Follow-up overview
Follow-up completion, med reconciliation, and SDOH assessment by TOC window
Average days to follow-up
8.2
Total outreach
232
Total IP & High/Critical ED discharges
234
30d readmission rate
17.7%
TOC timeline
Follow-up completion, med reconciliation, and SDOH assessment across time-to-contact windows
0–7 day follow-up
Follow-up completed41.3%(132 of 320)
Med reconciliation35.9%(115 of 320)
SDOH assessment32.5%(104 of 320)
8–14 day follow-up
Follow-up completed15.0%(48 of 320)
Med reconciliation14.4%(46 of 320)
SDOH assessment11.3%(36 of 320)
>14 day follow-up
Follow-up completed16.3%(52 of 320)
Med reconciliation14.7%(47 of 320)
SDOH assessment13.1%(42 of 320)
By risk cohort
Follow-up & readmission by CoC vs Non-CoC
| Group | N | ≤7d | ≤14d | Overdue | Not contacted | Readmit % |
|---|---|---|---|---|---|---|
| Non-CoC | 182 | 26.9% | 41.2% | 42 | 65 | 16.5% |
| CoC | 138 | 60.1% | 76.1% | 10 | 23 | 10.1% |
By discharge type
Follow-up & readmission by IP vs ED
| Group | N | ≤7d | ≤14d | Overdue | Not contacted | Readmit % |
|---|---|---|---|---|---|---|
| ED | 163 | 40.5% | 57.7% | 20 | 49 | 15.3% |
| IP | 157 | 42.0% | 54.8% | 32 | 39 | 12.1% |
These filters apply only to the charts below
Follow-up bucket
Timeline
Follow-up buckets over time
Discharges by first-contact bucket, weekly
Follow-up rate & readmission
Rate trend by weekly period
Follow-up rate: CoC vs Non-CoC
Follow-up rate trend by cohort, weekly
30d readmission rate: CoC vs Non-CoC
Readmission trend by cohort, weekly