Table 1 Indicators related to clinical information coordination across levels of care

Information flow across levels

IT1. Percentage of hospital discharges for which a discharge report is made available to primary care within the first 24 h

- Numerator: Discharge report available in primary care within the first 24 h after hospital discharge

Discharge reports in EMRs

[22, 30, 34, 37, 49]

- Denominator: Hospital discharges

IT2. Mean time to discharge report availability in primary care

- Numerator: Total hours elapsed from the time of hospital discharge to report availability in primary care

Discharge reports in EMRs

[19]

- Denominator: Hospital discharges

IT3. Percentage of emergency care visits for which there is an emergency care report available in primary care within 24 h

- Numerator: Emergency care report available in primary care within 24 h of the emergency care visit

Discharge reports in EMRs

[22, 30, 34, 37, 49]

- Denominator: Emergency care discharges

IT4. Mean time to emergency care report availability in primary care

- Numerator: Total hours elapsed from the emergency care visit to report availability in primary care

Discharge reports in EMRs

[19]

- Denominator: Emergency care discharges

Referral forms and discharge reports duly completed

IT5. Percentage of discharge reports duly completed

- Numerator: Hospital discharge reports which contain at least four of the following items: reason for admission, additional tests performed and pending, follow-up or monitoring for the patient after discharge, list of current medications and recommendations for the patient

EMR audit

[30]

Transfer of information on medication and tests across levels

- Denominator: Hospital discharge reports of patients discharged with a diagnosis of COPD, DM and/or HF

IT6. Percentage of emergency care reports duly completed

- Numerator: Emergency care reports which contain at least four of the following items: the reason for the emergency care visit, additional tests performed and pending (laboratory, radiology, etc.), follow-up or monitoring of the patient after the emergency care visit, list of current medications and recommendations for the patient

EMR audit

[30]

- Denominator: Emergency care reports of patients with COPD, DM and/or HF

IT7. Percentage of referral forms from primary care duly completed

- Numerator: Patients diagnosed with HF, COPD and/or DM that have been referred to secondary care with a referral form that contains relevant background morbidity, current medical treatment, and the reason for the referral

EMR audit

[30]

- Denominator: Patients diagnosed with HF, COPD and/or DM that have been referred to secondary care