Post-discharge follow-up within 7 days
Patient Experience & Access
How this indicator is defined
Methodology version v1.0
Percentage of hospital discharges with a documented primary-care follow-up within 7 days.
Proportion of eligible patients (percentage)
The percentage of eligible patients (the denominator) who have at least one Post-discharge follow-up (7d) record within the 1-year window. Each patient is counted once.
Data inputs
- Post-discharge follow-up (7d)
Derived from
What this indicator measures— Name, alignment, goal, rationale.
- Indicator nameField 1 — Indicator name
- Post-discharge follow-up within 7 days
- AlignmentField 2 — Alignment
- CIHI — care-transition / post-discharge follow-up
- Illustrative synthetic-demo definition pending clinical review
- Strategic goalField 3 — Strategic goal
- Strengthen care transitions so recently-discharged patients are reviewed promptly in primary care.
- RationaleField 5 — Rationale
- Timely post-discharge follow-up (medication reconciliation, early review) reduces avoidable 30-day readmissions and is a recognised care-transition quality signal.
How it's computed— Scoring method, numerator, denominator, inclusions, exclusions.
- NumeratorField 6 — Numerator
- Discharges with a follow-up encounter within 7 days.
- DenominatorField 7 — Denominator
Active rostered patients age 18+ discharged in the window.
- Sex eligibility:
- Age range: 18–120
- Active as of reporting-period end: yes
- ExclusionsField 9 — Exclusions
- Discharges to palliative or long-term care.
How patients are attributed— Attribution rule and risk adjustment.
- Attribution ruleField 10 — Attribution rule
- Enrolment (rostered)
- Risk-adjustment modelField 11 — Risk-adjustment model
- None
How comparison works— Peer group, reliability threshold, peer comparator.
- Reliability thresholdField 13 — Reliability threshold
- 30
Data + reporting— Data source, reporting frequency, direction of improvement, limitations.
- Reporting frequencyField 15 — Reporting frequency
- quarterly
- Direction of improvementField 16 — Direction of improvement
- Higher is better
Targets + governance— Target, justification, owner, review, approval, version, notes.
- TargetField 18 — Target
- 60.0% — the clinic's target for this indicator, set by the product owner.
- Methodology versionField 23 — Methodology version
- v1.0