D2D 1.0: Data Contribution Sign-up form

Name

Email Address

Phone Number

Name

Email Address

Phone Number

Name

Email Address

Phone Number

Yes

Childhood immunizations

Influenza immunizations among people over 65 years old

Patient experience with time spent with provider, opportunity to ask questions and be involved in their care

Access, as indicated by % of patients reporting they received appointments within the same or next day of booking

Colorectal and cervical cancer screening

Readmissions to hospital within 30 days of discharge for selected conditions

Cost of care per patient (hospital, ER, diagnostic, community care as well as primary care)

Regular primary care provider (% of all physicians visits with primary physician -- formerly referred to as “Continuity of care”)