Record the following information in the manner requested in the appropriate spaces on the Adult Health Schedule scan form. The first column represents the service target, the second column the range of potential responses and the third column the date where a date is required.
|
A) Self-Management* |
Y or N |
Date |
|
B) Hemoglobin A1c Test** |
Value |
Date |
|
C) Urine test for protein*** |
Y or N or NA |
Date |
|
D) Daily Aspirin Use**** |
Y or N or NA |
Date |
| *Documented in the chart or elsewhere Diabetes Goal Contract |
| **At least 2 with the past 12 months taken at least 3 months apart |
| ***At least 1 within the past 12 months |
| ****For all diabetics aged > 30 without contraindication |
Measures and Goals for 2002-3 Diabetes Collaborative
|
Core Measures |
Typical levels |
Target level |
|
Average HbA1c* |
9.0 mg |
7.0 mg |
|
Self-Management** |
20% |
70% |
|
*For Diabetes patients with one HbA1c reading in previous 12 months |
|
**Documented goal setting |
|
Measures are aligned with American Diabetes Association, external reporting requirements such as HEDIS, or other expert guidelines. |
Record the following information in the manner requested in the appropriate spaces on the Adult Health Schedule scan form. The first column represents the service target, the second column the range of potential responses and the third column the date where a date is required.
|
A) Self-Management* |
Y or N |
Date |
|
B) BP ** |
Value |
Date |
| *Documented Sample Cardiovascular (Hypertension) Self-Management tool |
| Cardiovascular Self-Management & Tips for Good Blood Pressure Control |
| **BP Documented twice per year |
Measures and Goals for 2002-2003 Hypertension (Cardiovascular Collaborative)
| Core Measures |
Typical
levels |
Target level |
| Self Management* |
<20% |
>70% |
| BP** |
50-70% |
>90% |
| BP <140/90 |
20-30% |
>50% |
| Cardiovascular Collaborative |
Record the following information in the manner requested in the appropriate spaces on the Adult Health Schedule. The first column represents the service target, the second column the range of potential responses and the third column the date where a date is required.
| Self
Management* |
Y or N |
Date |
|
Peak Flow** |
Y or N or NA |
Date |
|
Severity Assessment |
as noted*** |
Date |
|
|
| *Asthma-Patient Self Management Guide Asthma-Patient Action Plan |
|
**Moderate and Severe persistent asthma patients age ->5 |
| ***Mild Intermittent = MI, Mild Persistent = MP, Moderate Persistent = ModP or Severe Persistent = SP |
Measures and Goals for Asthma
| Core
Measures |
Typical
levels |
Target
levels |
|
Current severity assessment |
<20% |
>90% |
|
Self management goal setting |
<20% |
>70% |
|
Peak Flow Meters* |
<40% |
>80% |
ASTHMA DATA SOURCES
Record the following information in the manner requested in the appropriate spaces on the Adult Health Schedule.
|
Core Measures |
Typical level |
Appropriate
Goal |
|
Self-Management* |
<20 |
>70 |
|
*Documented goal setting in last 12 months |
|
Sample Self-Management Plan Patient Handout – Process for Managing Depression |
|
**Depression Screening Sample Hospital Anxiety and Depression Scale (online) |
| A) Self-Management* |
Y or N |
Date |
|
B) Evaluation** |
Y or /N |
Date |
|
*CSD (clinically significant depression) is defined as a
patient with a diagnosis of depression and an index assessment** (PHQ
score) of 10 or greater. |
|
** Index Assessment An index assessment is defined as that assessment which established the patient as having CSD*. |