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Release Notes:
Data Element
Version 2010B

Data Element Name: Home Management Plan of Care Document Addresses Arrangements for Follow-up Care
Collected For: CAC-3, Joint Commission Only , Test Measure
Definition:Documentation exists that the Home Management Plan of Care (HMPC) document, separate and specific to the patient and provided to the patient/caregiver, prior to or upon discharge, includes information that arrangements for referral or follow-up care with a healthcare provider has been made.
Suggested Data Collection Question:Does the HMPC document, separate and specific to the patient and provided to the patient/caregiver, prior to or upon discharge, include information that arrangements for referral or follow-up care with a healthcare provider has been made?
Format:
Length:1
Type:Alphanumeric
Occurs:1
Allowable Values:

1     The HMPC document includes documentation that an appointment for referral or follow-up care with a healthcare provider has been made.

2    The HMPC document includes documentation that the patient/caregiver has been given information (healthcare provider/clinic/office name and phone number) to make arrangements for follow-up care.

3    Documentation exists that the patient/ caregiver refused an appointment/information for referral or follow-up care with a healthcare provider.

4    The HMPC document does not include:

  • Documentation that an appointment for referral or follow-up care with a healthcare provider has been made
  • Documentation that the patient/caregiver has been given information (healthcare provider/clinic/office name and phone number) to make arrangements for follow-up care
    OR
  • Unable to determine from the medical record documentation.
Notes for Abstraction:
  • The healthcare provider could be a primary care physician, an asthma specialist, an advance practice registered nurse (e.g., APN), or a physician assistant (PA) in order to select “1 or 2.”
  • Documentation of appointment for referral or follow-up care must include all of the following in order to select “1” for the data element:
    • Provider/clinic/office name
    • Date of appointment
    • Time of appointment
  • Documentation of information for referral or follow-up care must include all of the following in order to select “2” for the data element:
    • Provider/clinic/office name
    • Telephone number
    • Time frame for appointment for follow-up care, e.g., 7 – 10 days
Suggested Data Sources:

  • HMPC document
Additional Notes:
Guidelines for Abstraction:
Inclusion Exclusion
  • None
  • None

Home Management Plan of Care Document Addresses Arrangements for Follow-up Care
Specifications Manual for Joint Commission National Quality Core Measures (2010B)
Discharges 10-01-10 (4Q10) through 03-31-11 (1Q11)