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Assisted Living Community Measures
Table of Contents
Acknowledgment and Conditions of Use
Introduction
Using the Manual for Assisted Living Community Measures
Measure Sets
Section 1: Measure Information Forms
Assisted Living Community (ALC)
ALC-1
ALC-2
ALC-3
ALC-4
ALC-5
Section 2: Data Dictionary
Introduction to the Data Dictionary
Alphabetical List of Data Elements
Section 3: Overview of Measure Information Form and Flowchart Formats
Overview of Measure Information Form and Flowchart Formats
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Acknowledgement
No royalty or use fee is required for copying or reprinting this manual, but the following are required as
a condition of usage: 1) disclosure that the
Specications Manual
is periodically updated, and that the
version being copied or reprinted may not be up-to-date when used unless the copier or printer has
veried the version to be up-to-date and afrms that, and 2) users participating in Joint Commission
accreditation, including vendors assisting hospitals, are required to update their software and associ-
ated documentation based on the published manual production timelines.
Example Acknowledgement: The Assisted Living Community (ALC) Specications Manual [Version xx,
Month, Year] is periodically updated by The Joint Commission. Users of the ALC Manual must update
their software and associated documentation based on the published manual production timelines.
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Introduction and Background
The Joint Commission Quality Initiative
In 1987, The Joint Commission announced its
Agenda for Change
, which outlined a series of major
steps designed to modernize the accreditation process. A key component of the
Agenda for Change
was the eventual introduction of standardized core performance measures into the accreditation
process. As the vision to integrate performance measurement into accreditation became more focused,
the name ORYX® was chosen for the entire initiative. ORYX® is The Joint Commission's performance
measurement and improvement initiative, which integrates outcomes and other performance measure
data into the accreditation process.
The ORYX® initiative became operational in March of 1999, when performance measurement systems
began transmitting data to The Joint Commission on behalf of accredited hospitals. ORYX® measure-
ment requirements are intended to support Joint Commission accredited organizations in their quality
improvement efforts.
The initial phase of the ORYX® initiative provided healthcare organizations a great degree of exibility
in terms of the measures that could be reported. Over time, the ORYX® measures have evolved into
standardized valid, reliable, and evidence-based quality measures
Related Joint Commission Activities
Accreditation Process
In January 2000, Joint Commission surveyors began using organization-specic ORYX®
Pre-Survey
Reports
, effectively commencing the use of performance measure data in the survey process.
In 2004, the survey process was substantially modied to be more data-driven and patient-centered
thus enhancing its value, relevance, and credibility. Many of the key components of the survey process
utilize data derived from the national hospital inpatient quality measures. The survey process now has
a greater focus on evaluating actual care processes because patients are traced through the care, treat-
ment and/or services they receive. In addition, surveyors conduct “systems tracers” to analyze key op-
erational systems that directly impact the quality and safety of patient care.
In June 2010 The Joint Commission categorized its process core performance measures into account-
ability and non-accountability measures. This approach placed more emphasis on an organization's
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performance on accountability measures — quality measures that meet four criteria designed to iden-
tify measures that produce the greatest positive impact on patient outcomes when hospitals demon-
strate improvement:
Research: Strong scientic evidence demonstrates that performing the evidence-based care
process improves health outcomes (either directly or by reducing risk of adverse outcomes).
Proximity: Performing the care process is closely connected to the patient outcome; there are
relatively few clinical processes that occur after the one that is measured and before the im-
proved outcome occurs.
Accuracy: The measure accurately assesses whether or not the care process has actually been
provided. That is, the measure should be capable of indicating whether the process has been
delivered with sufcient effectiveness to make improved outcomes likely.
Adverse Effects: Implementing the measure has little or no chance of inducing unintended ad-
verse consequences.
In 2021, The Joint Commission released the Assisted Living Community accreditation program and ap-
plied the same approach to selecting performance measures for the assisted living community setting.
Direct Data Submission Platform
The Joint Commission began accepting direct data submission of clinical quality measure data from or-
ganizations with the submission of calendar year (CY) 2017. The Direct Data Submission Platform en-
ables an ORYX measure submission process that simplies operations and reduces the burden for our
accredited organizations while ensuring regulatory compliance and security.
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Using The Specications Manual for Joint
Commission Assisted Living Community
Quality Measures
This portion of
The Assisted Living Community (ALC) Specications Manual
provides a brief overview
of the information contained within each section of the manual. It is intended for use as a quick refer-
ence to assist in the implementation of the Joint Commission ALC quality measures. The sections of
this manual are interrelated and are most useful when considered together.
Measures listed in this manual are chart-abstracted measures. Chart abstraction is the review of medi-
cal record documentation from the current episode of care for the purposes of data collection and sub-
mission. The Joint Commission ORYX performance measure reporting requirements are available on
the Joint Commission website under the Measurement tab.
Section 1: Measurement Information
The measure set sections contain specic measure information forms for each measure. This is fol-
lowed by a data element list for the measures, including the general data elements, algorithm output
data elements, and the specic measure data elements. Next is a document that describes the initial pa-
tient population and sample size requirements for each measure set. Also included are subsections for
each specic measure. These contain a Measure Information Form (MIF) and the Performance
Measure Algorithm.
The algorithms and data elements needed to calculate each of the ALC measures are identied in the
MIF. Each algorithm provides the logical steps, data element evaluation, arithmetic calculations, and
data manipulation steps that are required to calculate a given measure.
Section 2: Data Dictionary
The Data Dictionary describes the resident-level and facility-level data elements required to capture
and calculate individual measurements. It species those data elements that must be collected for each
resident that falls into the selected measure population and the data elements needed for a specic
measure.
Section 3: Overview of Measure Information Form and Flowchart Formats
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The Overview of Measure Information Form and Flowchart Formats explains each of the terms used on
the Measure Information Form and provides a brief introduction to owcharting, including an explana-
tion of owchart symbols. Each measure and has an associated Measure Information Form and
Flowchart (calculation algorithm).
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Assisted Living Community (ALC)
Set Measures
Set Measure ID Measure Short Name
ALC-01 Off-Label Antipsychotic Drug Use
ALC-02 Resident Falls
ALC-03 Resident Preferences and Goals of Care
ALC-04 Advanced Care Plan/ Surrogate Decision Maker
ALC-05 Staff Stability
Measure Set Specic Data Elements
Element Name Collected For
Advanced Care Plan/Surrogate Decision Maker ALC-04
Assisted Living Community Resident ALC-01, ALC-02
Fall With Transfer to Hospital ALC-02
New Resident ALC-03, ALC-04
Number of Direct Care Staff Employed ALC-05
Number of Direct Care Staff Positions ALC-05
Number of Positions ALC-05
Number of Staff Employed ALC-05
Off-Label Antipsychotic Drug Prescribed ALC-01
Resident Preferences and Goals of Care ALC-03
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Related Materials
Document Name
Acknowledgement
Appendix E - Overview of Measure Information Form and Flowchart Formats
Cover Page for Assisted Living Community Manual
Data Dictionary
Introduction to the Manual
Table of Contents
Using the The Joint Commission's Assisted Living Community Measures
Assisted Living Community Initial Population
To improve the quality of life for residents, accredited communities will abstract ve standardized per-
formance measures. The measures will allow organizations to track care provided to their residents
and improve on that care, where needed.
There are three populations that will be used to determine the initial population for the measure set:
total residents, new residents and number of staff positions. The measures with their corresponding
denominator population are listed in the table below.
Assisted Living Community Standardized Performance Measures
Measure
Number
Measure Name Denominator Population
ALC-01 Off-Label Antipsychotic Drug Use Total Residents
ALC-02 Resident Falls Total Residents
ALC-03 Resident Preferences and Goals of Care New Residents
ALC-04 Advanced Care Plan/ Surrogate Decision
Maker
New Residents
ALC-05 Staff Stability * Number of Positions
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Measure
Number
Measure Name Denominator Population
* Number of direct care staff
positions
Sampling / Sample Size Requirements
Sampling is not allowed for this measure set.
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Measure Information Form
Measure Set: Assisted Living Community (ALC)
Set Measure ID: ALC-01
Performance Measure Name: Off-Label Antipsychotic Drug Use
Description: Residents with an off-label antipsychotic drug prescribed.
Rationale:
Nearly two out of ve individuals in assisted living are living with some type of dementia.
For these individuals and as illness progresses, behavior often becomes a key form of communication.
This can be challenging for families and staff, and too often, antipsychotic medication is used in an at-
tempt to modify behavior.
The use of antipsychotic medication to treat behavior associated with dementia is not supported clini-
cally and is considered off-label by the FDA, which issued a “black box” warning for the elderly with de-
mentia. They increase the risk of death, falls and fractures, hospitalizations, and other complications
resulting in poor health and high costs. Additionally, antipsychotic drugs are expensive, costing
Medicare hundreds of millions. American Health Care Association/National Center for Assisted Living
(AHCA/NCAL). https://www.ahcancal.org/ncal/quality/qualityinitiative/Pages/Antipsychotics.aspx
Type Of Measure: Process
Improvement Noted As: Decrease in the rate
Numerator Statement: Number of residents with an off-label antipsychotic drug prescribed.
Included Populations: Not applicable
Excluded Populations: Not applicable
Data Elements:
Off-Label Antipsychotic Drug Prescribed
Denominator Statement: Number of residents who resided in the community on the last day of the
month.
Included Populations: Not applicable
Excluded Populations: Not applicable
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Data Elements:
Assisted Living Community Resident
Risk Adjustment: No.
Data Collection Approach:
Denominator: The total number from the data element
Assisted Living Community Resident
is the
Denominator.
This number will be entered into the Direct Data Submission Platform (DDSP) tool.
Numerator: Count number of residents with a Yes to
Off-Label Antipsychotic Drug Prescribed
; the to-
tal number is the numerator.
This number will be entered into the Direct Data Submission Platform (DDSP) tool.
Example: You are abstracting cases for the month of June. On June 30th there are 35 residents living at
the assisted living community. Your denominator will be 35. When you look back through the 35
resident’s records, there were 2 residents that were prescribed an antipsychotic for off-label use. Your
numerator will be 2.
Denominator = 35
Numerator = 2
Data Accuracy: N/A
Measure Analysis Suggestions: None
Sampling: No.
Data Reported As: Aggregate rate generated from count data reported as a proportion.
Selected References:
• American Health Care Association/National Center for Assisted Living (AHCA/NCAL)
https://www.ahcancal.org/ncal/quality/qualityinitiative/Pages/Staff-Stability.aspx
Original Performance Measure Source / Developer: American Health Care Association/National
Center for Assisted Living (AHCA/NCAL)
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Measure Algorithm:
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Measure Information Form
Measure Set: Assisted Living Community (ALC)
Set Measure ID: ALC-02
Performance Measure Name: Resident Falls
Description: Number of residents who fall and are transferred to the hospital.
Rationale: The effort to monitor the prevalence of falls at the facility level with transfer to the hospital
is very important for protecting the health of facility residents. Studies show that such falls can leave
up to 50%–65% of residents with fears that impact both their functional abilities and social activities
(Magaziner et al., 1997). Identifying falls risk factors can help facilities reduce incidence of falls among
their residents through clinical and non-clinical practices (Arling et al., 2014). Studies have shown that
falls account for 10% of visits to the emergency department and six percent of urgent hospitalizations
among elderly people (Tinetti, 2003).
Type Of Measure: Outcome
Improvement Noted As: Decrease in the rate
Numerator Statement: Residents who fall and are transferred to the hospital, per month.
Included Populations: Not applicable
Excluded Populations: Not applicable
Data Elements:
Fall With Transfer to Hospital
Denominator Statement: Number of residents who resided in the community on the last day of the
month.
Included Populations: Not applicable
Excluded Populations: Not applicable
Data Elements:
Assisted Living Community Resident
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Risk Adjustment: No.
Data Collection Approach:
Denominator: The total number from the data element
Assisted Living Community Resident
is the
Denominator.
This number will be entered into the Direct Data Submission Platform (DDSP) tool.
Numerator: Count the number of residents with a 'Yes' to the data element
Fall With Transfer to
Hospital
; the total number is the numerator.
This number will be entered into the Direct Data Submission Platform (DDSP) tool.
Example: You are abstracting cases for the month of August. On August 31st there are 85 residents liv-
ing at the assisted living community. Your denominator will be 85. When you look back through the 85
resident’s records, there were 4 residents that fell and were transferred to the hospital. Your numera-
tor will be 4.
Denominator = 85
Numerator = 4
Data Accuracy: None
Measure Analysis Suggestions: None
Sampling: No.
Data Reported As: Aggregate rate generated from count data reported as a proportion.
Selected References:
Arling, P. A., et al. (2014). "Communication and effectiveness in a US nursing home quality-im-
provement collaborative." Nurs Health Sci 16(3): 291-297.
Magaziner J, Lydick E, Hawkes W, Fox KM, Zimmerman SI, Epstein RS, Hebel JR. Excess mortal-
ity attributable to hip fracture in white women aged 70 years and older. Am J Public Health.
1997 Oct;87(10):1630-6.
Tinetti ME. Clinical practice. Preventing falls in elderly persons. N Engl J Med. 2003 Jan
2;348(1):42-9.
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Measure Algorithm:
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Measure Information Form
Measure Set: Assisted Living Community (ALC)
Set Measure ID: ALC-03
Performance Measure Name: Resident Preferences and Goals of Care
Description: Assisted living residents with documentation of preferences and goals of care.
Rationale: Residents who are given the opportunity to express preferences and goals are more likely to
receive care consistent with their values, and resident and family satisfaction outcomes improve. Use
of the resident preferences quality measure will improve attention to this important practice, in order
to enhance resident autonomy, facilitate resident-centered decision-making, and communicate resi-
dent preferences.
Type Of Measure: Process
Improvement Noted As: Increase in the rate
Numerator Statement: Residents who have documentation in their record of their preferences and
goals of care.
Included Populations: Not applicable
Excluded Populations: Not applicable
Data Elements:
Resident Preferences and Goals of Care
Denominator Statement: Number of residents who are new to the assisted living community each
month.
Included Populations: Not applicable
Excluded Populations: Not applicable
Data Elements:
New Resident
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Risk Adjustment: No.
Data Collection Approach:
Denominator: The total number from the data element
New Resident
is the Denominator.
This number will be entered into the Direct Data Submission Platform (DDSP) tool.
Numerator: Count the number of residents with 'Yes' to the data element
Resident Preferences and
Goals of Care
; the total number is the numerator.
This number will be entered into the Direct Data Submission Platform (DDSP) tool.
Example: You are abstracting cases for the month of November. On November 30th there were 6 new
residents living at the assisted living community. Your denominator will be 6. When you look back
through the 6 resident’s records, all 2 had documentation of their preference and goals of care; this is
the numerator.
Denominator = 6
Numerator = 2
Data Accuracy: None
Measure Analysis Suggestions: None
Sampling: No.
Data Reported As: Aggregate rate generated from count data reported as a proportion.
Selected References:
Institute for Healthcare Improvement http://www.ihi.org/Engage/Initiatives/Age-Friendly-
Health-Systems/Pages/default.aspx
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Measure Algorithm:
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Measure Information Form
Measure Set: Assisted Living Community (ALC)
Set Measure ID: ALC-04
Performance Measure Name: Advanced Care Plan/ Surrogate Decision Maker
Description: Residents who have documentation of an advance care plan or surrogate decision maker
in their record.
Rationale: This measure addresses advance care planning as one facet of high-quality care for older
adults. The aim of advance care planning is to ensure that care near the end of life aligns with the
patient’s wishes (IOM, 2014). Advanced care planning is associated with improved health outcomes for
older adults, including reducing hospitalizations, intensive care unit (ICU) admissions, and hospital and
ICU lengths of stay (Brinkman-Stoppelenburg, 2014; Hall et al., 2011; Khandelwal et al., 2015; Martin
et al., 2016). However, most older adults do not have advance care planning conversations with their
clinicians even though there is consensus among diverse stakeholders that advance care planning is a
key component of high-quality care (NQF 2006; IOM, 2014).
The intent of this measure is to promote advance care planning discussions and documentation of that
discussion in the resident’s record. As people age, consideration should be given to their treatment
wishes in the event that they lose the ability to manage their care. A large discrepancy exists between
the wishes of dying patients and their actual end-of-life care. Advance directives (AD) are widely rec-
ommended as a strategy to improve compliance with patient wishes at the end of life, and thereby en-
sure appropriate use of health care resources at the end of life.
Type Of Measure: Process
Improvement Noted As: Increase in the rate
Numerator Statement: Residents who have an advance care plan or surrogate decision maker docu-
mented in their record or documentation that an advance care plan was discussed but the resident did
not wish or was not able to name a surrogate decision maker or provide an advance care plan per
month.
Included Populations:
Residents that declined to discuss an advance care plan or surrogate decision maker.
Excluded Populations: Not applicable
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Data Elements:
Advanced Care Plan/Surrogate Decision Maker
Denominator Statement: Number of residents who are new to the assisted living community each
month.
Included Populations: Not applicable
Excluded Populations: Not applicable
Data Elements:
New Resident
Risk Adjustment: No.
Data Collection Approach:
Denominator: The total number from the data element
New Resident
is the Denominator.
This number will be entered into the Direct Data Submission Platform (DDSP) tool.
Numerator: Count number of residents with a 'Yes' to the data element
Advanced Care Plan/Surrogate
Decision Maker
; the total number is the numerator.
This number will be entered into the Direct Data Submission Platform (DDSP) tool.
Example: You are abstracting cases for the month of March. On March 31st there are 4 new residents
who moved into the assisted living community. Your denominator will be 4. When you look back
through the 4 resident’s records, all 4 had documentation of an advanced care plan/surrogate decision
maker present in the resident’s record or the resident refuses; this is the numerator.
Denominator = 4
Numerator = 4
Data Accuracy: None
Measure Analysis Suggestions: None
Sampling: No.
Data Reported As: Aggregate rate generated from count data reported as a proportion.
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Selected References:
Brinkman-Stoppelenburg, A., Rietjens, J. A., & van der Heide, A. (2014). The effects of advance
care planning on end-of-life care: a systematic review. Palliative Medicine, 28(8), 1000-1025.
Hall, S., Kolliakou, A., Petkova, H., Froggatt, K., & Higginson, I. J. (2011). Interventions for im-
proving palliative care for older people living in nursing homes. Cohrane Database of Systematic
Reviews, 3.
Institute of Medicine (IOM). (2014). Dying in America: improving quality and honoring individ-
ual preferences near the end of life. Washington, DC: The National Academies Press.
Khandelwal, N., Kross, E. K., Engelberg, R. A., Coe, N. B., Long, A. C., & Curtis, J. R. (2015).
Estimating the effect of palliative care interventions and advance care planning on ICU utiliza-
tion: a systematic review. Critical Care Medicine, 43(5), 1102-1111.
Martin, R. S., Hayes, B., Gregorevic, K., & Lim, W. K. (2016). The effects of advance care planning
interventions on nursing home residents: a systematic review. Journal of the American Medical
Directors Association, 17(4), 284-293.
National Quality Forum. (2006). A National Framework and Preferred Practices for Palliative
and Hospice Care Quality. Washington, DC: National Quality Forum.
Original Performance Measure Source / Developer: Adopted from National Committee for Quality
Assurance measure.
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Measure Algorithm:
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Measure Information Form
Measure Set: Assisted Living Community (ALC)
Set Measure ID: ALC-05
Set Measure ID Performance Measure Name
ALC-05a Overall
ALC-05b Direct Care Staff
Performance Measure Name: Staff Stability
Description: Improve staff stability through tracking turnover among assisted living community staff.
Rationale: Those who work most closely with residents are at the core of providing quality care.
Research shows that satised staff contributes to greater quality of life of the residents in assisted liv-
ing communities and provide better quality of care.
With a more satised, well-trained, and committed staff, providers see increased retention rates and
fewer work-related incidents and injuries to the workforce, all of which contribute to better overall
performance of the community. The more consistent and dedicated the staff is, the more they under-
stand and are able to effectively respond to each person’s needs – reinforcing the long term care
profession’s commitment to delivering person-centered care.
American Health Care Association/National Center for Assisted Living (AHCA/NCAL)
https://www.ahcancal.org/ncal/quality/qualityinitiative/Pages/Staff-Stability.aspx
Type Of Measure: Process
Improvement Noted As: Decrease in the rate
Numerator Statement:
ALC-05a: Total number of staff who left the assisted living community, during this month.
ALC-05b: Total number of direct care staff who left the assisted living community, during this
month.
Included Populations: Not applicable
Excluded Populations: Not applicable
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Data Elements:
Number of Direct Care Staff Employed
Number of Staff Employed
Denominator Statement:
ALC-05a: Number of positions/ employees who were employed on the last day of the month per
month, including all direct and non-direct.
ALC-05b: Number of direct care staff positions/ employees who were employed on the last day
of the month, per month.
Included Populations: Not applicable
Excluded Populations: Not applicable
Data Elements:
Number of Direct Care Staff Positions
Number of Positions
Risk Adjustment: No.
Data Collection Approach:
ALC-05a:
Denominator: Total number from the data element
Number of Positions
is the denominator.
This number will be entered into the Direct Data Submission Platform (DDSP) tool.
Numerator: Total number from the data element
Number of Staff Employed
minus the total
Number of
Positions
is the Numerator.
The total
Number of Staff Employed
will be entered into the Direct Data Submission Platform
(DDSP) tool, and the tool will calculate the Numerator.
ALC-05b:
Denominator: Total number from the data element
Number of Direct Care Staff Positions
is the
denominator.
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Numerator: Total number from the data element
Number of Direct Care Staff Employed
minus the to-
tal
Number of Direct Care Staff Positions
is the Numerator.
The total
Number of Direct Care Staff Employed
will be entered into the Direct Data
Submission Platform (DDSP) tool, and the tool will calculate the Numerator.
Example: You are abstracting ALC-05a for the month of June. On June 30th there are 15 employees
who were employed on the last day of the month. Your denominator will be 15. The total number of
employees who worked anytime this month was 18.
18-15 = 3 (Numerator)
Formula to calculate the rate is: Numerator divided by Denominator, times 100 = rate
3/15 = 0.2 or 20%
Note: The data collection tool will do this calculation
Data Accuracy: None
Measure Analysis Suggestions: None
Sampling: No.
Data Reported As: Aggregate rate generated from count data reported as a proportion.
Selected References:
American Health Care Association/National Center for Assisted Living (AHCA/NCAL)
https://www.ahcancal.org/ncal/quality/qualityinitiative/Pages/Staff-Stability.aspx
Original Performance Measure Source/Developer: American Health Care Association/National
Center for Assisted Living (AHCA/NCAL)
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Measure Algorithm:
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Name:
Advanced Care Plan/Surrogate Decision Maker
Collected For: ALC-04
Denition: Documentation of an advanced care plan or a surrogate decision maker in
the resident’s record. An advance care plan includes instructions given by
individuals specifying what actions should be taken for their health if they
are no longer able to make decisions due to illness or incapacity, and there-
fore appoints a person to make such decisions on their behalf.
Question: Is there documentation of an advanced care plan/surrogate decision maker
in the resident’s record?
Format: Length: 1
Type: Alphanumeric
Occurs: 1
Allowable Values:
Y (Yes) Documentation of an advanced care plan/surrogate decision maker
was present in the resident’s record or the resident refuses.
N (No) There was no documentation of an advanced care plan/surrogate de-
cision maker in the resident’s record, or unable to determine from medical
record documentation.
Notes for Abstraction:
Suggested Data
Sources:
Additional Notes:
Guidelines for Abstraction:
Inclusion Exclusion
Advance care plan
Advance decision
Advance directive
Advance healthcare directive
Health care proxy
Living will
Do Not Resuscitate (DNR) Orders
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MOLST (Medical Orders for Life-Sustaining
Treatment)
Personal directive
POLST (Physician Orders for Life-Sustaining
Treatment)
Power of attorney for healthcare
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Name:
Assisted Living Community Resident
Collected For: ALC-01, ALC-02
Denition: Resident of an assisted living community.
Question: Number of residents who were a resident of the community on the last day
of the month?
Format: Length: 3
Type: Numeric
Occurs: 1
Allowable Values:
Number 0-199 or UTD
Notes for Abstraction:
Suggested Data
Sources:
Additional Notes:
Guidelines for Abstraction:
Inclusion Exclusion
None None
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Name:
Fall With Transfer to Hospital
Collected For: ALC-02
Denition: Residents who fall and are transferred to the hospital, per month.
Question: Did the resident experience a fall and were they transferred to the hospital?
Format: Length: 1
Type: Alphanumeric
Occurs: 1
Allowable Values:
Y (Yes) The resident experienced a fall and was transferred to the hospital.
N (No) The resident experienced a fall but was not transferred to the hospi-
tal or the resident did not experience a fall and was not transferred to the
hospital.
Notes for Abstraction:
Suggested Data
Sources:
Additional Notes:
Guidelines for Abstraction:
Inclusion Exclusion
None None
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Name:
New Resident
Collected For: ALC-03, ALC-04
Denition: Number of new residents who moved in during the month being reviewed.
Question: What is the number of new residents at the assisted living community at the
end of the month?
Format: Length: 3
Type: Numeric
Occurs: 1
Allowable Values:
Number 0-199 or UTD
Notes for Abstraction:
Suggested Data
Sources:
Additional Notes:
Guidelines for Abstraction:
Inclusion Exclusion
None None
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Name:
Number of Direct Care Staff Employed
Collected For: ALC-05
Denition: Number of direct care staff employed at any time by the assisted living
community.
Question: What was the total number of direct care staff employed at any time by the
assisted living community, during this month?
Format: Length: 3
Type: Alphanumeric
Occurs: 1
Allowable Values:
0-199
Notes for Abstraction:
Suggested Data
Sources:
Additional Notes:
Guidelines for Abstraction:
Inclusion Exclusion
None None
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Name:
Number of Direct Care Staff Positions
Collected For: ALC-05
Denition: Number of direct care staff positions/ employees who were employed on the
last day of the month, per month.
Question: What was the total number of direct care staff positions/employees who
were employed on the last day of this month?
Format: Length: 3
Type: Numeric
Occurs: 1
Allowable Values:
0-199
Notes for Abstraction:
Suggested Data
Sources:
Additional Notes:
Guidelines for Abstraction:
Inclusion Exclusion
None None
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Name:
Number of Positions
Collected For: ALC-05
Denition: Number of positions/ employees who were employed on the last day of the
month per month, including all direct and non-direct.
Question: What was the total number of positions/employees who were employed on
the last day of this month?
Format: Length: 3
Type: Numeric
Occurs: 1
Allowable Values:
0-199
Notes for Abstraction:
Suggested Data
Sources:
Additional Notes:
Guidelines for Abstraction:
Inclusion Exclusion
None None
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Name:
Number of Staff Employed
Collected For: ALC-05
Denition: Number of staff employed at any time by the assisted living community.
Question: What was the total number of staff employed at any time by the assisted liv-
ing community, during this month?
Format: Length: 3
Type: Numeric
Occurs: 1
Allowable Values:
0-199
Notes for Abstraction:
Suggested Data
Sources:
Additional Notes:
Guidelines for Abstraction:
Inclusion Exclusion
None None
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Name:
Off-Label Antipsychotic Drug Prescribed
Collected For: ALC-01
Denition: Off-label use of antipsychotic drugs.
Question: Has the resident been prescribed an antipsychotic for off-label use?
Format: Length: 1
Type: Alphanumeric
Occurs: 1
Allowable Values:
Y (Yes) The resident been prescribed an antipsychotic for off-label use.
N (No) The resident has not been prescribed an antipsychotic listed for off-
label use.
Notes for Abstraction:
Select yes if the antipsychotic is prescribed as a PRN.
Example: resident given haldol for aggressive behavior, select ‘Yes’.
Antipsychotics Table
Conventional
Antipsyhcotics
(Generic
Name)
FDA Approved Uses
Haldol
(Haloperidol)
Schizophrenia, Tourette's Disorder
Loxitane
(Loxapine)
Schizophrenia
Navane
(Thiothixene
Schizophrenia
Orap
(Pimozide)
Tourette's Disorder
Atypical
Antipsychotics
(Generic
Name)
FDA Approved Uses
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Atypical
Antipsychotics
(Generic
Name)
FDA Approved Uses
Abilify
(Aripiprazole)
Schizophrenia, Bipolar Disorder, Major Depressive Disorder,
Irritability associated with autistic disorder
Saphris
(Asenapine)
Schizophrenia, Bipolar Disorder
Clozaril or
Fazaclo
(Clozapine)
Schizophrenia
Fanapt
(Iloperidon)
Schizophrenia
Zyprexa
(Olanzapine)
Schizophrenia, Bipolar Disorder, Treatment of resistant
depression
Invega
(Paliperidone)
Schizophrenia, Schizoaffective Disorder
Seroquel
(Quetiapine)
Schizophrenia, Bipolar Disorder, Major Depressive Disorder
Risperdal
(Risperidone)
Schizophrenia, Bipolar Disorder, Irritability associated with
autistic disorder
Geodon
(Ziprasidone)
Schizophrenia, Bipolar Disorder
Suggested Data
Sources:
Additional Notes:
Guidelines for Abstraction:
Inclusion Exclusion
None None
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Name:
Resident Preferences and Goals of Care
Collected For: ALC-03
Denition: There is documentation in the resident’s record that the assisted living care
team discussed or attempted to discuss the resident’s preferences and goals
for care. Documentation should include a discussion on preferences and
goals including, but not limited to:
Question: Is there documentation in the resident’s record that the assisted living care
team discussed or attempted to discuss the resident’s preferences and goals
for care?
Format: Length: 1
Type: Alphanumeric
Occurs: 1
Allowable Values:
Y (Yes) There is documentation in the resident’s record that the assisted liv-
ing care team discussed or attempted to discuss the resident’s preferences
and goals for care.
N (No) There is no documentation in the resident’s record that the assisted
living care team discussed or attempted to discuss the resident’s prefer-
ences and goals for care or unable to determine.
Notes for Abstraction:
Example: “discussed hospitalization and if needed Mr. Smith does not
wish to be transferred to the hospital.
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Suggested Data
Sources:
Additional Notes:
Guidelines for Abstraction:
Inclusion Exclusion
None None
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Data Dictionary Introduction
Introduction
This section of the manual describes the data elements that are required for collection for the The
Joint Commission's Assisted Living Center (ALC) measures. It includes information necessary for den-
ing and formatting the data elements, as well as the allowable values for each data element.
It is of primary importance that all organizations using the measures gather and utilize the data ele-
ments as dened in this section. This will ensure that the data are standardized and comparable across
organizations.
Data Element Dictionary Terms
Term Denition
Data Element Name: A short phrase identifying the data element. For each of identication the
data element name is
italicized
.
Collected For: Identies the measure(s) that utilize this data element or species that the
data element is used for data processing or verication.
Denition: A detailed explanation of the data element.
Data collection software may
include this information
.
Suggested Data Collection
Question:
A suggested wording for a data element question in a data abstraction
tool.
Format: Length = number of characters or digits allowed for the data element
Type = type of information the data element contains (e.g., numeric, al-
phanumeric, date, character, or time)
Occurs = the number of times the data element occurs in a single episode
of care record
Allowable Values: A list of acceptable responses for this data element
Notes for Abstraction: Provided to assist abstractor in the selection of appropriate value for a
data element
Suggested Data Sources: Source document from which data can be identied such as the resident
record.
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Term Denition
Guidelines for Abstraction: Designed to assist abstractors in determining how a data element should
be answered
Alphabetical List of All Data Elements
Data Element Name Collection Notes Associated Measures
Advanced Care Plan/Surrogate Decision
Maker
ALC-04
Assisted Living Community Resident ALC-01, ALC-02
Fall With Transfer to Hospital ALC-02
New Resident ALC-03, ALC-04
Number of Direct Care Staff Employed ALC-05
Number of Direct Care Staff Positions ALC-05
Number of Positions ALC-05
Number of Staff Employed ALC-05
Off-Label Antipsychotic Drug Prescribed ALC-01
Resident Preferences and Goals of Care ALC-03
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Appendix E
Overview of Measure Information Form and
Flowchart Formats for collected measures
Measure Information Form Introduction
Measure Set
The specic national hospital quality measure set to which an individual measure belongs (e.g., acute
myocardial infarction, stroke).
Set Measure ID #
A unique alpha-numeric identier assigned to a measure. Information associated with a measure is
identied by this unique alpha-numeric number.
Performance Measure Name
A brief title that uniquely identies the measure.
Description
A brief explanation of the measure”s focus, such as the activity or the area on which the measure cen-
ters attention (e.g., ischemic stroke patients prescribed antithrombotic therapy at hospital discharge)
Rationale
The reason for performing a specied process to improve the quality of care outcomes. This may in-
clude specic literature references, evidence based information, expert consensus, etc.
Type of Measure
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Indicates whether the measure is used to examine a process or an outcome over time.
Process: A measure used to assess a goal directed, interrelated series of actions, events, mecha-
nisms, or steps, such as measure of performance that describes what is done to, for, or by pa-
tients, as in performance of a procedure.
Outcome: A measure that indicates the result of performance (or non-performance) of a
function(s) or process(es).
Improvement Noted As
Describes how improvement would be indicated by the measure.
An increase in the rate/score/number of occurrences (for example, immunizations)
A decrease in the rate/score/number of occurrences (for example, potentially preventable ve-
nous thromboembolism)
Either an increase or a decrease in the rate/score/number of occurrences, depending upon the
context of the measure (for example, utilization)
Numerator Statement
Represents the portion of the denominator population that satises the conditions of the performance
measure to be an indicator event.
Note: If the measure is reported as a rate (proportion or ratio), the Numerator and Denominator
Statement are completed. If a performance measure does not have both a numerator and a denomina-
tor, then a Continuous Variable Statement is completed.
Included Population in Numerator Specic information describing the population(s) comprising the
numerator, not contained in the numerator statement, or not applicable
Excluded Population in Numerator Specic information describing the population(s) that should not
be included in the numerator, or none
Data Elements Those data elements necessary or required to determine (or establish) the numerator.
Denominator Statement
Represents the population evaluated by the performance measure.
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Note: If measure is reported as a rate (proportion or ratio), the Numerator and Denominator
Statement are completed. If a performance measure does not have both a numerator and a denomina-
tor, then a Continuous Variable Statement is completed.
Included Population in Denominator Specic information describing the population(s) comprising the
denominator, not contained in the denominator statement or not applicable
Excluded Population in Denominator Specic information describing the population(s) that should not
be included in the denominator, or none
Data Elements Those data elements required to determine (or establish) the denominator
Continuous Variable Statement
Describes an aggregate data measure in which the value of each measurement can fall anywhere along
a continuous scale.
Note: If measure is reported as a central tendency, Continuous Variable Statement is completed. This
item is only completed when the performance measure does not have numerator and denominator
statements.
Included Population in Continuous Variable Specic information describing the population(s) com-
prising the performance measure, not contained in the continuous variable statement or not applicable
Excluded Population in Continuous Variable Specic information describing the population(s) that
should not be included in the performance measure or none
Date Elements Those data elements required to determine (or establish) the measure for a continuous
variable
Risk Adjustment
Indicates whether a measure is subject to the statistical process for reducing, removing, or clarifying
the inuences of confounding factors to allow more useful comparisons.
Data Collection Approach
Recommended timing for when data should be collected for a measure. Data collection approaches in-
clude retrospective, concurrent or prospective data collection. Retrospective data collection involves
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collecting data for events that have already occurred. Concurrent data collection is the process of
gathering data on how a process works or is working while a patient is in active treatment. Prospective
data collection is data collection in anticipation of an event or occurrence.
Data Accuracy
Recommendations to reduce identiable data errors, to the extent possible.
Measure Analysis Suggestions
Recommendations to assist in the process of interpreting data and drawing valid conclusions.
Sampling
Indicates whether or not a measure can be sampled. Sampling is a process of selecting a representative
part of a population in order to estimate the organization's performance, without collecting data for
the entire population.
Data Reported As
Indicates how data will be reported for a measure.
Aggregate rate generated from count data reported as a proportion (for example, rate-based
measures which report summary data generated from the number of Cesarean sections as a
proportion of deliveries)
Aggregate rate generated from count data reported as a ratio (e.g., bloodstream infection per
1,000 line days).
Aggregate measures of central tendency (e.g., continuous variables which report means and
medians such as length of stay).
Calculation Model
A description of the steps or statistical calculations (computations) used to derive the numerator and
denominator or continuous variable values required for a measure. Measure Information Forms in this
manual will include either an algorithm or calculation model.
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Selected References
Specic literature references that are used to support the importance of the performance measure.
Algorithm Introduction
Each measure's initial patient population and the measure is described by a unique algorithm. An algo-
rithm is a predened set of rules that help to break down complex processes into simple, repetitive
steps.
Measure algorithms serve two purposes. First, they evaluate and identify which episode of care (EOC)
records contain missing and/or invalid data that will prohibit the ability to properly evaluate the mea-
sure. Second, they determine if:
For rate-based measures, the patient's EOC record belongs in the measure population of inter-
est described by the denominator, and if the patient experienced the event described in the
numerator.
For continuous variable measures, the patient's EOC record belongs in the patient population
described in the measure's statement and, if so, to dene and calculate the
measurement
value.
This section contains some standard ow-charting conventions used to develop each algorithm:
Flow lines are used to guide the reader to different parts of the algorithm, with arrows denoting
the direction of movement. Generally, movement is from the top to the bottom of the chart.
Symbols used in each algorithm ow charts are described later in this section under Flow Chart
Symbols.
Temporary variables within the algorithm are noted in the variable key at the top of each page.
Flowchart Symbols
Symbol Explanation
Start/Stop denotes the beginning or end of an algorithm
Diamonds represent "If…Then" decision points for logic tests and comparisons. Two
or three ow lines exit the decision point to reect alternative actions based upon an
evaluation of the condition(s) stated around the decision point.
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Symbol Explanation
Rectangles or process boxes show when computation or manipulation of the data are
required, such as a calculation or summarization.
Circle or "On-page: connectors, labeled with a letter, show a link to sections of the al-
gorithm which are continued on the same page.
Five-sided or "Off-page" connectors, labeled with a letter, show a link to sections of
the algorithm which are continued on different pages.
Note: Both circular, On-page,
ve-sided
, and
Off-page
Connectors containing the letters B, D, E, U, X, or Y lead to
measure Outcome Boxes
.
Outcome Boxes represent the result of data passed through the algorithm.
Connectors extending from outcome boxes lead to the end of the algorithm, or to risk
adjustment procedures, where applicable. This symbol is also used to identify the
strata within a stratied measure.
Symbol to represent comments that should be taken into account when programming
owchart.
This symbol is placed along side the Process box to which they are applicable.
Comments are used to expand upon information contained within the process box,
such as how to properly calculate age. Comments are never the sole location where
processing logic is provided.
Start/Return denotes the beginning and ending of a sub-routine. Algorithms that use
this symbol are called from another algorithm and the data processing ow returns to
the calling algorithm when the Return' is encountered. See the Initial Patient
Population Algorithms and Transmission Data Processing Flows for an example of the
usage of this symbol.
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