Transcript FE and GM 1QFY2012.ppsx

1Q FY2012
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Objective
 This presentation is to supplement information to be
reviewed on the 11/10/2011 training call
 Topics
 New dementia questions in Frail Elderly
 New Global Measures instrument
 New measures related to these instruments
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Frail Elderly
 Dementia questions have been added at the beginning
of the FE instrument
 Catnum 54 cases will get eight new questions about a
new diagnosis of dementia
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Dementia Diagnosis Codes
 To answer question 1 (demendx) you will look for a
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new diagnosis of dementia within the study year
The definition/decision rules contain a list of the
applicable ICD-9-CM codes
The diagnosis must be documented by a
physician/APN/PA
Dementia diagnosis recorded during an outpatient or
inpatient encounter is acceptable
If there is no new diagnosis of dementia in the study
year, you will skip the rest of the dementia questions.
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Date of Dementia Diagnosis
 If you did find a new diagnosis of dementia during the
study year, you will enter the earliest date when the
new diagnosis of dementia was documented in the
record in question 2
 The six month time period prior to and including the
earliest date of diagnosis is the timeframe for the
remaining 6 questions in this series
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Date of Onset and Course
 The intent of question 3 (demcisx) is to determine if
the physician/APN/PA documented the date of onset
of dementia and the course of cognitive signs and
symptoms
 Multiple notes during the timeframe (6 months prior
to and including the date of diagnosis) may be used,
but the chief complaint or history must refer to
cognitive impairment or signs/symptoms of cognitive
impairment (e.g. memory loss, confusion)
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Date of Onset and Course
 Date of Onset
 e.g. started one year ago
 Course
 How the cognitive impairment developed over time prior to
the diagnosis of dementia
 e.g. slowly worsening, stable following initial onset,
fluctuating, getting worse
 Suggested data sources
 Clinic notes
 History and physical
 HBPC notes
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Patient History
 In question 4 you will look for specific components
documented in the patient’s history and/or review of
systems during the 6 months prior to and including
the date of diagnosis
 The components may be accepted from notes and/or
history and physicals done on different dates during
the specified time frame
 Review the definition/decision rules for a description
of each component
 You will indicate all of the components that are found
or select 99 if none are found
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History/Review of Systems
 History of head trauma
 Social history to include
 History of psychiatric
disease
 History of cardiovascular
disease or cv risk factors
 Family history
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drug and alcohol use
Medication review
Functional status
Driving status
Access to firearms
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Cognitive Assessment
 Question 5 asks you to look for documentation of a
cognitive assessment
 Performed by a physician/APN/PA, RN, licensed social
worker, or psychologist
 Must use a standardized and published tool OR
 Documentation of neuropsychiatric testing by a
psychologist is also acceptable
 See the definition/decision rules for examples of
standardized and published tools
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Physical Exam
 Look for a physical examination documented in the
given timeframe to answer question 6
 The PE must be documented by a physician/APN/PA
 A psychologist or licensed MSW may document the
mental status exam and observation of behavior
symptoms
 Please review the definition/decision rules of question
7 for guidance on what each component of the physical
exam may contain
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Q7-Physical Exam Components
 Cardiovascular exam
 Observation of
 Neurological exam
behavioral symptoms
 Vision status
 Hearing status
 Mental status
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Physical Exam
 The components of the physical exam may be accepted
from clinic/progress notes and/or H&Ps done on different
dates within the timeframe
 Notes:
 Vision status may include documentation of visual acuity,
visual fields to confrontation, CNII intact, exam by optometry
or ophthalmology
 Hearing Status- May include documentation of CN VIII
intact; hard of hearing, reference to hearing aid, audiogram.
 Vision and Hearing Status may be documented together as
part of a sensory exam.
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Lab Tests
 In question 8 you will look documentation of several
laboratory tests performed within the timeframe
 Lab tests may have been done at any VAMC or outside
the VA
 Some lab tests may be performed as part of a panel,
e.g. electrolytes included in BMP
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Lab Tests
Indicate All That Apply
 Thyroid stimulating hormone
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(TSH)
Vitamin B12
Serum folate
Electrolytes (NA, K, CL, CO2)
Calcium
 CBC (complete blood count)
 Liver function tests (alk phos,
AST, direct bili, ALT, GGT)
 BUN and creatinine
 Glucose
 Urinalysis
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Other Changes to FE
 There are some other changes to the Frail Elderly
instrument
 Some questions have minor wording changes but the
intent of the questions has not changed
 There are also some changes to definition/decision
rules for clarification
 Most of these changes are to the rules for assessments
using a standardized and published tool (cognitive
assessment, assessment of ADLs, IADLs)
 Please read all highlighted changes carefully
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Global Measures
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Global Measures
 Global Measures is a Joint Commission Hospital
Inpatient Quality Measure set
 Although reporting to Joint Commission doesn’t begin
until January 2012, VHA has chosen to begin collecting
data in 1QFY2012
 The measures are pilot in 1QFY2012
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Four Measure Sets
 Four measures sets are included in Global Measures
 Emergency Department
 Immunizations
 Tobacco Treatment
 Substance Use Treatment
 The ED questions were previously part of the inpatient
instruments
 The immunization questions were previously in the
Prevention module
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Sample
 In 1QFY2012, cases on other EPRP inpatient lists
(except HBIPS) will go through the Global Measures
instrument
 ACS
 IHF
 Pneumonia
 Surgical Care (catnum 53)
 Each case will go through the GM module even if it
was excluded for the inpatient topic (ACS, IHF, PN,
SC).
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Pre-populate
 The first 12 questions of the global measures
instrument will pre-populate from the inpatient
instrument
 For that reason, you will want to complete the disease
specific module (ACS, IHF, PN, etc) before completing
the Global Measures module
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Emergency Department
 This series of questions remains basically the same as
in previous quarters
 There have been some changes to the
definition/decision rules that need to be noted
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Rule Changes: Q12 (edpt)
 If a patient is transferred in from any emergency department (ED) or
observation unit OUTSIDE of the VAMC under review, select “2”.
 This applies even if the emergency department or observation unit is
part of this hospital’s system (e.g., your hospital’s free-standing or
satellite emergency department), has a shared medical record or
provider number, or is in close proximity.
 Select “2”, even if the transferred patient is seen in this facility’s
ED.
 If the patient is transferred to your hospital from an outside hospital
where he was an inpatient or outpatient, select “2”.
 This applies even if the two hospitals are close in proximity, part
of the same hospital system, have the same provider number,
and/or there is one medical record.
 Select “2”, even if the transferred patient is seen in this facility’s
ED.
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Date/Time of Decision to Admit
 The definition/decision rules of questions 14 and 15
have an important change with regard to the includes
and excludes notes
 Includes, but is not limited to: Admit Order
Date(time), Disposition Order Date (time)
 Excludes, but is not limited to: Bed Assignment
Date (time), Direct admit patients seen in the ED,
report called time
 In previous quarters the admit order date/time was an
exclusion
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Date/Time of ED Departure
 Questions 16 and 17 have a change to the
definition/decision rules
 Excludes, but is not limited to: Disposition Date
(time)
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ED Measures
 There are 7 ED measures on the Pilot Exit Report
 Ed1 Median Time from ED Arrival to ED Departure for Admitted ED Patients –
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Overall Rate
Ed2 Median Time from ED Arrival to ED Departure for Admitted ED Patients –
Reporting Measure
Ed3 Median Time from ED Arrival to ED Departure for Admitted ED Patients –
Observation Patients
Ed4 Median Time from ED Arrival to ED Departure for Admitted ED Patients –
Psychiatric/Mental Health Patients
Ed5 Admit Decision Time to ED Departure Time for Admitted Patients –
Overall Rate
Ed6 Admit Decision Time to ED Departure Time for Admitted Patients –
Reporting Measure
Ed7 Admit Decision Time to ED Departure Time for Admitted Patients –
Psychiatric/Mental Health Patients
 The Pilot Exit Report Guide will provide details about the
denominator and numerator
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Immunizations
 Pneumonia cases will not get the immunization questions
in the Global Measures instrument since the questions are
still in the PN instrument at this time
 Other cases that will skip the immunization questions
 Principal or other diagnosis of organ transplant (JC Table
12.10)
 Discharge disposition status = expired (6)
 If the principal or other diagnosis is on JC Table 12.3
(pregnant) and discharge disposition is not 6 (expired), the
pneumococcal pneumonia question will be skipped and
the case will go to the influenza question
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Pneumococcal Vaccination Status
 Additional names for pneumococcal vaccination were
added to the definition/decision rules and question
 PPV23, pneumovax23, pnu-imune 23, polyvalent
pneumonia vaccine
 A change to the wording of option 4
 Is not likely to be effective because of bone marrow
transplant within the past 12 months (change from “is
medically contraindicated”)
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Influenza Question Changes
 Changes to question 19
 Documentation of allergy:
 Allergy to eggs must be stated as anaphylactic
 Allergy to latex must be stated as anaphylactic
 Please note that this rule applies only in the GM module
and does not apply to CGPI
 Another change to the wording of option 4
 Is not likely to be effective because of bone marrow
transplant within the past 12 months (change from “is
medically contraindicated”)
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Influenza Vaccination Rules
 Each year, flu vaccines start to become available
usually in September and most influenza vaccine is
administered in October – December, but the vaccine
is recommended to be administered throughout the
influenza season which can last until May in some
years.
 For the purposes of this project, hospitals are only
responsible for discharges October through March (not
a change)
 Additional names for influenza vaccination
 Afluria, Flumist, FluLaval, Fluarix, Fluzone High dose
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Immunization Measures
 The Pilot Exit Report Guide will provide details of
scoring for the 4 immunization measures
 Imm1 Pneumococcal Immunization (PPV23) – Overall
Rate
 Imm2 Pneumococcal Immunization (PPV23) – Age 65
and Older
 Imm3 Pneumococcal Immunization (PPV23) – High
Risk Populations (Age 18 through 64 years)
 Imm4 Influenza Immunization
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Tobacco and Substance Use
 The next section of the Global Measures instrument
contains question about tobacco use/treatment and
substance use/treatment
 These questions are very different from other
questions about tobacco and substance use in other
instruments (CGPI or inpatient)
 You will need to read all rules carefully and use care
not to confuse these questions/rules with those in
other instruments
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Exclusions
 Cases with a length of stay less than or equal to one
day will skip the tobacco and alcohol questions
 Patients who are cognitively impaired at the time of
screening, e.g. unable to answer questions due to
severe memory loss, are excluded
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Cognitive Impairment
 Q20 asks if there is documentation in the medical record that
indicates the patient is cognitively impaired
 For the purposes of the tobacco and substance use measures,
documentation at the time of the screening that the patient is
cognitively impaired (e.g., patient unable to answer questions
due to severe memory loss) is sufficient to answer “yes.”
 Look for documentation of
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cognitive impairment
cognitively impaired
confused
memory loss
mentally retarded
obtunded
 Exclude: temporary cognitive impairment due to acute
substance use
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Tobacco Use
 In question 21 look for documentation that the patient used any form
of tobacco during the past 30 days
 Current user
 Ex-user that quit less than 30 days prior to arrival
 Disregard conflicting documentation
 Include (in addition to cigarettes)
 Smokeless tobacco,
 Chewing (spit) tobacco
 Twist
 Redman
 Moist snuff
 Dry snuff
 Plug tobacco
 snus
 Exclude: Illegal drug use only (e.g., marijuana), E-cigarettes, hookah
pipe
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Tobacco Use Status
 If the answer to question 21 is “1” (yes, the patient has
used tobacco during the past 30 days) the case will go
on to question 22 about tobacco use status
 If the answer is no, refused, or patient was not
screened (or unable to determine) the case will go to
the substance abuse questions next
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Tobacco Use Status
 Question 22 has 11 options
 You will choose the option that best describes the
patient’s tobacco use status during the past 30 days as
documented in the record during the inpatient stay
under review
 Obviously you will need to read the options carefully
to determine the correct choice
 The answer options include
 the type of tobacco used (cigarettes, pipe or cigars,
smokeless tobacco)
 Volume of cigarettes smoked daily when applicable
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Tobacco Use Status
 You will need to review all of the rules for this question
 If the patient is a non-daily smoker (occasional smoker)
information should be collected on the number of days they
smoked during the past 30 days and the number of cigarettes
smoked on those days.
 If the patient is only using chew plus pipe or cigars, select
value “5” if the volume of cigar/pipe use is daily, otherwise
select value “4”.
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Tobacco Use Status
 More important rules:
 When there is conflicting information in the record
with regard to volume, for instance, one document
indicates patient is a light smoker and another indicates
patient is a volume greater than light smoking, select the
allowable value indicating the heaviest usage.
 If the medical record indicates the patient smokes
cigarettes and the volume is not documented or is
unknown, assume smoking at the heaviest level.
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Practical Counseling
 For question 23 you will look for documentation that practical
counseling was provided prior to discharge
 Documentation must be explicit enough to determine if the
counseling provided included all of the following components:
 Recognizing danger situations
 Developing coping skills
 Providing basic information about quitting
 Danger situations might include
 alcohol use during the first month after quitting
 being around smoke and/or other smokers,
 times/situations when the patient routinely smoked (in the car, on
break at work, with coffee, after a meal, upon waking up, social
events, etc.).
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Practical Counseling-Quitline
 A referral to the Quitline may be considered a
component of practical counseling (providing basic
information about quitting)
 However, handing the patient a phone number to call
for the quit line will not meet the intent of practical
counseling.
 There must be interaction between the patient and the
caregiver
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Tobacco Cessation Meds
 Depending on the tobacco use status entered, some
cases will go on to question 24
 Did the patient receive one of the FDA-approved * tobacco
cessation medications during the hospital stay?
 1. Yes
 2. No
 98. Patient refused FDA-approved tobacco cessation
medications during the hospital stay
 *Refer to Appendix C, Table 9.1 for the list of FDA-
approved tobacco cessation medications
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Tobacco Cessation Meds
 If nicotine replacement therapy (NRT) is ordered PRN
and the patient does not receive any doses during the
hospital stay, select value “98”
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Reasons for Not Administering Tobacco
Cessation Meds
 If the patient did not receive one of the FDA-approved
tobacco cessation medications during the hospital
stay, look for documentation of one of the following
reasons for question 25 (notobmed)
 Allergy to all of the FDA-approved tobacco cessation
medications.
 Drug interaction (for all of the FDA-approved
medications) with other drugs the patient is currently
taking.
 Other reasons documented by physician/APN/PA or
pharmacist.
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Reasons for Not Administering Tobacco
Cessation Meds
 Reasons for administering FDA-approved tobacco cessation
medications must be documented by a physician/APN/PA
or pharmacist.
 An allergy or adverse reaction to one of the FDA-approved
cessation medications would not be a reason for not
administering another of the cessation medications.
 To select “other reasons documented by physician/APN/PA
or pharmacist for not administering tobacco cessation
medications”, the reason must be explicitly documented.
 When conflicting information is documented in the
medical record, select the appropriate value for the
indicated reasons present for not administering the
tobacco cessation medications
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Referral for Outpatient Counseling
 Question 26 asks whether the patient received a referral for
outpatient tobacco cessation counseling
 The answer options are:
 1. The referral to outpatient tobacco cessation counseling treatment
was made by the healthcare provider prior to discharge.
 2. Referral information was given to the patient at discharge but the
appointment was not made by the provider prior to discharge.
 4. The referral for outpatient tobacco cessation counseling
treatment was not offered because the patient’s residence is not in
the USA.
 98. Patient refused the referral for outpatient tobacco cessation
counseling treatment and the referral was not made.
 99. The referral for outpatient tobacco cessation counseling
treatment was not offered at discharge or unable to determine from
the medical record documentation.
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Referral for Outpatient Counseling
 Include as a referral
 group counseling
 individual counseling
 quitline
 E-health
 internet structured programs
 Exclude: Self-help interventions (brochures,
videotapes, audiotapes)
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Cessation Meds at Discharge
 Look for prescription of an FDA-approved tobacco
cessation medication at discharge for question 27 and
select the appropriate answer
 1. A prescription was given to the patient at discharge
 2. A prescription was not offered because the patient’s
residence is not in the USA
 98. A prescription was offered but the patient refused
 99. Prescription not offered, or unable to determine
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Cessation Meds at Discharge
 Rules for Conflicting/contradictory information
 In determining whether a tobacco cessation medication was prescribed at
discharge, it is not uncommon to see conflicting documentation among
different medical record sources. For example, the discharge summary may list
Varenicline and this is not included in any of the other discharge medication
sources (e.g., discharge orders). All discharge medication documentation
available in the chart should be reviewed and taken into account by the
abstractor.
 In cases where tobacco cessation medication is in one source that is not
mentioned on other sources, it should be interpreted as a discharge medication.
Select value “1” unless documentation elsewhere in the medical record suggests
that it (tobacco cessation medication) was not prescribed at discharge
 If documentation is contradictory (physician noted “d/c Varenicline” or “hold
Varenicline” in the discharge orders, but Varenicline is listed in the discharge
summary’s discharge medication list), or after careful examination of
circumstance, context, timing, etc, documentation raises enough questions, the
case should be deemed unable to determine, select value “99”
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Reason For No Cessation Meds at Discharge
 If an FDA-approved tobacco cessation medication was
not prescribed at discharge, review the documentation
for a reason (question 28)
 The reasons and the rules are the same as those for
question 25
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Substance Use
 Questions 29-36 seek data about alcohol and drug use
 Again, you will need to set aside rules for data
collection about alcohol use in other modules as these
question seek different information
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Acute Intoxication
 Question 29: Did the record document a blood alcohol
test indicative of acute intoxication during this
hospitalization?
 Use the lab reference range to determine if the result is
indicative of acute intoxication
 A blood alcohol test performed in the ED prior to
admission is acceptable.
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Screening for Alcohol Use
 Question 30 asks if the patient was screened for
alcohol use during this hospital stay
 For purposes of this question, any tool used to assess for
alcohol use is acceptable
 An example would be screening with the AUDIT-C
 Prescreening may be done for example with a single
validated question in order to identify those patients
with no risk or who do not drink. Further screening
should be done on those patients who do drink to
determine if there is need for intervention.
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Standardized and Published Tool
 If the patient was screened for alcohol use, indicate
whether the tool used to screen for alcohol use was a
standardized and published tool (question 31)
 If you are uncertain whether a tool is standardized and
published, consult with your RM or WVMI office staff
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Results of Screening
 Enter the results of alcohol use screening as
documented in the record in question 32
 3. Score indicates no or low risk of alcohol related
problems
 4. Score indicates unhealthy alcohol use (moderate risk)
benefiting from brief intervention
 99. Results not documented or unable to determine
 The score or results will vary according to the tool that
was used.
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Brief Intervention
 If the results of alcohol screening indicated unhealthy
alcohol use (moderate risk) you will go to question 33 and
look for a brief intervention following the positive screen
and prior to discharge.
 The following components must be included in the brief
intervention
 feedback concerning the quantity and frequency of alcohol
consumed by the patient in comparison with national norms;
 a discussion of negative physical, emotional, and occupational
consequences; AND
 a discussion of the overall severity of the problem.
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Brief Intervention
 A brief intervention is defined as a single interaction
between the qualified healthcare professional and the
patient following a positive screening result for unhealthy
alcohol use or alcohol use disorder (abuse or dependence)
 Qualified healthcare professional
 Physician, APN and PA
 RN
 Certified addictions counselor
 Psychologist
 Social worker
 Health educator with training in brief intervention
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Brief Intervention
 The qualified health care professional engages the
patient in a joint decision-making process regarding
alcohol use and plans for follow-up are discussed and
agreed to
 Select value “2” if the documentation provided is not
explicit enough to determine if the intervention
provided contained the specific components or if it is
determined that the intervention does not meet the
intent of the measure.
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Next…..
 Cases with discharge disposition other than 1 or 99 will
go to the end of the module
 Some cases will skip question 34
 The discharge disposition is 1 (home, home health etc.)
or 99 (not documented, unable to determine) AND
 the principal or other diagnosis code is on JC Table 13.1
(alcohol dependence) or 13.2 (drug dependence) or
principal or other procedure code on JC Table 13.3
(alcohol or drug dependence procedures.)
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Alcohol or Drug Disorder
 Look for documentation that the patient had an alcohol or
drug disorder for question 34
 The health care provider must document explicitly that the
patient has an alcohol or drug use disorder.
 Inclusion Guidelines for Abstraction:
 Alcohol or Drug dependent/dependence (may be described as
appears to have, consider, consistent with (C/W), diagnostic
of, evidence of , indicative of , likely, most likely, probable ,
representative of )
 Admission for Detoxification
 Delirium Tremens (DTs)
 Withdrawal syndrome
 The abstractor should not try to determine if alcohol
or drug abuse exists from documentation of
symptoms
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Referral for Addictions Treatment
 Cases with documentation of an alcohol or drug use disorder go
on to question 35
 Was a referral for addictions treatment made for the patient
prior to discharge?
 1. The referral to addictions treatment was made by the healthcare
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provider prior to discharge.
2. Referral information was given to the patient at discharge but the
appointment was not made by the provider prior to discharge.
4. The referral for addictions treatment was not offered because the
patient’s residence is not in the USA.
98. The patient refused the referral for addictions treatment and the
referral was not made.
99. The referral for addictions treatment was not offered at
discharge or unable to determine from the medical record
documentation.
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Referral for Addictions Treatment
 Review documentation for a referral made at discharge
for addictions treatment by a physician or nonphysician (such as nurse, psychologist, or
counselor).
 A referral may be defined as an appointment made by
the provider either through telephone contact, fax or email.
 The referral may be to an addictions treatment program,
to a mental health program or mental health specialist
for follow-up for substance use or addiction treatment,
or to a medical or health professional for follow-up for
substance use or addiction.
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Referral for Addictions Treatment
 Inclusion Guidelines for Abstraction:
 Group counseling
 Individual counseling
 Personal physician
 Psychiatrist
 Psychologist
 Addictions counselor
 Exclusion Guidelines for Abstraction:
 Self help interventions (brochures, videotapes, audiotapes,
reactive hotlines/help lines)
 Support groups that are not considered treatment such as
Alcoholics Anonymous (AA)
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Medications for SUD
 Question 36: Was one of the FDA-approved
medications for alcohol or drug disorder prescribed at
discharge?
 Refer to Appendix C, Table 9.2 for a comprehensive list
of FDA-approved medications for alcohol and drug
dependence
 Follow the rules for dealing with
conflicting/contradictory documentation of
medications at discharge as in the definition/decision
rules
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Follow Up
 These cases will go through follow up questions
pertaining to their alcohol and drug use status post
discharge
 a blood test positive for acute alcohol intoxication on
admission or
 screening with a standardized and published tool
indicated moderate risk or
 screening with a tool other than a standardized and
published tool indicated no, low or moderate risk
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Follow Up Contact for Alcohol and Drug Use
Status
 Question 37 asks about the status of the follow-up contact with
the discharged patient relative to their alcohol or other drug use
status within 30 days post discharge?
 1. A follow-up contact was made within 30 days post discharge and
information regarding substance use status was collected.
 2. A follow-up contact was made within 30 days post discharge, but
no information regarding substance use status was collected.
 3. A follow-up contact was not made within 30 days post discharge
because the patient’s residence is not in the USA, the patient was
incarcerated, contact number was no longer valid, the patient had
no phone, or the patient was re-admitted to the hospital within 30
days post discharge.
 99. A follow-up contact was not made within 30 days post
discharge or unable to determine from medical record
documentation.
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Follow Up Contact
 The follow up contact must be made for the purpose
of gaining information about their alcohol or drug use
status post discharge.
 If information was obtained in person at the time of a clinic


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visit within 30 days post discharge, select value “1”.
If contact was made with a family member only, select value
“2”.
If there is documentation at discharge that the patient is
homeless, answer “3.”
If a follow-up contact was made but was outside the 30 day
time frame, select value “99”.
If follow-up contact is made by letter or e-mail and no
response is received from patient within 30 days post
discharge, select value “99”.
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Date of Follow Up Contact
 Enter the date the follow-up contact was made with the
patient to assess substance use post discharge in question
38
 If multiple contacts are made with the discharged patient
post discharge, select the date of the contact where progress
with substance use was addressed, even if this contact
occurred outside of the 30 day window.
 If multiple contacts address substance use post discharge,
select the date of the earliest contact.
 If contact is made through e-mail or letter, select the date of
receipt of the patient’s alcohol or drug use post discharge
status, not the date the e-mail or letter was sent.
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Alcohol or Drug Use Status 30 Days Post
Discharge
 Select all options that apply regarding the patient’s
alcohol or drug use within 30 days post discharge
 The 16 allowable values address 5 specific
categories:
 Addictions treatment, values 1, 2;
 Use of medication for alcohol use, values 3, 4;
 Quit attempt for alcohol use, values 5-9;
 Use of medication for drugs, values 10, 11; and
 Quit attempt for drug use, values 12-15.
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Select One Value from Each Relevant Category
 In order to obtain the most accurate picture of the
patient’s post discharge alcohol or drug use and
compliance with prescribed treatment, one value from
the categories of addiction treatment, one value from
the relevant categories related to quit attempt, and one
value from the relevant categories related to use of
medications should be selected.
 Only select one value in each of the categories relevant
to the patient’s reason for follow up.
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:
Inclusion Guidelines
 Quit (not used drugs or alcohol in the previous 7 day
timeframe)
 Quit Attempt (no use of drugs or alcohol within 24
hours following the initiation of the quit attempt)
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Tobacco Use Follow Up
 Patients who used tobacco during the past 30 days will
get follow up questions starting with number 40
 The questions and rules for tobacco follow up mirror
the alcohol and drug use follow up questions
 Status of follow up contact with the discharged patient
relevant to tobacco use status within 30 days
 Date of follow up contact to assess tobacco use
 Tobacco use within 30 days post-discharge
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Tobacco Use 30 Days Post-Discharge - Q42
 Select the most appropriate value for status (1-5)
 The most appropriate one value relevant to
outpatient counseling, and the one value relevant
to the use of tobacco cessation medications
should be selected.
 For example, if value 6 is selected, value 8 may not be
selected, and if value 7 is selected, value 9 may not be
selected
 A total of 3 values may be selected.
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Tobacco Use Measures
 Measures related to Tobacco Use are on the Pilot Exit
Report
 Tob1 Tobacco Use Screening
 Tob2 Tobacco Use Treatment Provided or Offered
 Tob3 Tobacco Use Treatment
 Tob4 Tobacco Use Treatment Provided or Offered at
Discharge
 Tob5 Tobacco Use Treatment at Discharge
 Tob6 Tobacco Use: Assessing Status After Discharge
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Alcohol and Drug Use Measures
 There are 6 measures for alcohol and drug use on the Pilot
Exit Report
 Sub1 Alcohol Use Screening
 Sub2 Alcohol Use Brief Intervention Provided or Offered
 Sub3 Alcohol Use Brief Intervention
 Sub4 Alcohol and Other Drug Use Disorder Treatment
Provided or Offered at Discharge
 Sub5 Alcohol and Other Drug Use Disorder Treatment at
Discharge
 Sub6 Alcohol and Drug Use: Assessing Status after Discharge
 Refer to the Pilot Exit Report Guide for details
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Thanks!
 Thanks for taking time to review this presentation and
the instruments prior to the training call
 Remember the call will be Thursday, November 10 at
2:00 PM EST.
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