Organization Name:

Time Period:

Population Health Worksheet

Use this worksheet as a tool in assessing readmission data for your hospital or community. Complete all fields as
appropriate to your analysis.
1a. Current length of stay
1b. Monthly average for the previous 12 months
1c. Median length of stay
2.

Admissions per year

3.

Discharges per year

4.

# observation patients per month

5.

Average length of stay of observation patients

6.

Readmission rates for the previous 12 months,

at various timeframes (such as 7, 30, 60, or 90 days)

7.

% of admissions from home

8.

% of admissions from home care

9.

% of admissions from long-term care

10. % of admissions from in-patient rehabilitation

11. % of admissions from assisted living
12. % of discharges to home
13. % of discharges to home with home care
14. % of discharges to long-term care
15. % of discharges to inpatient rehabilitation
16. % of discharges to assisted living
17. % of readmissions from home
18. % of readmissions from home care
19. % of readmissions from long-term care
20. % of readmissions from inpatient rehabilitation
21. % of readmissions from assisted living
22. Top 5 DRG for patients readmitted
23. Average # of medications prescribed for readmitted patients
24. Average time for discharge summary to be available for next care
provider post-discharge
25. % of patients without an attributed primary care provider on discharge
26. % readmissions by individual practitioner/clinic
27. %readmissions with behavioral health as a factor/co-morbidity
Adapted from RARE Campaign Population Health Assessment (www.rarereadmissions.org).
All material presented or referenced herein is intended for general informational purposes and is not intended to provide or replace the independent judgment of a qualified healthcare
provider treating a particular patient. Ohio KePRO disclaims any representation or warranty with respect to any treatments or course of treatment based upon information provided. Publication
No. 311302-OH-281-03/2012. This material was prepared by Ohio KePRO, the Medicare Quality Improvement Organization for Ohio, under contract with the Centers for Medicare & Medicaid
Services (CMS), an agency of the U.S. Department of Health and Human Services. The contents presented do not necessarily reflect CMS policy.