Post-Discharge Evaluation for Heart Failure Patients

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
Follow-Up

Defining Attributes

Definition

Percentage of patients who receive a re-evaluation for symptoms worsening and treatment compliance by a program team member within 72 hours after inpatient discharge. The Joint Commission's Disease-Specific Care Advanced Certification Heart Failure standards require: Assessment and reassessment are completed and that the patient is reevaluated within 72 hours after inpatient discharge.

Numerator

Patients who have a documented re-evaluation conducted via phone call or home visit within 72 hours after discharge.

Denominator

All heart failure patients discharged from a hospital inpatient setting to home or home care AND patients leaving against medical advice (AMA).

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. 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

Use of Risk Adjustment
No
Risk Adjustments

None

Stratifications

Collection and Reporting 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

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
Identified by PHARMA-Care Project
No
Upload Date
02 December 2025