2 TNGP-Data-Dictionary

OMB No. 0915-0311 Exp. XX/XX/20XX

Telehealth Network Grant Program (TNGP) Performance Measures
Focusing on Tele-emergency Services
Performance Improvement and Measurement System (PIMS)
As discussed in Section IV.2.ii of this NOFO, all recipients will be required to report data
collected on an annual basis in the Performance Improvement Measurement System
(PIMS). HRSA will provide additional information if awarded.
PROPOSED MEASURES
Please Note: The following Tele-emergency measures are proposed, have not been
finalized, and are subject to change. They have been included to make applicants
aware of the types of data reporting that will be required.
Tele-ED consultation:
Numerator: Identify the total # of patients that received tele-ED consultation at the
originating site, resulting in averted transfer, as a result of the grant
Denominator: Identify the total # of patients that received a tele-ED consultation, or
no tele-ED consultation, during visit to originating site resulting in a transfer to
distant site
Decrease by 5 percent the distant site ED utilization rate due to the implementation of
telehealth per each budget period year.
30-day ED re-admission rate:
Decrease by 5 percent the 30-day emergency department re-admission rate due to
the implementation of telehealth per each budget period year.
Averted transfer:
Recipient must identify total number of tele-ED consultations that resulted in averted
inpatient transfer and admission (for tele-ED patients who were treated and released
only).
I.
For that total patient population, indicate the mode of transportation to the
receiving inpatient facility that to which the tele-ED patient would most likely
have been taken (for tele-ED patients with averted transfer only).
Air
Enter total number of patients
Ambulance
Enter total number of patients
Boat
Enter total number of patients
Personal car
Enter total number of patients
Other
Enter total number of patients
II. For that total patient population, indicate the distance (in miles) to the most
likely receiving inpatient facility (for tele-ED patients who averted transfer only).
Calculate total distance (in miles) for each mode of transportation.
Reason for originating site visit:
Stroke:
I.
Indicate the total number of tele-consultations as a result of stroke being main
reason for the patient visits.
a. Out of that total number, indicate number of patients eligible for tissue
plasminogen activator (tPA), for patients with diagnosis of stroke only.

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II.

Increase by 5 percent from baseline the number of tele-consulted patients, who
have been diagnosed with stroke, by utilizing telehealth per each budget period
year.
Mental/Behavioral Health:
I.
Indicate total number of tele-consultations as a result of Mental/Behavioral
Health being main reason for the patient visits.
II. Increase by 5 percent from baseline the number of tele-consulted patients, who
have been diagnosed with mental/behavioral health, by utilizing telehealth per
each budget period year.
Tele-emergency service(s) Utilization:
Instructions
• If applicable and desired, use the table provided under this section to complete
responses.
• Hospital utilization tracking should be specific to the targeted patient population
(full patient panel) identified in your grant project’s awarded application
proposal, that were served with Tele-emergency service(s).
• If any responses under this section are not applicable or you chose to not
report, please respond “N/A.”
• Please refer to language outlined further below for specific calculation
instructions for completion of measure responses and for definitions of all
terminology included under this section.

Emergency Department (ED) Utilization Calculation

Numerator = Total number of patient ED admissions
Numerator Inclusion Criteria
• ED admissions are counted for patients within your grant project’s specified
target patient population (full patient panel) only.
• ED admissions are to be counted with respect to your grant project’s specified
related disease condition(s) only. This is not intended to count all-cause
admissions but count admissions specific to conditions addressed by the
services and activities implemented for your funded grant project.
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• ED admission are counted as ED admissions that occurred within the current
grant project reporting period of performance timespan.
• Multiple ED admissions for the same patient is included in this value. Ex. Ms.
Doe was admitted to the ED and then re-admitted two months later, both within
the budget period timeframe. Ms. Doe’s admissions would be counted as a
total of two (2) for this numerator.
Denominator = Total number of unique individuals from your project’s target
patient population (full patient panel) who received direct services during
this project performance period reporting.
Denominator Inclusion Criteria
• Value reported should be consistent with the same numerical value reported
for the numerator reported for measure 1.
• The total number reported includes the total number of unique individual
patients only. No patient should be counted more than once.
30-Day Emergency Department (ED) Re-Admission Calculation

Numerator = Total number of patient 30-Day ED re-admissions
Numerator Inclusion Criteria
• 30-day ED re-admission of patients include patients within your
project’s specified target patient population (full patient panel) only.
• 30-day ED admissions are to be counted with respect to your grant project’s
specified related disease condition(s) only. This is not intended to count allcause admissions but count admissions specific to conditions addressed by
the services and activities implemented for your funded grant project.
• 30-day ED re-admissions that occurred within the current grant project
reporting period of performance timespan.
• Duplicate 30-day ED re-admission for the same patient is included in this value.
Ex. Ms. Doe was admitted to the ED within 30 days on two different accounts
within the budget period timeframe. Ms. Doe’s 30-day ED re-admissions would
be counted as a total of two (2) for this numerator.
Denominator = Total number of patient ED admissions
Denominator Inclusion Criteria
• ED admissions are counted for patients within your grant project’s specified
target patient population (full patient panel) only.
• ED admissions are to be counted with respect to your grant project’s specified
related disease condition(s) only. This is not intended to count all-cause
admissions but count admissions specific to conditions addressed by the
services and activities implemented for your funded grant project.
• ED admission are counted as ED admissions that occurred within the current
grant project reporting period of performance timespan.
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• Multiple hospital re-admissions for the same patient is included in this value.
Ex. Ms. Doe was admitted to the ED and then re-admitted two months later,
both within the budget period timeframe. Ms. Doe’s admissions would be
counted as a total of two (2).
• Value reported should be consistent with same value reported for the
numerator used for the calculation of the Emergency Department Admission
Rate in the previous measure.
30-Day Hospital Re-Admission Calculation

Numerator = Total number of patient 30-day hospital re-admissions
Numerator Inclusion Criteria
• 30-day hospital re-admission of patients include patients within your grant
project’s specified intervention patient population only.
• 30-day hospital admissions are to be counted with respect to your grant
project’s specified intervention focus only (this is not intended to be allcause re-admissions but specific to conditions related to grant project).
• 30-day hospital re-admissions that occurred within the current grant budget
reporting period timespan.
• Duplicate 30-day hospital re-admission for the same patient is included in
this value. Ex. Ms. Doe was admitted to the ED within 30 days on two
different accounts within the budget period timeframe. Ms. Doe’s 30-day
hospital re-admissions would be counted as a total of two (2) for this
numerator.
Denominator = Total number of patient hospital admissions
Denominator Inclusion Criteria
• Hospital admissions count patients within your grant project’s specified
target patient population (full patient panel) only.
• Hospital admissions are to be counted with respect to your grant project’s
specified related disease condition(s) only. This is not intended to count
all-cause admissions but count admissions specific to conditions
addressed by the services and activities implemented for your funded
grant project.
• Hospital admission are counted as hospital admissions that occurred
within the current grant project reporting period of performance timespan.
• Multiple hospital admissions for the same patient is included in this value. Ex.
Ms. Doe was admitted to the hospital and then re-admitted two months later,
both within the budget period timeframe. Ms. Doe’s admissions would be
counted as a total of two (2).
Public Burden Statement: The purpose of this collection is to use a performance measurement tool to collect data from grantees receiving funds under the
Telehealth Network Grant Program. An agency may not conduct or sponsor, and a person is not required to respond to, a collection of information unless it displays
a currently valid OMB control number. The OMB control number for this information collection is 0915 -0311 and it is valid until XX/XX/202X. This information
collection is required to obtain or retain a benefit (Section 330I of the Public Health Service Act. The Health Care Safety Net Amendments of 2002 (Public Law
107-251) amended the Public Health Service Act by adding Section 330I)]. [If this information collection includes information protected by any form of confidentiality
then explain this confidentiality and cite the authority.] Public reporting burden for this collection of information is estimated to average 1 hours per response,
including the time for reviewing instructions, searching existing data sources, and completing and reviewing the collection of information. Send comments regarding
this burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden, to HRSA Reports Clearance Officer, 5600
Fishers Lane, Room 14N136B, Rockville, Maryland, 20857 or paperwork@hrsa.gov.

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