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Table 2 Indicators related to clinical management coordination across levels of care

From: Development and testing of indicators to measure coordination of clinical information and management 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 [36, 47]
- 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 [21, 24, 32, 37, 44, 60]
- 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 [21, 24, 32, 37, 44, 60]
- 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 [21, 24, 32, 37, 44, 60]
- 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 [21, 24, 32, 37, 44, 60]
- 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 [61, 62]
- 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 [61, 62]
- 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 [61, 62]
- 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 [61, 62]
- 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
  1. Indicators are available at: http://www.consorci.org/coneixement/cataleg-de-publicacions/80/indicadores-de-coordinacion-asistencial-entre-niveles-documento-de-trabajo
  2. COPD chronic obstructive pulmonary disease, DM diabetes mellitus, HF heart failure, EMR electronic medical record