Table 3.
Domains measured in TRACE-CORE.
| Patient interviews | Medical record abstractions 6, 12, 18, and 24M | |||||||
|---|---|---|---|---|---|---|---|---|
| Domains and measures | Project | Baseline | 1M | 3M | 6M | 12M | Baseline | |
| Transition quality | ||||||||
| Care Transitions Measure (CTM15) for index hospitalization9 | T | X | ||||||
| Caregiving support | T, A | X | ||||||
| Care Transitions Measure (CTM3) for most recent hospitalization10 | T | X | X | X | X | |||
| Quality of life | ||||||||
| Short-Form Health Survey (SF36)11, 12 | T, A | X | X | X | X | X | ||
| Seattle Angina Questionnaire (SAQ)13 | T, A | X | X | X | X | X | ||
| Disease impact scale (DIS-7) | T, A | X | X | X | X | X | ||
| Role functioning14, 15 | X | X | X | X | X | |||
| Clinical outcomes | ||||||||
| Readmissions | T, A | X | X | X | X | X | ||
| Emergency room visits | T, A | X | X | X | X | X | ||
| Outpatient encounters | T, A | X | X | X | X | X | ||
| Mortality | A | X | X | X | X | X | X | |
| Medical characteristics | ||||||||
| Vital signs and cardiac symptoms at hospitalization | A | X | ||||||
| Clinical findings (including ECG findings) | A | X | ||||||
| Cardiac procedures | T, A | X | X | |||||
| Medical histories and comorbidities | T, A | X | X | |||||
| Medications | T, A | X | X | X | X | X | X | |
| Access to medical care | T, A | X | X | X | X | X | ||
| Hearing and vision impairment | T, A | X | X | |||||
| Behavioral characteristics | ||||||||
| Physical activity16 | A | X | X | X | X | |||
| Diet17 | A | X | X | X | X | |||
| Alcohol consumption | A | X | X | X | X | |||
| Smoking and use of smokeless tobacco products | A | X | X | X | X | X | ||
| Weight changes, weight loss attempts | A | X | X | X | X | X | ||
| Recommendations for lifestyle change | A | X | X | |||||
| Medication adherence18, 19 | T, A | X | X | X | X | X | ||
| Online information-seeking behavior | T, A | X | X | |||||
| Psychosocial characteristics | ||||||||
| Telephone Interview for Cognitive Status (TICS)20 | T, A | X | X | X | X | X | ||
| Depression (PHQ9)21, 22 | T, A | X | X | X | X | X | ||
| Anxiety (GAD7)23, 24 | T, A | X | X | X | X | X | ||
| Trust in physicians25 | T, A | X | X | X | ||||
| Patient Activation Measure (PAM6)26 | T, A | X | X | X | ||||
| Shared decision making27 | T, A | X | ||||||
| Health literacy and numeracy28, 29 | T, A | X | ||||||
| Religiosity/spirituality | T, A | X | ||||||
| Perceived Stress Scale (PSS4)30 | T, A | X | X | X | ||||
| Social support31 | T, A | X | X | X | ||||
| Lubben Social Network Scale (LSNS6)32 | T, A | X | X | X | ||||
| Demographics | ||||||||
| Date of birth (age) | T, A | X | ||||||
| Race/ethnicity and education | T, A | X | X | |||||
| Marital status, living situation | T, A | X | X | X | X | X | ||
| Household size, annual income | T, A | X | X | |||||
T = Transitions Project, A = Action Scores Project.