7 Co-occuring Disorders

HRSA Patient Navigator Demonstration Program

Co-Occurring Disorders Form (DRAFT)

Introduction to the Co-Occurring Disorders Form

The Co-Occurring Disorders Form is a tool that may be used to facilitate the coding of co-occurring disorder data at intake. Data related to co-occurring disorders for all navigated patients will need to be collected and reported to NOVA Research for inclusion in the data analysis.

Co-Occurring Disorder Data for Patients Entering Navigation Prior to Database Distribution. Grantees may choose to complete this form at the time of intake for patients entering navigation prior to the dissemination of the online database. After the database is distributed grantees may key-enter the data from Co-Occurring Disorder Forms that were completed at intake, key-enter these data directly from other records (e.g., medical records), or may choose to create a dataset for upload (data file specifications and upload instructions will be sent separately).

Co-Occurring Disorder Data for Patients Entering Navigation After Database Distribution. After the data system is online, navigators at some sites will fill out the Co-Occurring Disorder Form for later data entry (on at least a weekly basis). Navigators at other sites with online access at the time of the intake interview may choose to enter data directly into the system without the intermediate use of paper. Other sites may choose to generate a data file that includes co-occurring disorder data for upload into the online system. No further changes are expected on the Co-Occurring Disorder Form, and since the data entry screen on the online system will mirror the attached form, sites should be able to use the paper form and the online screen interchangeably throughout the project, minimizing training needs.

Using the Co-Occurring Disorder Form. You are welcome to customize and otherwise modify the formatting of the Co-Occurring Disorder Form.

Study IDs. By the time the data system is online, NOVA will have worked with sites to determine the best strategy for assigning Study IDs to navigated patients. The process for linking patient information with the Study ID will need to be customized according to the data systems and data needs at each site. In the interim, please leave the field for Study ID blank.

Please email any questions or concerns regarding these instructions or the form to Debra Stark [email protected] and Caroline McLeod [email protected].

Co-Occurring Disorders Form

Site use only:

Local Identifier:

Study ID:

Date: __ __ / __ __ / __ __ __ __

Co-Occurring Disorders

List all co-occurring disorders at the time navigation was started.

Site use only, additional notes:

Entered: __ __ / __ __ / __ __ By: _______

Instructions for Completing the Co-Occurring Disorders Form

The data included on the Co-Occurring Disorder Form should be collected every time a new patient is brought into navigation. All of the data on this form should reflect the patient’s status at the time navigation started. (These data will also be collected at the end of navigation; see the Patient Closeout Form.)

Local Identifier This item should be used to record whatever local identifier will be helpful to local staff; these data will not be entered into the study database.

Study ID Use this space to record the Study Identifier; this is the unique numeric ID assigned to each navigated patient. This may be left blank until procedures for assigning study IDs are in place.

Date Date on which the co-occurring disorder data were recorded.

Co-Occurring Disorders Record all co-occurring disorders affecting the patient at the time of intake. This should not include the condition for which the patient is currently being navigated. The online system will allow sites to upload these data so sites may choose to export these data from their local EMR, rather than data enter them. If these data will be extracted from a local data system and uploaded separately, this section need not be completed and entered as part of the intake process.