4 Healthy Weight

0915-XXXX XX/XX/20XX

Federal Office of Rural Health Policy (FORHP)

Office for the Advancement of Telehealth (OAT)

Telehealth Network Grant Program (TNGP)

HEALTHY WEIGHT MODULE

This module will be used if the SB-TNGP offers healthy weight services.

The information in this section is collected for each student receiving healthy weight services via telehealth during the measurement period.

Data Element Dictionary

The data element dictionary documents definitions, allowable values, sources for information, and instructions for abstraction.

The data elements are designed to provide the necessary data to calculate the measures. A data collection tool will be used for data entry.

Throughout this document there are references to “the measurement period.” There will be two measurement periods, each six months in duration. These will be January 1 – June 30 and July 1 – December 31.

Public Burden Statement:  An agency may not conduct or sponsor, and a person is not required to respond to, a collection of information unless it displays a currently valid OMB control number.  The OMB control number for this project is 0915-XXXX.  Public reporting burden for this collection of information is estimated to average XX hours per response, including the time for reviewing instructions, searching existing data sources, and completing and reviewing the collection of information. Send comments regarding this burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden, to HRSA Reports Clearance Officer, 5600 Fishers Lane, Room 14N39, Rockville, Maryland, 20857

Data element number:	Healthy Weight - 1
Variable name:	Referral source
Variable definition:	Indicates the referral source for this student receiving telehealth healthy weight services as part of the SB-TNGP
Data collection level:	Student
Criteria:	Students who received telehealth healthy weight services through the SB-TNGP during the measurement period
Valid (allowable) values:	Check only one of the following. Options for response are: □ Student self-referred □ Student was referred by their parent/guardian □ Student was referred by a teacher at the school □ Student was referred by a guidance counselor at the school □ Student was referred by an administrator at the school □ Student was referred by SBHC staff or the school nurse □ Student was part of a registry indicating services were needed □ Other – please specify:__________________________________________ □ Unknown: Unable to determine from telehealth log or student visit record
Note for abstractions:	If student had multiple encounters or multiple referral sources, indicate the first referral source for this student for telehealth healthy weight services.
Source for definitions:	Rural Telehealth Research Center

Data element number:	Healthy Weight - 2
Variable name:	Students with BMI greater than or equal to 85th percentile whose blood pressure percentile was assessed and classified as normal or abnormal
Variable definition:	Indicates whether or not there the student’s blood pressure percentile was assessed and classified as normal or abnormal WITHIN THE PREVIOUS 12 MONTHS
Data collection level:	Student
Criteria:	Students who received telehealth healthy weight services through the SB-TNGP during the measurement period
Valid (allowable) values:	Check only one of the following. Options for response are: □ Student had BMI less than 85th percentile □ Student had BMI greater than or equal to 85th percentile and blood pressure percentile was assessed as NORMAL □ Student had BMI greater than or equal to 85th percentile and blood pressure percentile was assessed as ABNORMAL □ Student had BMI greater than or equal to 85th percentile and blood pressure percentile was NOT assessed
Note for abstractions:	Normal blood pressure is defined as systolic and diastolic blood pressures below 90th percentile on sex-specific by-age-and-height charts. Chart example: https://www.bcm.edu/bodycomplab/Flashapps/BPVAgeChartpage.html Other charts: https://www.nhlbi.nih.gov/files/docs/bp_child_pocket.pdf Blood pressure should be measured at least annually; so assessment must have been within last 12 months. If there is more than one measurement in the previous 12 months then report the classification for the most recent measurement.
Source for definitions:	NIH, National Heart, Lung, and Blood Institute AHRQ National Quality Measures Clearinghouse https://www.qualitymeasures.ahrq.gov/summaries/summary/49241

Data element number:	Healthy Weight - 3
Variable name:	BMI percentile, counseling for nutrition, and counseling for physical activity were reported
Variable definition:	Indicates whether or not there is report WITHIN THE PREVIOUS 12 MONTHS of the student’s BMI percentile, and counseling for nutrition, and counseling for physical activity
Data collection level:	Student
Criteria:	Students who received telehealth healthy weight services through the SB-TNGP during the measurement period
Valid (allowable) values:	Check those that apply of the following. Options for response are: □ Yes BMI: Indicates that BMI percentile was measured within the previous 12 months □ Yes Nutrition: Indicates that the student received counseling for nutrition within the previous 12 months □ Yes Physical Activity: Indicates that the student received counseling for physical activity within the previous 12 months □ No: Indicates that none of these was done within the previous 12 months
Note for abstractions:	BMI percentile should be assessed annually; so the values must be dated within last 12 months. A BMI percentile calculator for children and teens is available through the CDC at (http://apps.nccd.cdc.gov/dnpabmi/Calculator.aspx Counseling for nutrition includes: checklist indicating nutrition was addressed; educational materials on nutrition were provided Counseling for physical activity includes: checklist indicating physical activity was addressed; educational materials on physical activity were provided
Source for definitions:	SBHA http://www.sbh4all.org/resources/quality-counts/five-performance-measures/ HEDIS Child Documentation and Coding Guidelines, 2017AAP, Bright Futures. https://brightfutures.aap.org/Bright%20Futures%20Documents/Physical%20Examination.pdf

Data element number:	Healthy Weight - 4
Variable name:	Number of telehealth encounters that the student received for healthy weight
Variable definition:	Indicates how many encounters for healthy weight services that the student received that involved telehealth
Data collection level:	Student
Criteria:	Students who received telehealth healthy weight services as part of the SB-TNGP during this measurement period
Skip logic:	NOTE that the response to this question will be used to determine the extent of ENCOUNTER level data collection. In particular, a high number of healthy weight visits will trigger instructions to only complete ENCOUNTER level data collection for the first visit each month.
Valid (allowable) values:	Any numeric character
Note for abstractions:	An encounter can be of any duration, and it can be scheduled or impromptu.
Source for definitions:	SB TNGP FOA

Data element number:	Healthy Weight - 5
Variable name:	Number of non-telehealth encounters that the student received for healthy weight in the school setting
Variable definition:	Indicates how many encounters for healthy weight services that the student received in the school setting that did not involve telehealth
Data collection level:	Student
Criteria:	Students who received telehealth healthy weight services as part of the SB-TNGP during this measurement period
Valid (allowable) values:	Any numeric character or NA indicating that the data are “Not Available”
Note for abstractions:	We understand that this information will not be available in many schools, in which case enter NA. An encounter can be of any duration, and it can be scheduled or impromptu. Complete only for students who had telehealth healthy weight services. The school setting means the setting where the SB-TNGP operates.
Source for definitions:	Rural Telehealth Research Center

Data elements that are collected at the ENCOUNTER level

The information in this section will be collected for SB-TNGP telehealth healthy weight encounters.

Instructions

NOTE the following questions are to be answered for each telehealth healthy weight ENCOUNTER if the number of telehealth healthy weight encounters for the student during the measurement period is less than 6. If the number of telehealth healthy weight encounters during the measurement period is more than 6, then answer the following questions for each ENCOUNTER that was the first encounter of the month.

Data element number:	Healthy Weight - 6
Variable name:	Type of healthy weight provider seen via telehealth
Variable definition:	Indicates the type of licensed provider the student saw for telehealth healthy weight services during this encounter
Data collection level:	Encounter
Criteria:	Students who received healthy weight services via telehealth as part of the SB-TNGP during this measurement period
Valid (allowable) values:	Check ALL that apply. Options for response are: □ Primary care provider □ Registered nurse □ Registered dietitian □ Other – please specify:__________________________________________ □ Unknown: Unable to determine from telehealth log or student visit record
Note for abstractions:
Source for definitions:	Rural Telehealth Research Center

Data element number:	Healthy Weight - 7
Variable name:	Type of healthy weight service provided via telehealth
Variable definition:	Indicates the type of telehealth healthy weight services the student received during this encounter
Data collection level:	Encounter
Criteria:	Students who received healthy weight services via telehealth as part of the SB-TNGP during this measurement period
Valid (allowable) values:	Check ALL that apply. Options for response are: □ Assessment □ Nutrition counseling □ Physical activity counseling □ Service or assessment for crisis or emergent healthy weight need □ Other – please specify:__________________________________________ □ Unknown: Unable to determine from telehealth log or student visit record
Note for abstractions:
Source for definitions:	Rural Telehealth Research Center

Data element number:	Healthy Weight - 8
Variable name:	Telehealth technical success
Variable definition:	Indicates whether or not telehealth technology was administered successfully
Data collection level:	Encounter
Criteria:	Students who received healthy weight services via telehealth as part of the SB-TNGP during this measurement period
Valid (allowable) values:	Check only one of the following. Options for response are: □ Successful: The telehealth encounter was technologically successful □ Unsuccessful: The telehealth encounter was technologically NOT successful □ NA: Not Applicable □ Unknown: Unable to determine from telehealth log or student visit record
Note for abstractions:	Successful administration means that voice and video quality were sufficient to complete the consultation. Technical drop-outs of the telemedicine system did not occur. Unsuccessful administration means that the voice and/or video quality were not of sufficient quality to complete the consultation (e.g. unreachable network, poor image quality, poor audio signal quality). If unable to determine whether the telehealth consultation was technically successful, select ‘Unknown.’
Source for definitions:	Modified PIMS; Rural Telehealth Research Center

Data element number:	Healthy Weight - 9
Variable name:	Immediate disposition
Variable definition:	Indicates the student’s immediate disposition at the conclusion of this encounter
Data collection level:	Encounter
Criteria:	Students who received healthy weight services as part of the SB-TNGP during this measurement period
Valid (allowable) values:	Check only one of the following. Options for response are: □ Student was released to resume regular school schedule □ Student was released from school to parent/guardian’s care □ Student was transferred to other health care □ Other – please specify:__________________________________________ □ Unknown: Unable to determine from telehealth log or student visit record
Note for abstractions:
Source for definitions:	Rural Telehealth Research Center

Data element number:	Healthy Weight - 10
Variable name:	Follow-up referral
Variable definition:	Indicates whether or not the student was referred for follow-up care at the end of the encounter
Data collection level:	Encounter
Criteria:	Students who received healthy weight services as part of the SB-TNGP during this measurement period
Valid (allowable) values:	Check only one of the following. Options for response are: □ Student was determined to NOT need referral for follow-up care □ Student was referred for follow-up return visit to SB-TNGP WITH telehealth □ Student was referred for follow-up return visit to SB-TNGP WITHOUT telehealth □ Student was referred to primary care provider outside of school □ Student was referred to specialty care outside of school □ Student was referred for other care outside of school □ Other – please specify:__________________________________________ □ Unknown: Unable to determine from telehealth log or student visit record
Note for abstractions:
Source for definitions:	Rural Telehealth Research Center

Data element number:	Healthy Weight - 11
Variable name:	Avoided travel
Variable definition:	Indicates whether or not the student avoided travel for care because of this encounter
Data collection level:	Encounter
Criteria:	Students who received healthy weight services as part of the SB-TNGP during this measurement period
Skip logic:	NOTE the response to this question will be used for skip logic for the next two questions.
Valid (allowable) values:	Check only one of the following. Options for response are: □ Avoided travel for this encounter: The student received services through the SB-TNGP and if they had not received those services during this visit then the student would have had to see a provider elsewhere □ Did not avoid travel for this encounter: The student received services through the SB-TNGP but if they had not received those services during this visit then the student would NOT have had to see and travel to a provider elsewhere □ NA: Not Applicable □ Unknown: Unable to determine from telehealth log or student visit record
Note for abstractions:
Source for definitions:	Rural Telehealth Research Center

Data element number:	Healthy Weight - 12
Variable name:	Provider if travel was avoided
Variable definition:	Indicates the type of provider the student would have seen if travel was avoided because of this encounter
Data collection level:	Encounter
Criteria:	Students who received healthy weight services as part of the SB-TNGP during this measurement period where travel was avoided
Skip logic:	NOTE that if the response to the previous question indicates that travel was avoided then this question will follow.
Valid (allowable) values:	Check only one of the following. Options for response are: □ Primary care provider □ Registered nurse □ Registered dietitian □ Emergency Department or Urgent Care □ Other – please specify:__________________________________________ □ Unknown: Unable to determine from telehealth log or student visit record □ NA: Not Applicable
Note for abstractions:
Source for definitions:	Rural Telehealth Research Center

Data element number:	Healthy Weight - 13
Variable name:	Patient travel miles to likely source of care
Variable definition:	Indicates the number of miles from the school to the type of provider the student would have likely seen if travel was avoided because of this encounter
Data collection level:	Encounter
Criteria:	Students who received healthy weight services as part of the SB-TNGP during this measurement period
Skip logic:	NOTE that if the response to the previous question indicates that travel was avoided then this question will follow.
Valid (allowable) values:	Any numeric character
Note for abstractions:	Enter miles from the School to student’s likely provider as specified in the previous question. Use Google maps or similar program to determine travel miles by car one way.
Source for definitions:	Modified PIMS

SB TNGP Data Element Dictionary – Version 0.4	Page 0