Attachment O: Completion Guide for LTC Clinical Outcomes Data

Form Approved
OMB No. 0935-XXXX
Exp. Date XX/XX/20XX

Attachment O: Completion Guide for LTC Clinical Outcomes Data

COMPLETION GUIDE FOR CLINICAL OUTCOMES DATA COLLECTION FORM – Long-Term Care

1. Transfer of facility resident(s) to an acute care hospital, with reason (suspected or confirmed infection/not-infection) - monthly

• Count how many residents in the participating facility were transferred to an acute care hospital for the reason of a suspected or confirmed infection and how many were transferred to an acute care hospital for a reason OTHER THAN a suspected or confirmed infection for the month for which you are reporting data.

• On each row of the table:

  • In the first column, select the appropriate month and year for which you are reporting data from the dropdown menu.

  • In the second column, enter the number (count) of residents of the participating facility who were transferred to an acute care hospital for a given reason in the month and year for which you are reporting data.

  • In the third column, select the reason that the resident(s) were transferred to an acute care facility (suspected or confirmed infection versus a reason OTHER THAN a suspected or confirmed infection) cases from the dropdown menu.

2. All-cause Bacteremia with organisms – monthly

1. All-cause bacteremia is defined as a positive blood culture growing any organism from any cause (including contaminants and repeat positive blood cultures) sent from the participating facility and taken on day 3 or later after facility admission. If there are multiple positive cultures from the same individual, each culture with a positive result counts towards the all-cause bacteremia total.

2. The all-cause bacteremia rate is defined as the number of all-cause bacteremia events divided by the number of resident days in a participating facility in a specified time period.

• Count how many confirmed all-cause bacteremia events were caused by each organism on the list of organisms on Page 3 of the Attachment L: Clinical Outcomes Data for LTC in the participating facility for the month for which you are reporting data.

• On each row of the table:

  • In the first column, select the appropriate month and year for which you are reporting data from the dropdown menu.

  • In the second column, enter the number (count) of all-cause bacteremia cases caused by a given organism.

  • In the third column, select the specific organism that was identified to cause the reported all-cause bacteremia cases from the dropdown menu.

  • For all-cause bacteremia cases caused by multiple organisms (polymicrobial bacteremia), count the all-cause bacteremia only once as MRSA or MSSA if either of these grew in the blood culture. If the all-cause bacteremia was polymicrobial and both MRSA and MSSA grew in the blood culture, count the all-cause bacteremia only once and choose “MRSA” from the organism dropdown list. If the all-cause bacteremia was polymicrobial but neither MRSA nor MSSA grew in the blood culture, count the all-cause bacteremia only once and choose “polymicrobial” from the organism dropdown list.

3. Resident days – monthly

   1. Resident days: The cumulative number of days that each resident spent in the participating facility during a month for which you are reporting data. Each of these days contributes to the exposure risk for MRSA and other multidrug-resistant organisms.

   2. The date the patient is admitted to and physically locates to the participating facility is counted as day 1. Non-consecutive resident days should be included and added to the cumulative total for each month in which the resident days occurred.

• Count how many resident days occurred in the participating facility for the month for which you are reporting data.

• On each row of the table:

  • In the first column, select the appropriate month and year for which you are reporting data from the dropdown menu.

  • In the second column, enter the number (count) of resident days for the participating facility for the specified time period.