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Measure Summary
This measure is endorsed by the National Quality Forum
Title
Care transitions: percentage of patients, regardless of age, discharged from an emergency department (ED) to ambulatory care or home health care, or their caregiver(s), who received a transition record at the time of ED discharge including, at a minimum, all of specified elements.
Source(s)
ABIM Foundation, American College of Physicians, Society of Hospital Medicine, Physician Consortium for Performance Improvement (PCPI). Care transitions performance measurement set (phase I: inpatient discharges & emergency department discharges). Chicago (IL): American Medical Association; 2009 Jun. 51 p. [48 references]

Measure Domain

Primary Measure Domain
Clinical Quality Measures: Process
Secondary Measure Domain
Does not apply to this measure

Brief Abstract

Description

This measure is used to assess the percentage of patients, regardless of age, discharged from an emergency department (ED) to ambulatory care or home health care, or their caregiver(s), who received a transition record at the time of ED discharge including, at a minimum, all of the specified elements.

Rationale

Providing a detailed transition record at the time of emergency department (ED) discharge enhances the patient's preparation to self-manage post-discharge care and comply with the post-discharge treatment plan.

The following evidence statements are quoted verbatim from the referenced clinical guidelines:

The ED represents a unique subset of potential transitions of care. The transition potential can generally be described as outpatient to outpatient or outpatient to inpatient depending on whether or not the patient is admitted to the hospital. The outpatient to outpatient transition is represented by a number of potential variables. Patients with a medical home may be referred in to the ED by the medical home or they may self refer. A significant number of patients do not have a physician and self refer to the ED. The disposition from the ED, either outpatient to outpatient or outpatient to inpatient is similarly represented by a number of variables. Discharged patients may or may not have a medical home, may or may not need a specialist and may or may not require urgent (less than 24 hours) follow-up. Admitted patients may or may not have a medical home and may or may not require specialty care. This variety of variables precludes a single approach to ED transitions of care coordination. The determination  as to which scenarios will be appropriate for standards development (Coordinating Clinicians and Transitions Responsibility) will require further contributions from ACEP and SAEM and review by the Steering Committee. (Transition of Care Consensus Policy Statement [TOCCC], 2008)

Standard PC.04.02.01

When a [patient] is discharged or transferred, the [organization] gives information about the care, treatment, and services provided to the [patient] to other service providers who will provide the [patient] with care, treatment, or services.

  • At the time of the patient's discharge or transfer, the hospital informs other service providers who will provide care, treatment, or services to the patient about the following:
    • The reason for the patient's discharge or transfer
    • The patient's physical and psychosocial status
    • A summary of care, treatment, and services it provided to the patient
    • The patient's progress toward goals
    • A list of community resources or referrals made or provided to the patient

    (See also PC.02.02.01, EP 1) (Joint Commission, 2009)

Standard PC.04.01.05

Before the [organization] discharges or transfers a [patient], it informs and educates the [patient] about his or her follow-up care, treatment, and services.

  1. When the hospital determines the patient's discharge or transfer needs, it promptly shares this information with the patient.
  2. Before the patient is discharged, the hospital informs the patient of the kinds of continuing care, treatment, and services he or she will need.
  3. When the patient is discharged or transferred, the hospital provides the patient with information about why he or she is being discharged or transferred.
  4. Before the patient is transferred, the hospital provides the patient with information about any alternatives to the transfer.
  5. The hospital educates the patient about how to obtain any continuing care, treatment, and services that he or she will need.
  6. The hospital provides written discharge instructions in a manner that the patient and/or the patient's family or caregiver can understand. (See also RI.01.01.03, EP 1) (Joint Commission, 2009)
Evidence for Rationale
ABIM Foundation, American College of Physicians, Society of Hospital Medicine, Physician Consortium for Performance Improvement (PCPI). Care transitions performance measurement set (phase I: inpatient discharges & emergency department discharges). Chicago (IL): American Medical Association; 2009 Jun. 51 p. [48 references]

Joint Commission on Accreditation of Healthcare Organizations. 2009 hospital accreditation standards. Oakbrook Terrace (IL): Joint Commission Resources, Inc.; 2009.

Snow V, Beck D, Budnitz T, Miller DC, Potter J, Wears RL, Weiss KB, Williams MV, American College of Physicians, Society of General Internal Medicine, Society of Hospital Medicine, American Geriatrics Society, American College of Emergency Physicians, Society of Academic Emergency Medicine. Transitions of care consensus policy statement American College of Physicians-Society of General Internal Medicine-Society of Hospital Medicine-American Geriatrics Society-American College of Emergency Physicians Society of Academic Emergency Medicine. J Gen Intern Med. 2009;24(8):971-6. PubMed External Web Site Policy
Primary Health Components

Emergency department (ED) discharges; transition record

Denominator Description

All patients, regardless of age, discharged from an emergency department (ED) to ambulatory care (home/self care) or home health care (see the related "Denominator Inclusions/Exclusions" field)

Numerator Description

Patients or their caregiver(s) who received a transition record at the time of emergency department (ED) discharge including, at a minimum, all of the following elements:

  • Major procedures and tests performed during ED visit, AND
  • Principal diagnosis at discharge OR chief complaint, AND
  • Patient instructions, AND
  • Plan for follow-up care (OR statement that none required), including primary physician, other health care professional, or site designated for follow-up care, AND
  • List of new medications and changes to continued medications that patient should take after ED discharge, with quantity prescribed and/or dispensed (OR intended duration) and instructions for each

See the related "Numerator Inclusions/Exclusions" field.

Evidence Supporting the Measure

Type of Evidence Supporting the Criterion of Quality for the Measure
  • One or more research studies published in a National Library of Medicine (NLM) indexed, peer-reviewed journal
Additional Information Supporting Need for the Measure
  • Several studies have documented gaps in the provision or explanation of emergency department discharge instructions, compromising patient understanding of their post-discharge treatment instructions.
  • Variation in quality for the performance measured
Evidence for Additional Information Supporting Need for the Measure
Matlow AG, Wishen A, Read SE, Raboud JM. A study of provider-caregiver communication in paediatric ambulatory care. Paediatr Child Health. 2006 Apr;11(4):217-21. PubMed External Web Site Policy

Rudd RE, Colton T, Schacht R. An overview of medical and public health literature addressing literacy issues: an annotated bibliography. Cambridge (MA): Harvard School of Public Health; 2008. 62 p.
Extent of Measure Testing

The Physician Consortium for Performance Improvement (PCPI) recognizes the importance of testing all of its measures and encourages testing of the Care Transitions measurement set by organizations or individuals positioned to do so. The Measure Testing Protocol for PCPI Measures was approved by the PCPI in 2007 and is available on the PCPI web site (see Position Papers at www.physicianconsortium.org External Web Site Policy); interested parties are encouraged to review this document and to contact PCPI staff.

Evidence for Extent of Measure Testing
ABIM Foundation, American College of Physicians, Society of Hospital Medicine, Physician Consortium for Performance Improvement (PCPI). Care transitions performance measurement set (phase I: inpatient discharges & emergency department discharges). Chicago (IL): American Medical Association; 2009 Jun. 51 p. [48 references]

State of Use of the Measure

State of Use
Pilot testing
Current Use
Care coordination
Internal quality improvement
Professional certification

Application of the Measure in its Current Use

Measurement Setting
Ambulatory/Office-based Care
Emergency Department
Home Care
Transition
Type of Care Coordination
Coordination between providers and patient/caregiver
Professionals Involved in Delivery of Health Services
Advanced Practice Nurses
Nurses
Physicians
Least Aggregated Level of Services Delivery Addressed
Single Health Care Delivery or Public Health Organizations
Statement of Acceptable Minimum Sample Size
Does not apply to this measure
Target Population Age

All ages

Target Population Gender
Either male or female

National Strategy for Quality Improvement in Health Care

National Quality Strategy Aim
Better Care
National Quality Strategy Priority
Effective Communication and Care Coordination
Making Care Safer
Person- and Family-centered Care
Prevention and Treatment of Leading Causes of Mortality

Institute of Medicine (IOM) National Health Care Quality Report Categories

IOM Care Need
Getting Better
IOM Domain
Effectiveness
Patient-centeredness
Safety

Data Collection for the Measure

Case Finding Period

Unspecified

Denominator Sampling Frame
Patients associated with provider
Denominator (Index) Event or Characteristic
Encounter
Denominator Time Window
Does not apply to this measure
Denominator Inclusions/Exclusions

Inclusions
All patients, regardless of age, discharged from an emergency department (ED) to ambulatory care (home/self care) or home health care

Exclusions

  • Patients who died
  • Patients who left against medical advice (AMA) or discontinued care
  • Patients who declined receipt of transition record

Note: Refer to the original measure documentation for administrative codes.

Exclusions/Exceptions
Patient factors addressed
Numerator Inclusions/Exclusions

Inclusions
Patients or their caregiver(s) who received a transition record at the time of emergency department (ED) discharge including, at a minimum, all of the following elements:

  • Major procedures and tests performed during ED visit, AND
  • Principal diagnosis at discharge OR chief complaint, AND
  • Patient instructions, AND
  • Plan for follow-up care (OR statement that none required), including primary physician, other health care professional, or site designated for follow-up care, AND
  • List of new medications and changes to continued medications that patient should take after ED discharge, with quantity prescribed and/or dispensed (OR intended duration) and instructions for each

Numerator Element Definitions:

  1. Transition record (for ED discharges): a core, standardized set of data elements related to patient's diagnosis, treatment, and care plan that is discussed with and provided to patient in written, printed, or electronic format. Electronic format may be provided only if acceptable to patient.
  2. Primary physician or other health care professional designated for follow-up care: may be primary care physician (PCP), medical specialist, or other physician or health care professional. If no physician, other health care professional, or site designated or available, patient may be provided with information on alternatives for obtaining follow-up care needed, which may include a list of community health services/other resources.

Note: Refer to the original measure documentation for administrative codes.

Exclusions
None

Numerator Search Strategy
Encounter
Data Source
Administrative clinical data
Electronic health/medical record
Paper medical record
Type of Health State
Does not apply to this measure
Instruments Used and/or Associated with the Measure

Retrospective Data Collection Flowsheet: Transition Record with Specified Elements Received by Discharge Patients

Computation of the Measure

Measure Specifies Disaggregation
Does not apply to this measure
Scoring
Rate/Proportion
Interpretation of Score
Desired value is a higher score
Allowance for Patient or Population Factors
Unspecified
Standard of Comparison
Internal time comparison

Identifying Information

Original Title

Measure #4: transition record with specified elements received by discharged patients (emergency department discharges to ambulatory care [home/self care] or home health care).

Submitter
American Medical Association on behalf of the American Board of Internal Medicine Foundation, American College of Physicians, Society of Hospital Medicine, and the Physician Consortium for Performance Improvement® - Medical Specialty Society
Developer
American Board of Internal Medicine Foundation - Medical Specialty Society
American College of Physicians - Medical Specialty Society
Physician Consortium for Performance Improvement® - Clinical Specialty Collaboration
Society of Hospital Medicine - Medical Specialty Society
Funding Source(s)

Unspecified

Composition of the Group that Developed the Measure

Robert M. Palmer, MD, MPH (Co-Chair); Mark V. Williams, MD, FACP (Co-Chair); Dennis M. Beck, MD, FACEP; Eric S. Holmboe, MD, FACP; Judith S. Black, MD, MHA; Mary Ann Kliethermes, B.S., Pharm.D.; Caroline Blaum, MD; James E. Lett, II, MD; Clair M. Callan, MD, MBA, CPE; Janet R. Maurer, MD, MBA, FCCP; Jayne Hart Chambers, MBA; Andie Melendez, RN, MSN, HTPC; Steven Chen, MD, MBA; Donise Mosebach, RN, MS, CEN; Kenneth D. Coburn, MD, MPH; Michael O'Dell, MD, MSHA, FAAFP; Mirean Fisher Coleman, MSW, LICSW, CT; Eric D. Peterson, MD, MPH, FAHA, FACC; Sydney Dy, MD, MSc; Mark Redding MD, FAAP; Scott Endsley, MD, MSc; Michael Ries, MD, MBA, FCCM; David A. Etzioni, MD, MSHS; Hilary C. Siebens, MD; Beth Feldpush, MPH; Janet (Jesse) Sullivan, MD; Rita Munley Gallagher, PhD, RN; Randal J. Thomas, MD, MS, FACC, FAHA, FACP, FAACVPR; G. Scott Gazelle, MD, MPH, PhD; Christopher Tompkins, PhD; Robert W. Gilmore, MD; Robert Wears, MD, FACEP

ABIM Foundation: Daniel B. Wolfson, MHSA

American College of Physicians: Vincenza Snow, MD, FACP

Society of Hospital Medicine: Jill Epstein, MA

American Medical Association: Mark Antman, DDS, MBA; Heidi Bossley, MSN, MBA; Kerri Fei, MSN, RN; JoeAnn Jackson, MJ; Kendra Hanley, MS; Karen Kmetik, PhD; Joanne G. Schwartzberg, MD; Patricia Sokol, RN, JD; Chyna Wilcoxson

PCPI Consultants: Rebecca Kresowik; Timothy Kresowik, MD

National Committee for Quality Assurance Liaison: Aisha Tenea' Pittman, MPH

Financial Disclosures/Other Potential Conflicts of Interest

Conflicts, if any, are disclosed in accordance with the Physician Consortium for Performance Improvement® conflict of interest policy.

Endorser
National Quality Forum
NQF Number
0649
Date of Endorsement

2013 Apr 3

Adaptation

This measure was not adapted from another source.

Date of Most Current Version in NQMC
2009 Jun
Measure Maintenance

Unspecified

Date of Next Anticipated Revision

Unspecified

Measure Status

This is the current release of the measure.

The Physician Consortium for Performance Improvement reaffirmed the currency of this measure in November 2011.

Source(s)
ABIM Foundation, American College of Physicians, Society of Hospital Medicine, Physician Consortium for Performance Improvement (PCPI). Care transitions performance measurement set (phase I: inpatient discharges & emergency department discharges). Chicago (IL): American Medical Association; 2009 Jun. 51 p. [48 references]
Measure Availability

The individual measure, "Measure #4: Transition Record with Specified Elements Received by Discharged Patients (Emergency Department Discharges to Ambulatory Care [Home/Self Care] or Home Health Care)," is published in the "Care Transitions Performance Measurement Set." This document and technical specifications are available in Portable Document Format (PDF) from the American Medical Association (AMA)-convened Physician Consortium for Performance Improvement® Web site: www.physicianconsortium.org External Web Site Policy.

For further information, please contact AMA staff by e-mail at cqi@ama-assn.org.

NQMC Status

This NQMC summary was completed by ECRI Institute on January 29, 2010. The information was verified by the measure developer on April 1, 2010. This NQMC summary was retrofitted into the new template on May 9, 2011. The information was reaffirmed by the measure developer on November 30, 2011.

Copyright Statement

© 2009 American Medical Association. All Rights Reserved.

CPT® Copyright 2008 American Medical Association.

Disclaimer

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