EPRP Data Collection Instruments

1. EPRP Data Collection Instruments 2Q FY2010 Update Confidential and Proprietary-WVMI

2. Inpatient Instruments

3. Addition to Inpatient Instruments • A new module has been added to ACS, IHF, PN, and SCIP • The module is Delirium Risk and will be enabled if the patient is age 65 or greater • There are 20 questions in the module although as always there is the potential to skip some questions • The specific questions will be reviewed in a conference call.

4. No other changes • There are no other changes to ACS, IHF, PN or SCIP • Also no change to VTE

5. Skin Assessment • The Skin Assessment module has a wording addition in the definition/decision rules of question #2 bradtime1 • We see a good deal of disagreement on IRRAs with regard to the time of the first Braden Scale • Please note that you should record the time the first Braden scale note was completed and signed

6. Fall Assessment • There are similar clarifications in the Fall Assessment module • Question 3 (mfstm) asks you to enter the time the first Morse Fall Scale note was completed and signed • Question 4 (morscore) asks you to enter the total score of the first Morse Fall scale documented in the record

7. Medication Reconciliation • Question 3 (actmed) of the Medication Reconciliation module (inpatient instruments) has two important changes • There is a new option: 3.Documented that medications were not currently prescribed for the patient upon admission • Use this option only if there is explicit documentation that medications were not currently prescribed for the patient at the time of admission.

8. Med Rec (continued) • Question3 (actmed) definition/decision rule addition: • For surgical care cases that have surgery on the day of admission, documentation of the current medication list in the pre-op H&P done prior to admission AND provider documentation the day of or day after admission that the medications are unchanged (or similar wording) from the pre-op H&P is acceptable.

9. HBPC • There are no changes to the HBPC data base questions • However there is an important instruction that you need to bear in mind • If a patient moves from home HBPC to foster home HBPC, this should not be considered a new admission even though you may see it as a discharge and re-admit on the same day • This situation should be regarded as continuous care and not a new admission

10. HBIPS • Please note the definition/decision rules for question 48 (plndcmed) • All medications must have the names, dosage and indications for use listed in the continuing care plan. The indications for use can be as short as one or two words, but must be present for all medications, not just psychotropic medications.

11. CGPI

12. Changes • Most of the CGPI modules have no changes • No change to: • CHF • CKD • Core • DM • IHF • PI • SCI, SCI-AD • SMI • TBI (skip pattern changes only) • Validation

13. Low Back Pain • Until now the Low Back Pain module data has been collected only for a few facilities • Beginning in 2Q10, cases may be flagged for low back pain at all facilities • There are no changes to the module from last quarter • Education for abstractors who have not been doing this review will be provided by conference call

14. Mental Health Module • A new option is added to the two questions that ask about whether the patient was seen in a substance use disorder clinic (questions 25 and 32) • The new option is #7 545 SUD-Telephone

15. Another MH Module Change • There is a change to questions 90 and 142: Enter the date the suicide ideation/behavior evaluation was completed. • The change is to the date parameter so that a date one day after the end of the study interval is allowed • Since the suicide evaluation may be completed on the day or the day after the positive (depression or PTSD) screen, the parameter was changed to allow for screens done on the last day of the study interval and evaluations done the following day

16. Depression and BPD Codes • When looking for ICD-9-CM codes as evidence of depression or bipolar disorder as a reason for a clinical encounter, please note the codes carefully • There are changes from 1Q10 and these codes should be in alignment with the National Clinical Reminder for Depression screening

17. Depression and BPD Codes • Codes for Depression (questions 52 and 56) • 298.0, 300.4,301.12, 309.0, 309.1, 309.28, and 311 • Codes for Bipolar Disorder (questions 58 and 62) • 296.2x, 296.3x, 296.5x, 296.6x, 296.7, and 296.8x

18. Shared Module • The wording of question 9 (prevldl) has changed although the intent remains the same • During the timeframe from (computer to display date = stdybeg – 1 year) to (computer to display ldldt – 1 day), was a LDL in mg/dL or mg/100mg obtained? (Disregard any report that does not include an actual LDL value.) • You need to answer this question only if the LDL could not be calculated due to high triglycerides when the most recent lipid profile was done

19. Shared Module • You will note that the “no” option for several questions has been expanded to read “no or unable to determine”

20. Which Provider • Question 13 (which provider ordered the most recent ldl) has a new option and definition/decision rules • #5: Pharmacist • If there is documentation that a health care provider other than the providers listed ordered the LDL test “by protocol”, select “1.” (physician) • The same change is also noted for all questions asking which provider prescribed or changed the dose of lipid lowering medications

21. Question 14 • The wording of question 14 has been changed for clarification • After the study end date and up to the date the chart was opened for review, was an LDL test obtained? (Disregard any report that does not include an actual LDL value.) • Review date is the first date the chart was opened for review • This wording change also was made to question 16

22. Questions 19, 21 and 23 • The time frame for obtaining a total cholesterol, HDL and triglycerides is clarified • ….done at any time up to and including the study end date

23. Prescribed (Taking), Not Taking • Question 47 now has 3 options • On (display LSTLDLDT), the date entered for the most recent LDL value, does the record document the patient was currently prescribed (or taking) a statin medication? • 1. Yes • 2. No • 3. Yes, a statin was currently prescribed AND there is documentation the patient was not taking the statin on the date the most recent LDL was obtained • Answer “2” if the patient was NOT currently prescribed a statin on the date the most recent LDL was obtained, but a statin was newly prescribed on the date the most recent LDL-c was obtained,

24. Prescribed (Taking), Not Taking • The same change as in question 47 was made to other similar questions about non-statin meds, meds taken at the time of the most recent Nexus visit and antihypertensive medication questions

25. New Statin Drug • Pitavastatin (Livalo) • This drug as been added as an option to several questions that ask about statin drugs

26. Non-statin Lipid Lowering Drugs • Cholesterol absorption inhibitors and Omega-3 Fatty Acids have been removed from the questions about non-statin lipid lowering medications

27. Anti-hypertensive Drug Table • A new drug has been added to the anti-hypertensive drug table • Nebivolol is in the beta blocker section

28. Reminders • Although the following items are not new or recently changed, they have come up in requests for reconsideration and possibly warrant a reminder for all • TBI • The date parameters for entering the date of a TBI consult following a positive TBI screen and for the date of the second level evaluation go up to and include the pull list date (not the study end date)

29. Reminders • Appropriate antibiotic choices for Pneumonia and Surgical Care • Please consult the Joint Commission reference tables for appropriate antibiotic choices when answering questions • These tables were sent to you in 1Q10 and are very helpful in showing which antibiotics are appropriate for ICU and non-ICU cases (PN) and the various types of surgery (SC) • It is important that you are able to accurately explain why a case failed an indicator

30. Reminders • Remote Data • Remember that you are required to review data from other VAMCs that a veteran may have visited during the appropriate time period • Occasionally there are reconsiderations because the abstractor has forgotten to check remote data

31. Reminders • Cod1A: Coded CHF diagnosis with documentation in the record to support the diagnosis code • Please look carefully in outpatient clinic notes for a documented diagnosis of CHF • Catnum 64 cases with selchf not selected will fail this indicator

32. Reminders • Please use your exit report guides and the data base questions to help you understand the exit report indicators and to help you determine why cases fall out • Sometimes reconsiderations are submitted because the reason the abstractor gave for a failure is not correct • If you are not sure why a case failed a certain indicator and you can’t determine why by using the exit report guide, please call your Regional Manager

33. Exit Reports and Scoring • Change from SI to HSI • You will note on the exit report formats that indicators that were formerly called supporting indicators (SI) are now called HSI (Health System Indicators) • This is the only change for the report for ACS, IHF, PN, SC • There are no changes to HBPC scoring or exit report

34. Exit Reports and Scoring • HBIPS • The HBIPS indicators are HSIs instead of SIs • There is a change in scoring to IPS4a, b, and c • Cases where the number of scheduled antipsychotic medications prescribed for the patient at discharge is not able to be determined (answer zz) are included in both the denominator and numerator • There is also a scoring change to IPS6a, b, and c • Cases where the number of scheduled antipsychotic medications prescribed for the patient at discharge is not able to be determined (answer zz) are included in the denominator • See exit report guide for complete information

35. Exit Reports and Scoring - CGPI • You will notice that the numerator column has been added back to the report • This is a true numerator, i.e. the number will reflect the actual number of cases that pass without regard to weighting. • The score will continue to reflect weighting so that you cannot derive the score by dividing the numerator by the denominator

36. Exit Reports and Scoring CGPI • A new indicator has been added • P31 Breast (cancer) Screen Ages 50-74 • Scoring is the same as the other breast cancer screening indicators except for the age range • The exit report guide will provide scoring details • P31 is an HSI • Cod1a: has been moved to new exit report, Pilot Data Exit Report • Scoring remains the same

37. Exit Reports and Scoring CGPI • The chronic kidney disease indicators and the low back pain indicators have been moved to the Pilot Data Exit Report • No other changes to the CGPI exit report format or scoring

38. Nursing Exit Report • The Skin Integrity and Fall Assessment indicators remain on the Nursing Exit report and scoring is unchanged from 1Q10 • The indicators are now HSIs rather than SIs. • The Medication Reconciliation indicators have been moved to the Pilot Data Exit Report

39. Pilot Exit Report • There will be a new exit report in 2Q10 • This is a report that will show pilot indicators and the data will come from several different instruments • As previously mentioned, cod1A, LBP and CKD indicators have been moved from the CGPI report to the Pilot Report • The Medication Reconciliation indicators have been moved from the Nursing Report to the Pilot Report

40. Pilot Exit Report • There are also some new indicators that will be on the pilot report • VTE indicators • Blood Management indicators (data from SC and VTE) • An indicator for delirium risk (data from ACS, IHF, PN, and SC) • Cod1B (data from CGPI) • Coded DM diagnosis with documentation on the record to support the diagnosis code • CGPI cases flagged for DM with seldm=true will pass

41. Pilot Exit Report • Details on the numerator and denominator for each indicator on the pilot report will be in a Pilot Exit Report Guide • Instructions on how to run the Pilot exit report will be provided at the time the software is released

42. Thanks for your good work! • Please review the 2Q changes and reminders carefully • Consult your data base questions as necessary while conducting your review • Ask questions of your Regional Manager as needed