Every Woman’s Life PROGRAM MANUAL UPDATE

1. Every Woman’s LifePROGRAM MANUAL UPDATE 2012-2013

2. RECRUITMENT • No Changes

3. RECRUITMENT ATTACHMENTS: • None

4. ELIGIBILITY & ENROLLMENT • Eligibility – no change • Federal Poverty Guidelines – no change • Client Participation Agreement – added info on “What you need to know about Every Woman’s Life” • Client Transfer – no change

5. ELIGIBILITY & ENROLLMENT ATTACHMENTS: • Client Participation Agreement – no change • Client Transfer – no change

6. SERVICES • Client Education – no change • Cervical 18-39 – no change • Breast 18-39 – New NCCN Breast Cancer Screening and Diagnosis Guidelines

7. SERVICES • Cervical 40-64 – New USPHS Cervical Screening Guidelines • Breast 40-64 – New NCCN Breast Cancer Screening and Diagnosis Guidelines

8. SERVICES • Managing Abnormal Cervical – New USPHS Cervical Screening Guidelines • Managing Abnormal Breast – updated NCCN version • Over Age 65 – no change

9. SERVICES • Rescreening – no change • Referrals – no change • Cancellation of Services – no change

10. SERVICES ATTACHMENTS: • EWL Screening Guidelines – no change • CBE Core Competencies – no change • Cervical Diagnostic Guidelines – no change • Breast Diagnostic Guidelines – no change • QuitNow Virginia Order Form – no change

11. CASE MANAGEMENT • CM for Women with Abnormal Screening Results – no change • CM Needs Assessment – no change • CM Care Plan – no change • Tracking System – added clarification to patient confidentiality • Tracking & Follow-up – added clarification for inactivating patients

12. CASE MANAGEMENT ATTACHMENTS: • Needs Assessment & Care Plan – no change • Tracking & Follow-up Diagram – no change

13. DATA COLLECTION, REPORTING & RETENTION • Data Collection Forms – no changes to policy (Forms Changes will be discussed at the end of this presentation) • Reporting Requirements – removed section on Community Health Worker Annual Work Plan • Medical Record Management – no change

14. DATA COLLECTION, REPORTING & RETENTION ATTACHMENTS: • Forms Changes will be discussed at the end of this presentation • Monthly Screening Log – no change • Match Form – no change

15. REIMBURSEMENT • Reimbursement for EWL Services – added: • Clarifications on the forms needed to submit for reimbursement • Removed section on Community Health Workers • Updated the state EWL address

16. REIMBURSEMENT Changes to Federal Forms

17. REIMBURSEMENT Changes to State Forms

18. TREATMENT • BCCPTA • Updated policy to include information on Project Wish

19. TREATMENT ATTACHMENTS: • BCCPTA Application – no change • BCCPTA Policy – no change • Medicaid FAQ – Added question 22 • DSS Regional Consultants – no change

20. QUALITY ASSURANCE & IMPROVEMENT • Federal Performance Indicators – no change • State Performance Indicators – no change

21. QUALITY ASSURANCE & IMPROVEMENT • Observational Site Visit • No changes • No changes

22. QUALITY ASSURANCE & IMPROVEMENT • Problem-Focused Visit • No changes

23. QUALITY ASSURANCE & IMPROVEMENT ATTACHMENTS: • None

24. STAFFING • EWL Provider Site Staff – removed the section on Community Health Workers • Training & Technical Assistance – no changes

25. STAFFING ATTACHMENTS: • None

26. EWL Data: Overview and Update Changes to the Data Forms

27. Why does EWL collect data? • To monitor program • Quality • Timeliness of screening to diagnosis and diagnosis to treatment… • Outcomes • Number of women served, number of cancer diagnosis… • Cost • Cost of screening per women served, estimated cost to serve projected number of women…

28. What does EWL do with the data? • Submit to CDC in the form of MDEs • Sent to the CDC in April and October each year • Analyzed by CDC for performance indicators, trends, and missing/erroneous data • Analyze for trends and problem areas • By provider site, by year, etc. • Collaborate with partners to provide information and conduct research • Local universities, community organizations, other VDH agencies, other provider sites

29. How do we ensure data quality? • Accurately complete all necessary fields on data forms • Be aware of changes in data requirements • Use the most current forms • Submit data in a timely manner

30. Why are we changing the data forms….again? • Reflect the new changes in the cervical guidelines • To more accurately reflect the MDEs • To better capture currently clinical practices • To provide more accurate information to the CDC

31. Client Eligibility Form Change #1 Removed the breast symptom questions from the Breast Screening and Diagnostic Form. The client self reports any abnormal breast symptoms.

32. Client Eligibility Form Change #2 Removed “Unknown” as a choice in order to better capture race data. If a patient truly does not know their race please call the State office for guidance.

33. Client Eligibility Form Change #3 *A referral includes offering clients Virginia Quit Line or other tobacco information Check “Yes” even if the client refuses the referral information

34. Breast Screening and Diagnostic Form Change #1 Asterisk (*) procedures require further diagnostic evaluation Moved the breast symptom question to the Eligibility form

35. Breast Screening and Diagnostic Form Change #2 Added Unilateral/Bilateral to mammogram type. Please use this box for all Diagnostic mammograms and not Additional Mammogram Views.

36. Breast Screening and Diagnostic Form Change #3 Asterisk (*) results require further diagnostic evaluation

37. Breast Screening and Diagnostic Form Change #4 • Assessment is incomplete (BI-RADS 0) should only be used in instances were the radiologist/clinician does not feel comfortable determining whether there is cancer present. All other instances should use Unsatisfactory, if the film cannot be interpreted, or Unknown if the results are not known. • Instances of Assessment is incomplete should have additional imaging done or a film comparison only if required by the radiologist • Film comparisons as part of a routine visit should NOT be documented.

38. Breast Screening and Diagnostic Form Change #5 Added new result options for an Ultrasound to be reflect CDC data collection requirements.

39. Breast Screening and Diagnostic Form Change #6 Added the result Atypical Ductal Hyperplasia, to better reflect CDC data collection requirements

40. Breast Screening and Diagnostic Form Change #7 Separated Repeat CBE from Surgical Consult for clarity. Please only use the choices under each procedure as results.

41. Breast Screening and Diagnostic Form Change #8 • Added Deceased to more accurately capture data • Added short-term follow up options for when clinicians/radiologists recommend short-term follow up in lieu of immediate diagnostic work. • Please use the short term follow up check boxes rather than hand writing in notes.

42. Cervical Screening and Diagnostic Forms Change #1 Added 3 year (without HPV test) and 5 year (with HPV test) to the data forms to reflect the new changes in cervical guidelines.

43. Cervical Screening and Diagnostic Form Change #2 Asterisk (*) results require further diagnostic evaluation

44. Cervical Screening and Diagnostic Form Change #3 Removed “Clearly defined lesion of CIN” as per the CDC

45. Cervical Screening and Diagnostic Form Change #4 Added No tissue present This should only be used for ECC

46. Cervical Screening and Diagnostic Form Change #5 • Added Deceased to more accurately capture data • Added short-term follow up options for when clinicians/radiologists recommend short-term follow up in lieu of immediate diagnostic work. • Please use the short term follow up check boxes rather than hand writing in notes.

47. These new forms will go into effect January 1, 2013.