Form #8 Attachment I - Hospital system variables 12 15 10

Form Approved
OMB No. 0935-XXXX
Exp. Date XX/XX/20XX

Attachment I. Hospital system variables

Reutilization Variables

Each month calculate and report on 4 rates:

(1) 30-day readmission rate for patients who received the RED

(2) 30-day ED visit rate for patients who received the RED

(3) 30-day readmission rate for patients who do not receive the RED

(4) 30-day ED visit rate for patients who did not receive the RED

(5) A list of names and record numbers of patients who received the RED who were admitted within 30 days of discharge

(6) A list of names and record numbers of patients who received the RED who visited the ED within 30 days of discharge

This information can be generated from hospital information technology systems, using a flag to indicate the RED recipients.

Definitions:

30-day readmissions = number of hospital readmissions in the 30 days post-discharge for each person discharged

30-day ED visits = number of ED visits that did not result in admission in the 30 days post-discharge for each person discharged

Rate Specifications:

(1) 30-day readmission rate for those who received the RED

Numerator: Number of admissions within 30 days of discharge of RED recipients who had been discharged during index month

Denominator: Number of discharges of RED recipients during index month

(2) 30-day ED visit rate for those who received the RED

Numerator: Number of ED visits that did not result in admission within 30 days of discharge of RED recipients who had been discharged during index month

Denominator: Number of discharges of RED recipients during index month

(3) 30-day readmission rate for those who do not receive the RED

Numerator: Number of admissions within 30 days of discharge patients that did not receive RED who had been discharged during index month

Denominator: Number of discharges of patients that did not receive RED during index month

(4) 30-day ED visit rate for those who did not receive the RED

Numerator: Number of ED visits that did not result in admission within 30 days of discharge of patients that did not receive RED who had been discharged during index month

Denominator: Number of discharges of patients that did not receive RED during index month

RED Workstation Variables

Download the following patient-level variables from the RED workstation for all patients receiving RED.

• Name and record number

• Age

• Gender

• Self-reported cultural/racial/ethnic background

• Language preference

• Language services received

• Admitting Dx

• Discharge Dx

• Co-Morbidities

• Number hours spent educating patient

• PCP follow-up appointment made (Y/N)

• Diet recommendations made (Y/N)

• Exercise recommendations made (Y/N)

• Substance abuse recommendations made (Y/N)

• Medications reconciled (Y/N)

• Post-discharge services organized (Y/N)

• AHCP given and reviewed by DE (Y/N)

• Final teaching completed (Y/N)

• Discharge summary transmitted to PCP within 24 hours (Y/N)

• Phone follow-up completed (Y/N)

• DE Help Line used (Y/N)

Public reporting burden for this collection of information is estimated to average 42 hours per response, the estimated time required to complete the survey. An agency may not conduct or sponsor, and a person is not required to respond to, a collection of information unless it displays a currently valid OMB control number. Send comments regarding this burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden, to: AHRQ Reports Clearance Officer Attention: PRA, Paperwork Reduction Project (0935-XXXX) AHRQ, 540 Gaither Road, Room # 5036, Rockville, MD 20850.

Public reporting burden for this collection of information is estimated to average 1 hour per response, the estimated time required to complete the survey. An agency may not conduct or sponsor, and a person is not required to respond to, a collection of information unless it displays a currently valid OMB control number. Send comments regarding this burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden, to: AHRQ Reports Clearance Officer Attention: PRA, Paperwork Reduction Project (0935-XXXX) AHRQ, 540 Gaither Road, Room # 5036, Rockville, MD 20850.