The Pediatric Hospital Care Improvement Project’s (P-HIP) Hospital-to-Home Transitions Collaborative sought to improve reporting on hospital-to-home transitions through timely and feasible data collection, uploading, and measure scoring.
Both the level of discharge documentation and content of discharge instructions to families/caregivers are essential for ensuring a successful transition between care settings. The measures for this toolkit were developed to capture the quality of care coordination in transition between care settings. They are based on medical records documentation and focus on the content of discharge instructions provided to patients’ families and caregivers.
Measure Specifications and Reporting
Children/adolescents admitted to the hospital should have documentation in the medical record of written discharge instructions provided to their family/caregivers that contain the following:
- Admission and discharge diagnoses.
- Medication list at discharge.
- Pending test results.
- Follow-up tests that need to be completed.
- List of follow-up appointments.
- 24/7 telephone contact number if problems arise.
- Number to call for assistance getting needed appointments.
- Immunizations given.
- Admit and discharge dates.
To assist toolkit users with timely and feasible data collection, uploading, and measure scoring, the Pediatric Hospital Care Improvement Project’s (P-HIP) Hospital-to-Home Transitions Collaborative created an Excel Macro Medical Record (MR) abstraction tool that includes an automated scoring function. The tool allows the user to easily produce output to a Comma Separated Values (CSV) file, which provides plain text for analysis and processing. The tool can be downloaded (Zipped file, 741 KB. Note: Persons with disabilities who experience problems accessing this content or file should contact AHRQ at PQMP@ahrq.hhs.gov).
Using the MR abstraction tool ensures that the correct variables are being used to create a legitimate score and output. The MR abstraction tool is designed to support users in making valid comparisons, as appropriate. The MR abstraction tool is accompanied by a guidance document (PDF, 1.2 MB). Together, these tools can be used to improve reporting on this measure.
Quality Measures to Assess Care Transitions for Hospitalized Children (PDF), featured in Pediatrics, discusses the processes used for both developing and validating the Quality of Pediatric Hospital-to-Home Transitions measure.