and contains 13-17 years old

aShape112 Shape111 ll of the following: reason for hospitalization, principal 18-64 years old

discharge diagnosis, discharge medications, and next level of 65 and over

care.



DShape113 ENOMINATOR Q4 2012 Q1 2013

PShape116 Shape115 Shape114 lease enter the total number of psychiatric patients 1-12 years old

dShape118 Shape117 ischarged for each age group. 13-17 years old

Shape120 Shape119 18-64 years old

65 and over



Shape121 Q4 2012 Q1 2013

Measure rates of psychiatric patients who were discharged 1-12 years old

from a hospital-based inpatient psychiatric setting 13-17 years old

with a Continuing Care Plan Created for each age group. 18-64 years old

65 and over

Overall

NOTE: Measure rates will be auto calculated from above entries.







HBIPS-7 Patients Discharged from a Hospital-based Inpatient Psychiatric Setting with a Continuing Care Plan Provided to the Next Level of Care Clinician or Entity.

NShape123 Shape122 UMERATOR Q4 2012 Q1 2013

PShape125 Shape124 lease enter the number of psychiatric patients for whom 1-12 years old

tShape127 Shape126 he post discharge continuing care plan was transmitted 13-17 years old

tShape129 Shape128 o the next level of care. 18-64 years old

65 and over



DShape130 ENOMINATOR Q4 2012 Q1 2013

PShape133 Shape132 Shape131 lease enter the total number of psychiatric patients 1-12 years old

dShape135 Shape134 ischarged for each age group. 13-17 years old

Shape137 Shape136 18-64 years old

65 and over



Shape138 Q4 2012 Q1 2013

Measure rate of psychiatric patients who were discharged 1-12 years old

from a hospital-based inpatient psychiatric setting 13-17 years old

with a continuing care plan provided to the next level of care 18-64 years old

fShape140 Shape139 or each age group. 65 and over

Overall

NOTE: Measure rates will be auto calculated from above entries.

PRA Disclosure Statement
According to the Paperwork Reduction Act of 1995, no persons are required to respond to a collection of information unless it displays a valid OMB control number. The valid OMB control number for this information collection is 0938-XXXX . The time required to complete this information collection is estimated to average 10 minutes per response, including the time to review instructions, search existing data resources, gather the data needed, and complete and review the information collection. If you have comments concerning the accuracy of the time estimate(s) or suggestions for improving this form, please write to: CMS, 7500 Security Boulevard, Attn: PRA Reports Clearance Officer, Mail Stop C4-26-05, Baltimore, Maryland 21244-1850.

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AuthorCMS
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File Created2021-01-30

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