7-day-follow-up-after-leaving-hospital - Health Quality Ontario (HQO)

INDICATOR NAME

Name

In-person patient follow-up with a family doctor after leaving hospital

Alternate Name

7 day in-person follow-up after leaving hospital for selected conditions

INDICATOR DESCRIPTION

Description

This indicator measures the rate of in-person follow-up visits to a family doctor within 7 days of discharge, after hospitalization for pneumonia, diabetes, stroke, gastrointestinal disease, congestive heart failure, chronic obstructive pulmonary disease, heart attack, or other cardiac conditions. It does not include virtual visits. Timely follow-up can help smooth a patient’s transition from hospital to home or community.

A higher rate is better.

HQO Reporting tool/product

Public reporting

Dimension

Effective, Timely

Type

Process

DEFINITION AND SOURCE INFORMATION

Unit of Measurement

Percentage

Calculation Methods

Numerator divided by the denominator times 100

Numerator (short description i.e. not inclusions/exclusions)

Number of patients who had an in-person primary care physician visit within 7 days of discharge after hospitalization for any of the following conditions: pneumonia, diabetes, stroke, gastrointestinal disease, congestive heart failure, chronic obstructive pulmonary disease, heart attack and other cardiac conditions (selected HBAM Inpatient Grouper (HIG) conditions).

Denominator (short description i.e. not inclusions/exclusions)

Number of patients discharged from hospital after hospitalization for any of the following conditions: pneumonia, diabetes, stroke, gastrointestinal disease, congestive heart failure, chronic obstructive pulmonary disease, heart attack and other cardiac conditions (selected HBAM Inpatient Grouper (HIG) conditions).

Adjustment (risk, age/sex standardization)- generalized

None

Data Source

Client Agency Program Data (CAPE), Corporate Provider Database (CPDB), Discharge Abstract Database (DAD), Ontario Health Insurance Plan (OHIP) Claims History Database

Data provided to HQO by

Ministry of Health

Reported Levels of comparability /stratifications (defined)

Income, Region, Rurality, Sex, Time

OTHER RELEVANT INFORMATION

Caveats and Limitations

Other types of follow-up (e.g. with a specialist or nurse practitioner) and virtual follow-up visits with any provider are not captured by this indicator. In-person follow-up visit is not condition/discharge-specific and does not necessarily have the same reason for visit as the hospitalization. It captures an in-person visit for any reason within 7 days and may include visits unrelated to the index hospitalization. Due to age restrictions/differences for some conditions the results are not reported by age groups. Deaths which take place in the community within 7 days following discharge are not accounted for and cannot be removed from the calculation. Results for calendar years 2020-2022 should be interpreted with caution, as changes in primary care delivery during the pandemic affected this indicator. This indicator measures in-person follow-up visits only. The proportion of primary care visits that are virtual has greatly increased since the beginning of the COVID-19 pandemic. Results for this indicator for calendar years 2020-2022 are lower than in in the years before 2020 mainly because virtual care visits are not included in this indicator. Additionally, the proportion of virtual care visits was high in 2020 but has been decreasing in subsequent years. As a result, values increased for this indicator in 2021 and 2022 as the proportion of visits shifted more toward in-person visits.