Table 2 Indicators related to clinical management coordination across levels of care
Dimension attribute | Description | Formula | Source of data | Adapted from | |
|---|---|---|---|---|---|
Care coherence | |||||
Coordinated medical testing across involved care levels | CC1. Percentage of secondary care visits of patients diagnosed with HF in which the specialist ordered tests that were performed in the previous six months in primary care | - Numerator: First secondary care visit of HF patients referred from primary care in which the specialist ordered a non-urgent, non-priority X-ray of the thorax, ECG or general blood test that was performed in the previous six months in primary care | Clinical and administrative databases | [50] | |
- Denominator: Total first non-urgent, non-priority secondary care visits of patients referred from primary care for HF | |||||
CC2. Percentage of pneumology visits of patients diagnosed with COPD in which the specialist ordered a spirometry that was performed in the previous six months in primary care | - Numerator: First non-urgent, non-priority pneumology visit of COPD patients referred from primary care in which the specialist ordered a spirometry that was performed in the previous six months in primary care | Clinical and administrative databases | [50] | ||
- Denominator: Total first non-urgent, non-priority pneumology visits of patients referred from primary care for COPD | |||||
Coordinated management of medication by involved levels | CC3. Percentage of patients with DM who started insulin therapy during hospitalization and whose primary care medical record documents a follow-up within one week of discharge | - Numerator: Patients with DM who started insulin therapy during hospitalization and whose primary care medical record documents a follow-up within one week of discharge | Clinical and administrative databases | ||
- Denominator: Patients with DM who started insulin therapy during hospitalization | |||||
Care at the most appropriate level | CC4. Percentage of patients with HF correctly referred from primary care to non-urgent outpatient secondary care | - Numerator: Patients diagnosed with HF and correctly referred to cardiology or internal medicine | EMR audit | [17] | |
- Denominator: Patients diagnosed with HF that have been referred from primary care to cardiology or internal medicine | |||||
CC5. Percentage of patients with HF that have been correctly referred to emergency care from primary care | - Numerator: Patients with exacerbation of HF that have been correctly referred to emergency care from primary care | EMR audit | [17] | ||
- Denominator: Patients that visit emergency care for decompensated HF referred by primary care | |||||
Completion of diagnostic process when more than one level is involved | CC6. Percentage of patients with HF diagnosed in the past year who had an echocardiogram as part of the diagnostic process | - Numerator: Patients diagnosed with HF who had an echocardiogram as part of the diagnostic process | Clinical and administrative databases | [47] | |
- Denominator: Total of patients diagnosed with HF | |||||
Follow-up across levels | |||||
Communication between involved levels | FU1. Percentage of hospital discharges with contact between the hospital and primary care prior to the discharge of patients hospitalized for severe exacerbation of COPD | - Numerator: Hospital discharges with principal diagnosis related to the severe exacerbation of COPD and in which the hospital has contacted primary care prior to the discharge | Clinical and administrative databases | ||
- Denominator: Hospital discharges with principal diagnosis related to severe exacerbation of COPD | |||||
FU2. Percentage of hospital discharges with contact between the hospital and primary care prior to the discharge of patients hospitalized for decompensated HF | - Numerator: Hospital discharges with principal diagnosis related to decompensated HF in which primary care has been contacted prior to discharge | Clinical and administrative databases | |||
- Denominator: Hospital discharges with principal diagnosis related to decompensated HF | |||||
Follow-up visits after hospital discharge | FU3. Percentage of hospital discharges of patients admitted for exacerbation of COPD who have a consultation in primary care in less than 72 h | - Numerator: Hospital discharges with principal diagnosis related to severe exacerbation of COPD and with a consultation in primary care in less than 72 h | Clinical and administrative databases | ||
- Denominator: Hospital discharges with principal diagnosis related to severe exacerbation of COPD | |||||
FU4. Percentage of hospital discharges of patients admitted for decompensated HF who have a consultation in primary care in less than 7 days | - Numerator: Hospital discharges with principal diagnosis related to decompensated HF and with a consultation in primary care in less than 7 days | Clinical and administrative databases | |||
- Denominator: Patients discharged with principal diagnosis related to decompensated HF | |||||
Accessibility across levels | |||||
Waiting time after referral | AAL1. Mean time elapsed from non-urgent, non-priority primary care referral of HF patients to cardiologist visit | - Numerator: Total days elapsed from non-urgent, non-priority, primary care referral of HF patients to cardiologist visit | Clinical and administrative databases | ||
- Denominator: Total HF patients with non-urgent, non-priority referrals from primary care to cardiology | |||||
AAL2. Mean time elapsed from the referral of a patient with suspected cancer (lung, colorectal, breast, bladder and prostate) to the first specialist care visit | - Numerator: Total days elapsed from the primary care referral of a patient with suspected cancer to the first appointment with rapid diagnosis program | Clinical and administrative databases | |||
- Denominator: Total patients referred from primary care to specialist care for suspected cancer (lung, colorectal, breast, bladder and prostate) | |||||
AAL3. Mean time elapsed from the referral of a patient with suspected cancer (lung, colorectal, breast, bladder and prostate) to time of cancer diagnosis | - Numerator: Total days elapsed from the primary care referral of a patient with suspected cancer to the diagnosis of cancer | Clinical and administrative databases | |||
- Denominator: Total patients with suspected cancer (lung, colorectal, breast, bladder and prostate) first identified in primary care and with a later diagnosis of cancer | |||||
AAL4. Mean time elapsed from the referral of a patient with suspected cancer (lung, colorectal, breast, bladder and prostate) to the initiation of cancer treatment (surgery and/or chemotherapy and/or radiotherapy) | - Numerator: Total days elapsed from the referral from primary care of a patient with suspected cancer to the initiation of cancer treatment (surgery and/or chemotherapy and/or radiotherapy) | Clinical and administrative databases | |||
- Denominator: Total patients diagnosed with cancer (lung, colorectal, breast, bladder and prostate) referred to secondary care from primary care who initiate treatment including surgery, chemotherapy and/or radiotherapy at the hospital to which they were referred from primary care | |||||