Care Transition Record Transmitted

Identifying Attributes

Care Settings
Care Transitions
Country
United States of America
Publishing Organisation
Joint Commission National Quality Measures: Advanced Certification Heart Failure
Type of Quality Indicator
Process
IOM Quality Dimension
Timeliness
Domain
Communication

Defining Attributes

Definition

Percentage of heart failure patients discharged to home or home care with a care transition record transmitted to a next level of care provider within 7 days of discharge containing ALL of the following: Reason for hospitalisation Procedures performed during this hospitalisation Treatment(s)/Service(s) provided during this hospitalisation Discharge medications, including dosage and indication for use Follow-up treatment(s) and service(s) needed

Numerator

Care transition record transmitted to a next level of care provider within 7 days of discharge containing ALL of the following: Reason for hospitalisation Procedures performed during this hospitalisation Treatment(s)/Service(s) provided during this hospitalisation Discharge medications, including dosage and indication for use Follow-up treatment(s) and service(s) needed

Denominator

All heart failure patients discharged from a hospital inpatient setting to home or home care. Discharges with ICD-10-CM Principal Diagnosis Code for HF as defined in Appendix A, Table 2.1, and A discharge to home, home care, or court/law enforcement

Exclusions

Patients who had a left ventricular assistive device (LVAD) or heart transplant procedure during the hospital stay or a past medical history of an LVAD or heart transplant (ICD-10-PCS procedure code for LVAD and heart transplant as defined in Appendix A Table 2.2, and ICD-10 diagnosis codes on Table 2.13) Patients less than 18 years of age Patient who have a Length of Stay greater than 120 days Patients with Comfort Measures Only documented Patients enrolled in a Clinical Trial Patients discharged to locations other than home, home care, or law enforcement Patients who left against medical advice (AMA)

Use of Risk Adjustment
No
Risk Adjustments

None

Stratifications

Data Attributes

Type of Data Collection
Administrative data, Electronic/paper chart records
Data Collection Methods

Retrospective data sources for required data elements include administrative data and medical records.

Frequency of Data Collection
Frequency of Data Collection in Days
Reporting Methods

For accreditation purposes - measure retired

Reporting Frequency
Reporting Frequency in Days
Indicator Has Recommended Targets
No

Source and Reference Attributes

Evidence Source

Specifications Manual for Joint Commission National Quality Measures (v2023A1) manual.jointcommission.org/releases/TJC2023A1/MIF0240.html

Technical Specifications
Link to Measurement Tools
Quality Indicator Confirmed to be Part of a Program Used to Monitor Quality and Safety of Care Among Older People at a Population-Level between 2012-2022
No
Assessed by the Australian Consortium for Aged Care Collaborators as Generally Containing Good Properties (Importance and Scientific Acceptability)
No
Australian Consortium for Aged Care Endorsed
No
Identified by PHARMA-Care Project
No
Upload Date
23 July 2025