HRSA Patient Navigator Demonstration Program
ClinicWide Measures Form (DRAFT)
Introduction to the Clinicwide Measures Form
These are draft instructions. Do not train staff with this document until drafts have been finalized. Revisions may be made to improve form/data entry screen layout and the clarity of instructions. A final version of this document will be released no later than May 2011. Suggestions for improvements are welcome. |
The Clinicwide Measures Form is a tool that may be used to facilitate the collection of clinicwide data from sites with data systems capable of providing these data. The data are reportable in the final two years of the grant program. Sampling of paper medical records is not required. Data may be reported at the site or subsite level, depending on the strategy agreed upon in discussions between each grantee and NOVA staff.
You are welcome to customize and otherwise modify the formatting of the Clinicwide Measures Form. For example, you may choose to highlight options under required elements (categories) applicable to your site, or to delete those that are not applicable. However, you are responsible for the information on the form, so take care to avoid deleting required data elements. Since the data entry screen on the online database will mirror this data entry form, major changes are likely to cause increased data entry effort. If there is doubt about whether a specific modification may cause problems, please contact NOVA.
Please email any questions or concerns regarding these instructions or the form to Debra Stark [email protected] and Caroline McLeod [email protected].
Clinicwide Measures Form (DRAFT)
Site
If applicable:
Subsite
Date __ __ / __ __ / __ __ __ __
Population
Missed appointment rate
If navigating for Diabetes:
Diabetic Foot Check Rate
Eye Check Rate
If navigating for Diabetes or Dyslipidemia:
Lipid Check Rate
If navigating for Asthma:
ER/Hospital Utilization for Patients with Asthma
If navigating for CHF
ER/Hospital Utilization for Patients with CHF
If navigating for CVD:
ER/Hospital
Utilization for Patients with CVD
Site
use only, additional notes:
Instructions for Completing the Clinicwide Measures Form (DRAFT)
These are draft instructions. Do not train staff with this document until drafts have been finalized. Revisions may be made to improve form/data entry screen layout and the clarity of instructions. A final version of this document will be released no later than May 2011. Suggestions for improvements are welcome. |
The data included on the Clinicwide Measures Form will be collected from sites with data systems capable of producing reports on these measures. The data will be collected in the final two years of the grant.
Site Enter the name of your site.
Subsite Enter the name of the subsite associated with the data being reported. This is applicable only if data are being reported at the subsite, rather than the site, level. If data are being reported at the site level, this item may be left blank.
Date Enter the data associated with the data being reported.
Population Record the total number of patients in clinic/system population on which the rates are based.
Missed appointment rate Rate of missed appointments; Number of missed appointments divided by number in the patient population.
Diabetic Foot Check Rate Proportion of diabetics who have had a foot check in the last year. This is applicable only for sites navigating diabetes.
Eye Check Rate Proportion of diabetics with dilated eye check performed in the last year. This is applicable only for sites navigating diabetes.
Lipid Check Rate Proportion of persons with diabetes or dyslipidemia with lipid check in the last 6 months. This is applicable only for sites navigating diabetes and dyslipidemia.
ER/Hospital Utilization for Patients with…
Asthma Percent of asthmatics with an ER or hospital visit in the last 6 months This is applicable only for sites navigating asthma.
CHF Percent of CHF patients with an ER or hospital visit in the last 6 months. This is applicable only for sites navigating CHF.
CVD Percent
of CVD patients with an ER or hospital visit in the last 6 months.
This
is applicable only for sites navigating CVD.
Site
use only, additional notes:
| File Type | application/msword |
| Author | Debra Stark |
| Last Modified By | HRSA |
| File Modified | 2011-06-13 |
| File Created | 2011-06-13 |