# Care-gap outreach measurement worksheet

Ethon AI · Revised September 5, 2026

Blank administrative planning aid. Use fictional examples only.
This worksheet does not define clinical measures, coding, eligibility, or completion.
Use the program's approved specifications and qualified reviewers.

## Program definition

- Program/measure:
- Approved specification and version:
- Responsible reviewer:
- Measurement window:
- Eligibility source:
- Exclusions:
- Completion evidence required:
- Who may approve a completed status:

## Keep milestones separate

| Milestone | Definition | Denominator/time window | Evidence source | Owner | Unresolved questions |
| --- | --- | --- | --- | --- | --- |
| Eligible for outreach | | | | | |
| Contact attempted | | | | | |
| Person reached | | | | | |
| Appointment booked | | | | | |
| Completion verified | | | | | |

## Review before rollout

- [ ] Eligibility and contact permissions follow approved program rules.
- [ ] Clinical questions are handed to qualified staff.
- [ ] Bookings do not automatically become completed care gaps.
- [ ] Missing evidence remains visible.
- [ ] Each count has a defined window and denominator.
- [ ] Comparisons record exclusions, changing case mix, and staff effort.
- [ ] Any financial estimate lists costs, assumptions, and potential overlap.