The Opportunity

There are currently no measures that address the quality of transitions of care for a medical condition into and out of an emergency department (ED), such as patients who visit the ED from a usual source of care from various care settings (e.g. primary care provider or specialist, long-term care hospitals, skilled nursing facilities, etc.) and then who are discharged from the ED to their usual source of care. ED visits often represent critical inflection points in a patient’s health trajectory, making management of these transitions of care important. Consequently, bidirectional information flows from outpatient providers to EDs and EDs to outpatient providers require attention. Improving the management of transitions of care in and out of the ED has the potential to improve person-centered care, value, and cost efficiency.

Lack of information sharing between providers may lead to anxiety, uncertainty, avoidable resource utilization, or a worsening in the patient’s condition and potential harm. In fact, almost a quarter (22.3%) of patients treated in the ED revisit the ED within 30 days, and one in five Medicare beneficiaries discharged from the hospital are readmitted within 30 days - half of whom have not yet seen an outpatient doctor for follow-up.¹ The lack of optimal communication during transitions from one care setting to another may also contribute to confusion among clinicians about the patient’s severity of condition, duplicative tests, inconsistent patient monitoring, medication errors, delays in diagnosis, and lack of follow-through on referrals. System failures may contribute to poor outcomes in patient safety, quality of care, and health outcomes.²

Objectives

National Quality Forum (NQF) will conduct a multi-stakeholder review of existing and potential emergency department transition of care metrics, leading to the identification of measurement gaps, and the development of a measure framework and set of guiding principles for future measurement opportunities. The purpose of this work is to identify concepts for a transitions of care quality measure for conditions that cross healthcare settings that could increase care coordination, provide accountability for providers, decrease waste, increase person-centeredness, and result in higher quality care for all patients. This type of quality measure will create a precedent for increasing communication among providers throughout the care continuum across a number of commonly treated conditions.

NQF Process

Over a 12-month period, NQF will convene a multi-stakeholder expert panel to conduct an environmental scan of existing and potential emergency department-centric metrics, conduct a gap analysis, develop a measure framework, and produce a detailed final report of the measure framework, with a prioritized list of measure concepts and guiding principles to be considered for future measurement. Throughout this project, NQF will solicit input from NQF’s multi-stakeholder audience, including NQF membership and public stakeholders.

Funding

This project is funded by the Department of Health and Human Services.

For information about the availability of auxiliary aids and services for NQF’s federally funded projects, please visit http://www.medicare.gov/about-us/nondiscrimination/nondiscrimination-notice.html.

Contact Information

For more information, please contact the project team at EMTransitions@qualityforum.org.

Notes

1. Jencks, SF, Williams MV, Coleman EA. Rehospitalizations among patients in the Medicare fee-for-service program. New England journal of medicine 2009;360(14):1418-1428.
2. National Transitions of Care Coalition. Improving Transitions of Care: Findings and Considerations of the “Vision of the National Transitions of Care Coalition.” September 2010. http://www.ntocc.org/portals/0/pdf/resources/ntoccissuebriefs.pdf