Transcript First Quarter FY2010

First Quarter FY2010
CGPI and HBPC UPDATE
1st Quarter FY10 Changes
 This presentation is for the purpose of conveying
the changes to CGPI and HBPC for 1Q10.
 In addition there will be conference calls to
present information on the extensive changes to
the Shared Module and the new information in
the PI module regarding HIV testing
 Please be sure you review the data base
questions as you go through the slides.
 Be certain you note all highlighted changes as
not all will be pointed out in this presentation
Electronic Validation
Throughout the instruments you will see
some new questions that ask whether you
found certain data in specific places in
CPRS and whether certain medications
were prescribed by VHA
As VHA seeks to capture some
information electronically, your answers
serve to validate that data
Catnums
 The following catnums will be used for CGPI:
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50 Nexus Random Sample
51 Nexus with Mental Health Diagnosis
48 Women
16 Past AMI
64 CHF outpatient
57 OEF/OIF
36 SCI
61 SCI inpatient
68 CBOC
Catnums
Please note that catnum 48 is no longer
called mature women, but is now women
ages 20-69
Catnum 68 is new and will be pulled from
contract CBOCs
There is no longer an augmented sample
for diabetes (catnum 60) but cases will be
flagged for diabetes module review based
on a DM code.
VALIDATION MODULE
 One new question has been added to the CGPI
Validation module
 Question 12 (wichprov): Which provider saw the patient
at the most recent NEXUS clinic visit?
 After identifying the most recent NEXUS clinic visit in
question 10 and the name of the clinic in question 11,
you will identify the credentials of the provider who saw
the patient.
 Physician
 Nurse Practitioner (NP)
 Physician Assistant (PA)
 Clinical Nurse Specialist (CNS)
 Psychologist
Other Validation Module Changes
Selihd has been changed to selmi.
There are no changes to the rules or intent
Look for documentation that the patient had an
AMI in the past (more than 8 weeks prior to the
most recent NEXUS visit)
For cases flagged for a diabetes
diagnosis, a new CGPI module, OP
Medication Reconciliation will be enabled
Core Module Changes
Note additions to the definition/decision
rules for question 1 (vhabps/vhabpd)
The rules clarify exclusions for acceptable
BP readings
BPs taken during an OP visit which was for the
sole purpose of having a diagnostic test or
surgical procedure performed
BPs obtained the same day as a major
diagnostic or surgical procedure
Quiz 1
True or False: The most recent visit is a
dermatology clinic visit for a mole removal.
The BP taken during this visit is
acceptable
False. BP taken during an OP visit which
was for the sole purpose of having a
diagnostic test or surgical procedure is not
acceptable
BP Entered in Vitals Signs Package
Questions 3 and 4 in the Core module are
new
#3 seeks to verify whether the blood
pressure you entered as the most recent
(in vhabps and vhabpd) was documented
in the vital signs package of CPRS
If the BP you entered was documented only in
the progress notes (or if even one part was only
in the progress notes) answer “no”
Seen by a Physician?
Question 4 (seehtnpt) asks: on the date
when the most recent blood pressure was
taken, was the patient seen by a
physician, APN or PA?
The date of the blood pressure reading will
be displayed as part of the question
BP Reading after the Study End Date
We are no longer collecting a BP prior to
the most recent reading
Rather we will be looking for a blood
pressure < 140/90 that was recorded after
the study end date and up to the review
date (question 8 postbp)
The same rules apply as to which visits the BP
reading may be taken from as when collecting
the most recent BP in the study interval
More BP Questions
 If you answer yes to question 8, question 9 will
auto fill the date you answered the question
 Question 10 (postbps/postbpd) asks you to enter
the first BP <140/90 documented in the record
after the study end date
 Enter the date the BP was documented in
question 11
 Question 12 asks if the BP you entered in
postbps/postbpd was documented in the Vital
Signs package
ACOVE
Please note the addition to the
definition/decision rules for question 35
uiscreen
Documentation of “no bowel or bladder
problems” without mention of questioning
re: urinary incontinence is not acceptable
for urinary incontinence screening
Prevention Indicators Module
 Influenza Immunization (question 4-fluvac09)
 Dates for the influenza immunization season have been changed
to reflect the current season: 8/1/2009-3/31/2010
 Please note the important changes to the
definition/decision rules with regard to the H1N1 vaccine
 If the medical record does NOT document that the patient
received the seasonal flu vaccination during the period from
8/01/2009 to 3/31/2010, but there is documentation the
patient received the H1N1 flu vaccine during this timeframe,
select “1” or “3” as applicable.
 If there is documentation the patient received BOTH the
seasonal flu and H1N1 vaccination during the specified
period, select “1” or “3” as applicable for the seasonal flu
vaccination.
QUIZ 2
There is documentation that a patient had
H1N1 vaccination on 10/22/09 at a local
health department. At the time of review
there is no documentation that the
seasonal flu vaccination had been given.
The answer to fluvac09 is 3. True or false
True. If only the H1N1 vaccine is received
answer 1 or 3 as appropriate
Hepatitis C
There have been several
changes/clarifications to the Hepatitis C
series of questions
Questions 9-12 seek information regarding
testing for hepatitis C specifically using the
EIA or ELISA tests
Testing for Active HCV
Questions 13 and 14 seek information
about testing for assessment of active
HCV
Testing for active HCV infection is
accomplished via an HCV RNA test (see
D/D rules for listing of tests)
If an HCV RNA test was performed answer
1 (results positive) or 2 (results negative)
as applicable
Testing for Active HCV
If the RIBA test was performed, enter
option 3 to question 13 only if the results
were negative
If RIBA test was positive, an RNA test
must be performed to confirm or exclude
active HCV infection
If an RIBA test was positive and no RNA
test was done, enter 99
Clarifications to Question 15
Informpt: was the patient notified of the
positive HCV confirmatory tests results?
This question refers to the HCV RNA test date
entered in question 14
Answer 3 if the patient was not notified of the
HCV test results AND the positive confirmatory
test result was reported from the lab less than
60 days prior to the study end date
Treatment Options/Referral
 Question 17 (hctxref) asks: within 3 months of the
positive HCV RNA confirmatory test result (date entered
in hcvcondt), does the record document discussion of
HCV treatment options with the patient or referral to a
specialty clinic?
 Choose 1, 2 or 3 as applicable if treatment options were
discussed or a referral to a specialty clinic was made or
both
 Enter option 4 if HCV treatment options were not
discussed or referral to a specialty clinic was not done
AND the positive HCV RNA test was reported less than 3
months prior to the study end date
HIV
There is a new series of questions in the
PI module about HIV Testing
These questions will be reviewed in a
conference call with Anna Marshall on
11/6/09 at 11:00 AM EST
The same series of questions also
appears in the HBIPS instrument
Pap Tests
Please review the definition/decision rules
for question 72 (test)
 An important note about adequate samples has
been added
 Do not count biopsies because they are
diagnostic and therapeutic only and not valid for
screening
Pap Tests
 Some questions from the series have
been deleted, and question 74 (paplab) is
new
Were the results of the pap test found in
the laboratory package?
Answer yes if the pap test results are recorded
in the laboratory package
If the reports are scanned in VISTA imaging
only, answer no
Chronic Kidney Disease Module
 There is one change in the CKD module
 Question15 (ckdialys) Is there documentation
the patient is receiving chronic dialysis?
 The answer options have changed from yes/no
to:
 3. receiving chronic dialysis at VHA
 4. receiving chronic dialysis at non-VHA facility
 99. no documentation the patient is receiving chronic
dialysis
Mental Health Module
 Alcohol treatment question changes:
 There is a new answer option to question 36
(refaudtx) Was the patient referred for treatment
of alcohol use disorder in the past year?
 Option 4: Documented patient already receiving care
for mental health disorder
 In order to answer “4”, there must be documentation by the
primary care provider or mental health provider that the patient is
already receiving care for a mental health disorder (e.g.
depression, anxiety, substance abuse) and that provider will
provide treatment for the alcohol use disorder.
Brief Addition Measure (BAM)
Question 47 (sudbam) Within the past
year, does the record document
completion of the Brief Addiction Measure
(BAM)
The BAM is a 17 item symptom severity scale
used for patients with substance use disorder
If the BAM was completed, enter the date
of the most recent one in question 48
MH Module-Depression
Note the changes to the acceptable codes
for depression in questions 52 and 56 and
for bipolar disorder in questions 58 and 62
These are the codes you will look for as
evidence that depression or bipolar
disorder was identified as a reason for a
clinical encounter
Codes
Depression: 301.12, 309.0, 309.1, or 311.
Bipolar Disorder: 296.0x, 296.1x, 296.2x,
296.3x, 296.4x, 296.5x, 296.6x, 296.7,
296.8x, 296.90, 296.99
Depression Treatment
Note the addition of answer option 4 to
question 65: Was the patient referred for
treatment of depression (or bipolar
disorder) in the past year?
Option 4: Documented patient already
receiving care for mental health disorder
In order to answer “4”, there must be documentation by
the primary care provider or mental health provider that
the patient is already receiving care for a mental health
disorder (e.g. anxiety, PTSD, substance abuse) and that
provider will provide treatment for depression.
Depression Screening
Acceptable settings for depression
screening:
 outpatient encounter
 inpatient hospitalization
 screening by telephone
 televideo (real time) with face to face
encounter between provider and patient
Suicide Ideation/Behavior Evaluation
 Question 89 has changed to specify the
timeframe
 On the day of or the day after the positive PHQ2 or PHQ-9 depression screen, or affirmative
answer to PHQ-9 question 9, did the provider
document a suicide ideation/behavior evaluation
 If the patient had a positive PTSD screen on the same
date, only one suicide ideation/behavior evaluation is
required on that date; the evaluation may precede either
the depression screen or the PTSD screen
 This change is mirrored in question 141 for
PTSD
PTSD Treatment
Question 119 (refptdtx) Was the patient
referred for treatment of PTSD in the past
year?
 New option 4: Documented patient
already receiving care for mental health
disorder
In order to answer “4”, there must be documentation by
the primary care provider or mental health provider that
the patient is already receiving care for a mental health
disorder (e.g. depression, anxiety, substance abuse)
and that provider will provide treatment for PTSD.
PCL-M
 For those cases going through the PTSD
treatment questions, question 128 is new
 Within the past year, did the record document
completion of the PCL-M (PTSD checklist)?
 The PCL-M questions and possible responses
are in the definition/decision rules
 Question 129 is a table that asks you to enter
the date, total score and outcome for all PCL-Ms
done in the past year
Screening for PTSD
Acceptable settings for PTSD screening:
 outpatient encounter
 inpatient hospitalization
 screening by telephone
 televideo (real time) with face to face
encounter between provider and patient
QUIZ 3
You can find no evidence of depression
screening or PTSD screening in outpatient notes
during the acceptable timeframe. However the
patient did have an inpatient admission during
the study year. As part of the initial nursing
assessment a PHQ-2 and a PTSD-PC were
completed. Are these acceptable for screening?
Yes, the rules have been changed so that
screening as an inpatient is acceptable
TBI
There are several changes in the TBI
module which include clarifications and
changes in the order of the questions
Please read all highlighted sections
carefully as all changes will not be
discussed in this presentation
TBI Treatment Prior to Screening
The intent of question 2 (actxtbi) has not
changed, but wording has been added for
clarification
The question is asking if there is
documentation of treatment for TBI after
9/11/2001 but prior to the TBI screen
Notification In Person
Please note the addition of a timeframe in
question 14 (inperson)
On the date of or within 14 days after
the positive TBI screen, does the record
document the facility notified the patient in
person regarding the second level
evaluation appointment?
Second Level Evaluation Completed
 Question 16 (com2eval)
 During the timeframe following the positive TBI
screen up to and including the pull list date,
does the record document a second level
evaluation was completed by a licensed
independent medical provider
 This question has been moved up in the
sequence; if a second level evaluation was
completed within 30 days the module ends after
the relevant questions about the evaluation
findings are completed
Second Level Evaluation Delayed or Not
Completed
If the second level evaluation was not
done OR if it was completed greater than
30 days after the positive TBI screen, the
questions about no shows and
cancellations will follow
No Show
 Question 25: Following the positive TBI screen, does
the record document the patient did not show for a
second level evaluation appointment?
 Please note the intent of the question:
 The intent of the question applies to two possible scenarios:
1) The second level evaluation was completed greater than
30 days after the positive TBI screen and there is
documentation that the patient did not show for a previously
scheduled appointment, or
2) The second level evaluation was NOT completed at
anytime after the positive TBI screen and there is
documentation the patient did not show for a scheduled
appointment.
Cancelled Appointment
 Please note the intent of question 26 (ptcancel):
 Following the positive TBI screen, does the record
document that the patient cancelled the second level
evaluation appointment?
 The intent of the question applies to two possible scenarios:
1) The second level evaluation was completed greater than 30
days after the positive TBI screen AND there is documentation
that the patient cancelled a previously scheduled appointment,
or
2) The second level evaluation was NOT completed at anytime
after the positive TBI screen and there is documentation the
patient cancelled a scheduled appointment.
No Show for a Rescheduled Appointment
Question 30 is new: Does the record
document that the patient did not show for
the rescheduled second level evaluation
appointment?
Contact Attempts
If the second level evaluation was not
completed within 30 days following the
positive screen, or if the patient was not
contacted in person, and the patient did
not refuse the second level evaluation, you
will get the questions about attempts to
contact the patient via phone or certified
letter on the date of or within 14 days after
the positive TBI screen
QUIZ 4
The veteran has a positive TBI screen on 9/10/09. On
9/12/09, the record documents that an attempt was
made to notify the veteran about an appointment for a
second level evaluation for TBI. There was no answer.
The clerk attempted to call the patient a second time on
9/12/09 with the same result. True or False: You will
enter 9/12/09 in both cont1dt and cont2dt
False. A subsequent telephone attempt is made after
the date of the first telephone attempt but within 14 days
following the positive TBI screen
Diabetes Module
Question 4 (amputee): Does the patient
have a lower extremity amputation?
This is not a new question but bears a
reminder to read the answer options
carefully
Both options 1 and 2 are positive answers,
i.e 2 is not “no”
1. Unilateral amputation
2. Bilateral amputation
99. No documentation of lower extremity amputation
Dialysis
Question 11 (dmdialys) is new
At the time of the most recent NEXUS
clinic visit, was the patient receiving
chronic dialysis?
3. Receiving chronic dialysis at VHA
4. Receiving chronic dialysis at non-VHA
facility
99. No documentation the patient is receiving
chronic dialysis
Chronic Dialysis
The intent of question 11 is to determine if
the patient was receiving ongoing dialysis
at the time of the most recent Nexus clinic
visit
Dialysis = ESRD with
Hemodialysis
Peritoneal dialysis
Continuous arterio-venous hemofiltration
Continuous veno-venous hemofiltration
Medication Reconciliation
As previously noted, cases flagged for DM
will go through a medication reconciliation
module
The questions are familiar to you from the
medication reconciliation module in IHF
with a few notable differences
Medication Reconciliation
The questions only pertain to the most
recent Nexus clinic visit
 For the purpose of this module, psychology
visits are not included
 If the most recent Nexus visit was a
psychology visit, you will indicate that in the first
question and go out of the module
Medication Reconciliation
Please note the following instruction for
question 10-12
As some patients may have more than one
acceptable NEXUS or outpatient clinic
encounter on the same date, a reconciled
medication list may not be given to the patient
until the last encounter is completed.
CHF Module
No changes to this module other than
some clarifications in the
definition/decision rules of question 1
(lvsfdoc).
 Left Ventricular Systolic Function (LVSF)
assessment: Left ventricular contractile function, which
may be recorded either in quantitative (EF=30%) or
qualitative (moderate left ventricular systolic dysfunction)
terms. The LVSF may also be referred to as “wall
motion” or “systolic function.”
No Changes
No changes to these modules:
 IHD
 Low Back Pain
 SCI
There is a change to the SCI AD module
smokcigs question. This change is
discussed in the inpatient presentation
Exit Report Changes
You will notice several changes to the exit
report format including additional columns
for:
 Targets
 Quarter to date scores
 Year to date scores
The most significant change to the CGPI
exit report involves weighting
Weighting
Previously, cases were excluded from
certain indicators because of the catnum,
for example catum 16 cases were not
included in the DM indicators
Now most cases will be included in most
indicators but each case will be weighted
depending on the catnum, in other words
not all cases will count equally in the score
Weighting
 The weighting will be done “behind the scenes”
in other words you will not see how the
weighting is applied to each case
 The numerator and denominator will no longer
be reflective of the exact number of cases
included in each; rather the N and D will be
determined by the weight of each case included
and the score will be derived from that
 There will be a column on the report to show the
actual number of cases in the denominator
Terminology Changes
The term mission critical is no longer being
used on the exit report
You will continue to see some indicators
that are performance measures and some
that are supporting indicators with the
same meaning as in the past
Some measures are now called emerging
measures; formerly these were called
transformational measures.
Scoring Changes
 As previously noted, there are changes in the
catnums and in which indicators they are
included
 Please check the catnum column of the exit report
guide for this information
 Sre1: % of patients screened positive for PTSD
or MDD with timely suicide evaluation
 the denominator is the sum of the denominator of ptsd
51 and mdd 41; numerator is the sum of the numerator
of ptsd 51 and mdd 41
CGPI Scoring Changes
 TBI2 is now TBI4: OEF/OIF patients who
screen positive for TBI with second level
evaluation per protocol.
The changes to the scoring algorithm will
be shown in the exit report guide
HBPC
Changes
Question 2 (enrol4lab): Was the patient
enrolled in HBPC only for lab monitoring?
This question did not change, but the answer
options are now only yes or no
Lab monitoring may include blood draws for
INRs (for anticoagulant monitoring) or blood
draws to monitor other conditions/treatments
Telephone visit
Question 3 (visithbpc) really has no
changes but a new bullet point was added
to the definition/decision rules to
emphasize that an acceptable HBPC
encounter may be an HBPC telephone
visit by any member of the HBPC team
The separate question about a telephone visit
has been deleted
There will be discussion about HBPC on
the 11/5 conference call
HBPC Scoring
There are no changes to HBPC scoring
however the report mnemonics have been
changed for every indicator
Please see exit report format and the exit
report guide for details
Conference Calls
Attendance at both conference calls is
essential
 November 5 at 11AM ET (HBPC and Shared)
 November 6 at 11AM ET (HIV, MH)
Please review the Shared module
questions prior to the 11/5 call
As always please call your Regional
Manager with questions as you begin
1Q10 work