Transition Record With Specified Elements Received by Discharged Patients (Emergency Department Discharges to Ambulatory Care [Home/Self Care] or Home Health Care)

Identifying Attributes

Care Settings
Care Transitions
Country
United States of America
Publishing Organisation
Centers for Medicare & Medicaid Services (CMS) and Physician Consortium for Performance Improvement Foundation: Care Coordination Project
Type of Quality Indicator
Process
IOM Quality Dimension
Timeliness
Domain
Communication

Defining Attributes

Definition

Percentage of discharges in which the patient or their caregiver(s) received a transition record at the time of emergency department (ED) discharge including, at a minimum, the listed elements

Numerator

Discharges in which the patient or their caregiver(s) received a transition record at the time of emergency department (ED) discharge including, at a minimum, all of the following elements: - Summary of major procedures and tests performed during ED visit, AND - Principal clinical diagnosis at discharge which may include the presenting chief complaint, AND - Patient instructions, AND - Plan for follow-up care (OR statement that none required), including primary physician, other health care professional, or site designated for follow-up care, AND - List of new medications and changes to continued medications that patient should take after ED discharge, with quantity prescribed and/or dispensed (OR intended duration) and instructions for each

Denominator

All discharges for patients, regardless of age, from an emergency department (ED) to ambulatory care (home/self care) or home health care

Exclusions

Patients who died; Patients who left against medical advice (AMA) or discontinued care

Use of Risk Adjustment
No
Risk Adjustments

None

Stratifications

None

Collection and Reporting Attributes

Type of Data Collection
Electronic/paper chart records
Data Collection Methods

Electronic Health Data; Paper Patient Medical Records

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

Measure Retired and Endorsement Removed

Reporting Frequency
Reporting Frequency in Days
Indicator Has Recommended Targets
No

Source and Reference Attributes

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
Can the Quality Indicator be Readily Implemented at a Population Level in Australia Given its Current Data Landscape?
Implementation of this quality indicator was not assessed.
Identified by PHARMA-Care Project
No
Upload Date
31 March 2026