EPRP QUARTERLY UPDATE Fourth Quarter FY 2011 WVMI-Confidential and Proprietary WVMI-Confidential and Proprietary CGPI CGPI CHANGES No Changes to These Modules: TVG CHF IHF DM SMI SCI Core Minor wording change to PI question offmedrx The CKD.
Download ReportTranscript EPRP QUARTERLY UPDATE Fourth Quarter FY 2011 WVMI-Confidential and Proprietary WVMI-Confidential and Proprietary CGPI CGPI CHANGES No Changes to These Modules: TVG CHF IHF DM SMI SCI Core Minor wording change to PI question offmedrx The CKD.
EPRP QUARTERLY UPDATE Fourth Quarter FY 2011 WVMI-Confidential and Proprietary WVMI-Confidential and Proprietary CGPI CGPI CHANGES No Changes to These Modules: TVG CHF IHF DM SMI SCI Core Minor wording change to PI question offmedrx The CKD module has been deleted WVMI-Confidential and Proprietary Other Changes Include: FRAIL ELDERLY Catnum 54 patients with an inpatient stay at this VAMC in the past year (length of stay>= 48 hours) will get a new Frail Elderly instrument Details of the new instrument will be covered in a separate presentation. WVMI-Confidential and Proprietary MH MODULE Brief Alcohol Counseling [alcbac, question 27] Please note the changes to the Acceptable Provider definition: Acceptable provider: For a “provider” to be deemed acceptable to perform brief alcohol counseling, he/she must be a MD/DO, Psychologist, LCSW, LCSW-C, LMSW, LISW, NP, CNS, RN, PA, MS Level counselor, or Addictions therapist. A trainee with appropriate co-signature, or other allied health professional who by virtue of educational background AND approved credentialing, privileging, and/or scope of practice, has been determined by the facility to be capable of brief alcohol counseling, may perform the counseling. It is important that you check the signature line for the credentials of the author of the note documenting brief alcohol counseling WVMI-Confidential and Proprietary SUICIDE RISK EVALUATION Please note important changes to the definition/decision rules of question 90 [deprisk] and question 142 [ptsdrisk]. The requirement for a summary or conclusion statement of the risk of suicide has been deleted The clinical reminder from Patient Care Services is acceptable when certain conditions are met. The same wording was also added to the definition/decision rules for question 162 [mhtxrsk] Please consult with your RM or WVMI if you are uncertain as to whether the documentation in the record meets the intent of the question WVMI-Confidential and Proprietary SUICIDE RISK EVALUATION Acceptable Provider Documentation of Suicide Risk Evaluation: WVMI-Confidential and Proprietary A clinical reminder is available from Patient Care Services (PCS) and is acceptable if all required elements (feelings of hopelessness, suicidal thoughts, suicide plans if having suicidal thoughts, and history of suicide attempts) of the reminder are completed by the provider and contained in the medical record; OR If the PCS Clinical Reminder is NOT used, there must be at a minimum, a notation by the provider that the suicide risk evaluation was completed. The provider notation is an attestation that hopelessness, suicidal thoughts, suicide plan if having suicidal thoughts, and history of suicide attempts were addressed with the patient. MHRSKSU If the provider documents the patient is demonstrating suicidal ideation/behavior or is at risk for suicide, enter “1” for outcome. If the provider documents the patient is not demonstrating suicidal ideation/behavior or is not at risk for suicide, enter “2” for outcome. The term ‘risk’ does not need to be present to answer the outcome question. WVMI-Confidential and Proprietary Some additional guidance (below in red) is also provided in the rules for question 163 regarding outcome of the suicide behavior/ideation evaluation ACCEPTABLE PROVIDER Please note the changes to the definition of Acceptable Providers who can perform a suicide ideation/behavior evaluation See questions 90 [deprisk], 142 [ptsdrisk] and 162 [mhtxrsk] Acceptable Provider: For a “provider” to be deemed acceptable for suicide risk evaluation he/she must be an MD, DO, PhD or PsyD Psychologist, LCSW, LCSW-C, LMSW, LISW, NP, CNS, or PA. Trainees in ANY of these categories may complete a suicide risk evaluation with appropriate co-signature. Please note the credentials of the author of a progress note documenting a suicide risk evaluation WVMI-Confidential and Proprietary SHARED MODULE CHANGES There is a change to the order of the lipid questions If the answer to protinyr is no (urinalysis for protein not done in the past year), the question macroalb (and subsequent date question) will be skipped The CKD lab questions were deleted WVMI-Confidential and Proprietary The questions asking for the cholesterol, HDL and triglyceride values now precede the LDL questions SHARED MODULE CHANGES An liraglutide (Victoza) Only the generic names will be displayed in the drug table Refer to your drug handbook to find the generic name if the trade name is documented in the record WVMI-Confidential and Proprietary addition was made to the list of antidiabetes drugs in the rules for q41 [poantidm], q43 [chgdmrx], and q44 [addmrx] REVISED DEFINITION/DECISION RULESSHARED MODULE Reasons for not prescribing a beta-blocker [question 104 , nobetab] Documented beta-blocker allergy/sensitivity/intolerance counts regardless of type of reaction Documented beta-blocker allergy/sensitivity/intolerance to one beta blocker is acceptable as allergy to all BBs EXCLUDE (do not count) allergy to BB eye drops Severely de-compensated heart failure: there must be a specific diagnosis documented by the physician/APN/PA to choose option 10 WVMI-Confidential and Proprietary The format of the definition/decision rules has been changed and allows easier correlation to the answer options A couple of the rules have been expanded for clarification REVISED DEFINITION/DECISION RULESSHARED MODULE Acerx Definition of ACEI expanded ACEI: Angiotensin converting enzyme inhibitors; ACEIs may be described as RAS (renin-angiotensin system) or RAAS (renin-angiotensin-aldosterone system) blockers/inhibitors Brand names added to list of ACEIs WVMI-Confidential and Proprietary [question 105] ACEINOT [QUESTION 107] INCLUDE: AS described as moderate, severe, 3+, 4+, critical or significant; degree of severity not specified; aortic valve area of less than 1.0 square cm; subaortic stenosis, moderate/severe, or degree of severity not specified EXCLUDE: aortic insufficiency/regurgitation only; AS described as 1+ or 2+; AS using qualifiers: cannot exclude, cannot rule out, may have, may have had, may indicate, possible, suggestive of, suspect, or suspicious WVMI-Confidential and Proprietary The format of the definition/decision rules has been changed and allows easier correlation to the answer options Moderate/Severe Aortic Stenosis has clarifications REVISED DEFINITION/DECISION RULES-SHARED MODULE Arbrx [question 108] ARB: Angiotensin receptor blockers or angiotensin II receptor antagonists (AIIRA); ARBs may be described as RAS (renin-angiotensin system) or RAAS (reninangiotensin-aldosterone system) blockers/inhibitors Brand names added to list of ARBs Changes as noted in aceinot WVMI-Confidential and Proprietary Definition of ARB expanded Contrarb [question 110] OP MEDICATION RECONCILIATION MODULE There is a significant change in this module which affects several questions In question 1, you will look for an outpatient clinic visit during the past year at which a physician/APN/PA administered, prescribed, or modified medications Outpatient clinic encounter includes Nexus Clinics AND several specialty clinics WVMI-Confidential and Proprietary Please refer to the list of clinics in the definition/decision rules of new question 1 [opmedrx] Also note there is a list of clinics that are not included (exclusion list) and that for purposes of this question psychology group visits are not included OP MED RECON If there is no outpatient visit in the past year at which a physician/APN/PA administered, prescribed, or modified medications, the case is excluded from the Medication Reconciliation module after question 1. If there was such a visit, you will enter the date of the visit at which a physician/APN/PA administered, prescribed, or modified medications in question 2 [medrxdt] You will select the name of the clinic from a drop down list of clinics in question 3 [medclin] WVMI-Confidential and Proprietary OP MED RECON Questions 4 through 9 of this module are unchanged from the previous quarter EXCEPT now the question will display the date you entered in medrxdt (date of the most recent OP visit at which a physician/APN/PA administered, prescribed, or modified medications). You will answer the questions based on documentation in the notes for that visit WVMI-Confidential and Proprietary CGPI SCORING CHANGES No changes to CGPI scoring in 4Q FY2011 WVMI-Confidential and Proprietary TBI No changes to TBI questions, rules or scoring for 4QFY11 WVMI-Confidential and Proprietary WVMI-Confidential and Proprietary HBPC HBPC ADMISSION DATE Admission to HBPC is the visit in which a full assessment of the patient is initiated The date of this visit is the only acceptable HBPC admission date. Disregard earlier notes that refer only to HBPC admission. Please be sure to follow this rule when entering the date of admission to HBPC. WVMI-Confidential and Proprietary The definition/decision rules for entering the HBPC admission date have been clarified [question 7, admisdt] HBPC-BEHAVIORAL TRIGGERS Please note the change to the rules for documentation of behavioral triggers [question 22 behvtrig] For HBPC admissions that occur on or after July 1, 2011, the ONLY ACCEPTABLE DATA SOURCE for this data element is the HBPC admission assessment. Remember that the date of admission to HBPC must be July 1, 2011 or > for this new rule to apply and you will not have those cases immediately WVMI-Confidential and Proprietary FOLLOW COGNITIVE ASSESSMENT Follow-up for cognitive impairment may include, but is not limited to: taking a medical history, performing a neurological exam, psych consult, blood work, brain imaging, supportive counseling, care planning for dementia or other similar diagnosis, caregiver education, neuropsychological testing, or depression screening. Please remember that there must be clinician documentation that the follow up was done in relation to the patient’s cognitive impairment (not new) WVMI-Confidential and Proprietary Some additional examples of follow up of a positive cognitive assessment have been added to question 29 [addfolo] UP OF HBPC SCORING There are no changes to HBPC scoring or the exit report for 4QFY2011 WVMI-Confidential and Proprietary WVMI-Confidential and Proprietary ACS REASONS FOR NO BETA-BLOCKER There are some changes to the definition/decision rules for the three beta blocker questions in ACS As noted in CGPI, the rules have been reformatted and some changes made for clarification of the answer options The most significant change is in the rules for option 3; 2nd or 3rd degree HB on ECG and no pacemaker Please review the includes and excludes terms WVMI-Confidential and Proprietary Betanone [question 35 Initial Presentation Module] Betanon1 [question 31 After Admission Module] Nodcbb [question 16 Discharge Module] REASONS ARB FOR NOT PRESCRIBING AN ACEI AND Please review the changes to the rules for questions 3 [noacewhy[ and 6 [acsnoarb] in the Discharge module The definition/decision rules have been reformatted for clarification and correlation to the answer options. Please review the rules carefully Note the changes to the rules for aortic stenosis (included terms and excluded terms) WVMI-Confidential and Proprietary CARDIOLOGY INVOLVEMENT-DATE AND TIME Questions 41 and 42 [carddt and cardtme] in the Initial Presentation module Questions 37 and 38 [carddt1 and cardtme1] in the After Admission module Questions 11 and 12 [carddt2 and cardtme2] in the Transfer In module WVMI-Confidential and Proprietary There are clarifications to the definition/decision rules for entering the date and time of Cardiology involvement CARDIOLOGY INVOLVEMENT DATE TIME Inter-rater reliability scores for these questions need improvement, so please read the rules carefully Pay special attention to the rules for entering time of cardiology involvement If a cardiologist was the attending physician, or saw the patient in consultation enter the time the cardiology note was started. If there was cardiology consultation by telephone or telemedicine, and recommendations were made to the attending physician, enter the time the attending physician documented the telephone or telemedicine consult was completed. If a cardiac catheterization or PCI was performed at this VAMC, use the start time of the cath or PCI as the documented time of cardiology involvement, unless the patient was seen by cardiology pre-procedure. WVMI-Confidential and Proprietary AND NO CHANGES No changes to Validation History and Assessment Revascularization Continuing Care and Assessment No changes to ACS exit report or scoring WVMI-Confidential and Proprietary WVMI-Confidential and Proprietary IHF RULES REVISIONS Changes to The changes to these questions are the same as noted previously in the comparable questions in ACS There are no other changes to IHF WVMI-Confidential and Proprietary Contace3 Contrarb Contrabb Noacewhy Noarbdc Nobbatdc IHF SCORING There are no changes to IHF scoring or to the Exit Report WVMI-Confidential and Proprietary WVMI-Confidential and Proprietary PNEUMONIA PN ACUTE CARE MODULE Heltrisk (question 1) There are no changes to content of the definition/decision rules but they have been reformatted for better understanding and correlation to the bulleted points in the question Please note: If there is physician/nurse practitioner/physician assistant documentation that the patient has ‘healthcare associated pneumonia’, ‘HCAP’, or ‘nosocomial pneumonia’, select “1.” WVMI-Confidential and Proprietary PN SCORING No changes to the scoring or exit report for Pneumonia WVMI-Confidential and Proprietary WVMI-Confidential and Proprietary SURGICAL CARE NEW FEATURE An ICD-9 “checker” is now built into all inpatient software (not just SC) WVMI-Confidential and Proprietary If you enter an invalid code (numbers that are not a real ICD-9 code), you will get an error message as you attempt to exit the module You will be unable to exit the module until a valid code has been entered. Both procedure codes and diagnosis codes will be checked for validity PRINCIPAL PROCEDURE CODE [QUESTION 7, PRINPX] The Surgical Care software will continue to warn you if the principal procedure code you entered is not on Table 5.10 Consult with your Regional Manager or WVMI if you are unsure If the principal procedure is not on Table 5.10, the case will be excluded. Do not search for another code and enter that one just because it is on Table 5.10 if it is NOT the principal procedure. Enter xx.xx to indicate no procedure was performed WVMI-Confidential and Proprietary Since VA records do not identify the principal procedure, it is important to determine the correct code to enter when there are multiple procedures during one admission Use the definition of principal procedure as guidance SC Bioname [Question 38] No changes to the Informed Consent module WVMI-Confidential and Proprietary There are some highlighted changes to the definition/decision rules These are mainly wording or formatting changes for added clarification Informed Consent FRAIL ELDERLY-INPATIENT INSTRUMENT more information on that in a separate presentation WVMI-Confidential and Proprietary If the age of the SC patient is >= 75 years and the length of stay is >=48 hours, the case will get the new Frail Elderly inpatient instrument SC SCORING No changes to SC scoring or Exit Report for 4QFY2011 WVMI-Confidential and Proprietary WVMI-Confidential and Proprietary VTE MINOR CHANGES The only changes to VTE are minor wording/formatting changes in the definition/decision rules for a few questions There are no changes to VTE scoring WVMI-Confidential and Proprietary WVMI-Confidential and Proprietary HBIPS ADMISSION DATE [QUESTION 1, ADMDT] If there are multiple inpatient orders, use the order that most accurately reflects the date that the patient was admitted. The admission date should not be abstracted from the earliest admission order without regards to substantiating documentation. If documentation suggests that the earliest admission order does not reflect the date the patient was admitted to inpatient care, this date should not be used. ONLY ALLOWABLE SOURCES: Physician orders, face sheet WVMI-Confidential and Proprietary There are changes to the definition/decision rules consistent with the changes made in other inpatient instruments in 3Q FY2011 REFRNEXT [QUESTION 18] Please note this important change to the definition/decision rules When a patient checks himself out of a hospital against the advice of his doctor (AMA) this is not the same as an elopement. The patient should still be offered a referral to a next level of care provider. If the patient refuses the referral, select “2.” If the patient checks out AMA and is not offered a referral to next level of care provider, select “5.” WVMI-Confidential and Proprietary SCORING CHANGE WVMI-Confidential and Proprietary The only change to HBIPS scoring for 4Q FY2011 is the discharge date parameter for inclusion which is now >=04/01/2011 COMMON MODULES No changes to: No changes to the Nursing Exit Report/scoring WVMI-Confidential and Proprietary Fall Assessment Prevention Delirium Risk Blood Management Inpatient Medication Reconciliation PILOT EXIT REPORT CKD indicators were deleted New Frail Elderly indicators were added Change to mrec 23, 24, 25, 26, 27, 28, 29, and 33 to add exclusion if optmedrx=2 (no medication was administered, prescribed, or modified at an outpatient clinic visit in the past year) Wording at the top of the Pilot report has been revised to reflect the changes to the content of the report WVMI-Confidential and Proprietary More on these with FE education Details provided in exit report guide QUESTIONS???? Please call your RM or WVMI if you have questions about any topic Please complete the required learning assessment using the questions and this presentation as references WVMI-Confidential and Proprietary 4TH QUARTER REVIEW OF 7/11/2011 WILL START THE WEEK WVMI-Confidential and Proprietary