Transcript 1QFY2015 Update.ppsx

First Quarter FY2015
Objectives
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 The objectives of this presentation are:
 To acquaint you with new questions in EPRP data
collection instruments for 1QFY2015
 To make you aware of changes to existing questions
 To introduce you to new mnemonics
 To alert you to changes in scoring of existing measures
Changes
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 Please review the question sets along with this
presentation
 Some highlighted areas represent only minor
changes or changes made for consistency with other
questions/instruments
 Some highlighting indicates a new question or a
major change
 The exit report guides will provide additional details
on scoring changes
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CGPI
CGPI
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 We will start with CGPI
 Some modules have only minor changes or no
changes
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Validation
Core
CHF
OP Medication Reconciliation
Diabetes
Mental Health
IHD Module
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 Q7 bb6mos has a clarification
 The proper timeframe to look for continuous beta
blocker therapy will display in the question
 Was the patient on a beta-blocker continuously
during the timeframe from (computer to display
most recent of amidcdt or frstdcdt + 179 days)?
Shared Module
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 There are several changes to medication questions in
the Shared module
 poantidm, chgdmrx and addmrx have changes to the
list of oral anti-diabetes medications in the
definition/decision rules
 Please note that highlighting may mean that the
highlighted medication is an addition or that the
medication before the highlighted med has been
deleted
 Brand names of non-statin medications have been
added to the rules for the question adnonsta
More Med Question Changes
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 The format of the beta blocker, ace inhibitor and arb
questions have changed to include examples of each
drug
 The questions that asked you to specify which drug
the patient was taking have been deleted
Communication of Test
Results Module
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 Pharmacist has been added as an ordering provider
for the following questions in the CTR module
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q5-encpot (potassium)
q14-encbili (bilirubin)
q23-enwbc (WBCs)
q32-enhct (hematocrit)
q41-enchiv (HIV)
Revised Timeframe
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 The look back period for several tests in the CTR
module has changed
 You will look back one year for
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Chest x-ray
CT scan
Biopsy of the GI tract
Prostate biopsy
 The timeframe in the inpatient admission questions
(inptadm and inadmdt) has also been changed to
coincide with the 1 year period
Prevention Module
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 There are several changes in the Prevention module
 The immunization period for influenza has changed
 07/01/2014 to 3/31/2015
 Keep in mind that the CGPI influenza immunization
measures are not scored until 3Q
Pneumococcal Immunization
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 Effective 11/01/14, documentation of pneumococcal
vaccination must specify PPSV23 or equivalent in
order to select value 1, 3, or 98
 Equivalents:
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PPSV
Pneumovax
Pneumovax 23
Pnu-immune 23
Pneumococcal Immunization
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 If pneumococcal immunization was given prior to
11/1/2014 documentation is acceptable if
 The patient had pneumovax and at least the year of
administration is known
Changes to PI Module CTR questions

 q19 enchv: pharmacist added as an ordering
provider
 q 60 encfobt: pharmacist added as an ordering
provider
 The CTR look back time period for mammograms is
now one year
Tobacco Counseling/Referral
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 There is an update to the definition/decision rules
for q30 tuconsel and q32 tucrefer
 The VA Quitline number has been updated
CRC-DCBE
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 Q68 dcbe
 Does the medical record contain the report of a
double-contrast barium enema performed during the
timeframe from (computer to display stdybeg – 5
years to 9/30/2010)?
 The timeframe will be calculated and will appear in
the question
Cervical Cancer Screening
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 There are several changes to questions re: Pap tests and
HPV
 There is an important change to q75 (testpap), answer
option
 Hysterectomy (with no residual cervix) or congenital
absence of a cervix
 In order to select option 6, the hysterectomy operative
report does not have to be present in the medical record;
however,
 documentation of hysterectomy in the medical record
must indicate no residual cervix (i.e., “complete”, “total”,
or “radical” abdominal or vaginal hysterectomy).
HPV
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 You will now look for HPV test when
 Pap test was done in VHA or non-VHA within the
past 5 years
Pap Results
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 q78 (papreslt) is a new question that was added to
collect pap test results for the CTR measure
 Use only the pap test report to answer the question
 What results for the pap test were documented?
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3. Normal
4. Abnormal
95. Not applicable
99. Unable to determine
Pap Results
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Documentation of pap test results may include but are
not limited to:
 Normal:
 negative findings
 no cell abnormalities
 negative for
intraepithelial lesion or
malignancy
 benign cellular changes
 Abnormal:
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atypical squamous cells of
undetermined significance
atypical squamous cells cannot
exclude a high-grade squamous
intraepithelial lesion
low grade squamous
intraepithelial lesions
high grade squamous
intraepithelial lesions
squamous cell carcinoma
atypical glandular cells
endocervical adenocarcinoma in
situ
adenocarcinoma
HPV Report Date
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 Q82 (hpvrptdt) is new and collects the date of the
HPV test result for the new CTR questions
 Enter the date the HPV test result was reported
 HPV report date is the date on which the results were
completed by the lab and could be reported to the
clinician if he/she called to ask for the results.
Pap/HPV CTR
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 A series of questions has been added to capture
communication of tests results data for pap tests
done within the past year
 Please review new questions 83-88
Pap/HPV CTR
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 You will get q83 (compap) if a pap was done in the
past year and the result was normal, abnormal or
unable to be determined and no HPV test was done
 During the timeframe from [computer display papdt to papdt + 30 days and <=
pulldt or (<= stdyend if stdyend > pulldt)], was the pap test result
communicated to the patient by licensed health care staff?
 1. Yes
 2. No
 3. No, 30 day timeframe has not elapsed
 The rules for this question are the same as for other similar CTR
questions
Pap/HPV CTR
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 You will get q84 (compap2) if a pap was done in the past year
and the result was normal, abnormal or unable to be
determined and an HPV test was done in VHA or was
performed by a private sector provider
 During the timeframe from [computer display papdt to papdt + 30 days and <=
pulldt or (<= stdyend if stdyend > pulldt)], was the pap test result
communicated to the patient by licensed health care staff?
 1. Yes
 2. No
 3. No, 30 day timeframe has not elapsed
 The rules for this question are the same as for other similar CTR
questions
Pap/HPV CTR
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 q87 (compapro) and q88 (compapmet) ask which
licensed health care provider communicated the test
results to the patient and what method was used
 Rules are the same as for other similar CTR questions
Mammogram
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 The rules for q96 (nomammo) have been revised
 If the patient had two unilateral mastectomies, the
following rule applies:
 Documentation the patient had two unilateral
mastectomies on different dates of service, with
service dates at least 14 or more days apart, is
acceptable to answer “1”.
 Example: If first unilateral mastectomy was 2/1/20xx,
service date for second unilateral mastectomy must be
on or after 2/15/20xx.
CGPI Scoring Changes
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 There are several changes to scoring of CGPI
measures
 Details will be provided in the Exit Report Guide
 An overview will be provided in the following slides
HTN Measures
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 Htn9h has been discontinued
 There are 3 new measures for patients with a
diagnosis of hypertension
 ihd5h: HTN: BP < 140/90 age 18 – 59
 ihd52h: HTN: BP < 150/90 age 60 – 85
 ihd51h: HTN and DM: BP < 140/90 age 60 - 85
p20-Osteoporosis
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 There is a change to the scoring for p20 (Female age
> 64 had bone density test after age 60)
 To pass, skeletal site of testing must include both hip
and lumbar spine
 Skelsite1=true AND
 Skelsite3=true
Influenza
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 Influenza measures have been removed from the exit
report until the second pull list of 3QFY15 (April
study interval)
 p25h
 p26h
 p19s
Measures Removed
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 dmg25h (ldl <100) and dmg32h (ldl measured) have
been removed from the CGPI exit report
 cod1b has been removed from the Combined
Cohorts exit report
CTR Measures
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 The date parameter for chest x-ray, CT scan,
mammogram, GI biopsy and prostate biopsy has
been changed from 90 days to 365 days in all CTR
measures
 Communication of pap test results has been added to
the algorithms of all ctr measures
TBI
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Positive TBI Screen
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 Please note the change in q1 (tbiscrdt) and q2
(actdxtbi)
 Enter the date of the most recent positive screening for
Traumatic Brain Injury
 Prior to the most recent positive TBI screen, was there
evidence in the record that the veteran had a preexisting diagnosis of Traumatic Brain Injury prior to
the TBI Screen?
 A current or pre-existing diagnosis of TBI may be
documented in a progress note, listed as a health factor
in the TBI Clinical Reminder or documented as a
comment on the consult
Verify Positive Screen
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 q3 (vertbiscr) is new and serves to verify
documentation of a positive TBI screen
 On (computer to display tbiscrdt), is there
documentation of a positive TBI screen in a progress
note?
 It is possible for the TBI clinical reminder to be completed erroneously
as positive and not saved in a note
 The health factors from the clinical reminder may be saved in the
medical record resulting in an erroneous positive TBI screen
Verify Positive Screen
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 To answer q3 (vertbiscr), review the progress notes
for the date provided to verify a positive TBI screen
was completed
 Do not consider documentation after the specified
date of the TBI screen (TBISCRDT) when answering
this question
 If you answer no (no documentation of a positive
TBI screen in the progress notes), the case is
excluded
Contact Attempts
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 Please note the change in the rules for q29 (trycont2)
and q31 (try2dt)
 Documented attempts to contact the patient by
phone AND by secure messaging or certified letter
on the same date are acceptable
TBI Scoring
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 The only change to the scoring of tbia5 is the
addition of the new exclusion for vertibiscr=2 ( no
documentation of a positive TBI screen in the
progress notes)
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HBPC
Medication Management
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 There are changes to the Medication Management
section of the HBPC tool
 Medrev2 has been replaced by medrev3 (q9)
 Did the record document the patient’s HBPC
medication management plan in a note signed by the
pharmacist?
medrev3
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 To meet the intent of medrev3, documentation of the patient’s
HBPC medication management plan in a note signed by the
pharmacist is acceptable
 A medication review of the patient’s medication management
plan consists of a review by a pharmacist of all medications
 There is an important change to the definition/decision rules:
 The pharmacist should review all medications for appropriateness
(e.g., indication for medications or medication is no longer
indicated, dosage), adverse reactions and interactions, and
communicate concerns and recommendations to the HBPC
provider or primary care provider
New Questions
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 There are two new questions in the medication
management series
 q11 (medchg)
 Did the pharmacist make any recommendation for
change in the patient’s medication regimen?
 Answer “yes” if the pharmacist recommends a change
to at least one medication
 Examples: change in dose, frequency, discontinuation of
medication
medcomm
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 q12
 Did the pharmacist communicate any change in the
patient’s medication regimen to the HBPC or primary
care provider?
 Pharmacist communication of a change to the medication
regimen may be completed by
 direct communication (e.g., pharmacist calls the provider)
 by co-signature of the medication plan review note by the
HBPC or primary care provider.
 It is not necessary to see documentation of
communication of all recommended changes in the
medication regimen
HBPC Scoring
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 Changes to HBPC scoring:
 replacement of medrev2 with medrev3 in the
algorithms for hc33 (Medication Management Plan
Review by Pharmacist quarterly) and hc34
(Medication Management Plan Review by Pharmacist
Within 30 Days)
 Inclusion of new questions medchg and medcomm in
hc33 and hc34
 See the HBPC exit report guide for details
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Inpatient Instruments
ACS
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 There are no changes to the ACS instrument
 cod2, cod7n and cod8n have been discontinued
Heart Failure
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 There are no changes to Heart Failure questions
 cod5 has been discontinued
Pneumonia
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 There are no changes to the Pneumonia instrument
 There are no changes to Pneumonia scoring
Surgical Care
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 There are no changes to the Surgical Care or
Informed Consent instruments
 There are no changes to the Surgical Care scoring or
exit report
HBIPS
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 The following clarification has been added to the
definition/decision rules for the admission
assessment questions (strength, traumhx, assessud,
harmothr, harmself)
 If there is documentation the patient was medically
unstable requiring transfer to a medical or surgical
unit within the first 3 days of admission and
admission screening for violence risk to others was
not completed, select value X
HBIPS Scoring
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 The cod9 indicator has been discontinued
Global Measures
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 There are no changes to the Global instrument
 There are no changes to the scoring/exit report
Common Modules
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 There are no changes to the Inpatient Medication
Reconciliation module
 There are no changes to the Delirium Risk module
 There are no changes to measures associated with
these modules
Reminders
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 Please remember that the quality of EPRP data is of
utmost importance
 If you have questions about abstraction of any data
element, new or old, please check with your
Regional Manager
 Accurate data is critical in order for the facility to get
an accurate picture of their performance
 A thorough review of the medical record is essential
 Be certain the data you enter accurately reflects what
is documented in the medical record
Thanks!
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 Thank you for the role you play in improving
healthcare for Veterans!