diabetes physician audit tool

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• Publié par: Nifor
• Nombre de lectures: 16
• Langue: English

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Instructions for the Diabetes Physician Audit Tool

Step 1:Choose and pull the records 25 medical records of patients with diabetes should be reviewed.The records will be chosen from a random sampling of all patients with a diagnosis of diabetes (ICD9 code 250, 357.2, 362.0, 366.41, 648.0) between the ages of 1875.To obtain this sample, use a claim computer system query that includes all patients with the above age and diagnostic codes.Then, take the entire number, divide by 25 and take that interval for the sample frequency to pull the records.Do not use patients with latestage renal disease.

Example: If100 patients show up on the computer report as having any of the above ICD9’s, divide 100 by 25 = 4.Take every fourth name for the audit.

Step 2: HbA1c  two components For any time in the past six months, find if HbA1c (also known as A1c) was done.If it was done, put a check in the “yes” column (column 2). Then record theactual resultsin column 4 if 7.0 or less and column 5 if more than 7.0.

If it the HbA1c was not done, put checks in both the “no” column (column 3) and “More than 7.0” column under “HbA1c result” (column 5).

You may find the value under any of the following names:look for the HgA1c, HgbA1c, glycated hemoglobin, glycosylated hemoglobin, A1c, glycohemoglobin A1c, or hemoglobin A1c.The CPT code for this test is 83036. Typically you will see a note that the HbA1c is “certified as traceable to the DCCT standard”.

Step 3: Eye Exam by an Eye Professional Look in the chart for a consult note or a physician note that states that an ophthalmologist or optometrist did an eye exam within the past 24 months.If an eye exam was done, place a check in the “yes” column (column 6).If no evidence of an eye exam by an ophthalmologist or optometrist is noted, place a check in the “no” column (column 7).(Note: This does not follow HEDIS exactly, but closely parallels the recommendations.)

Step 4: LDLC For any time in the past 24 months, find the result of the LDLCholesterol in the medical record.Record the LDLC result in either column 8 if less than 100 mg/dL or in column 9 if 100 mg/dL or more.If no result is available place a check in column 9.

Step 5: Monitoring for Diabetic Nephropathy For any time in the past 24 months, determine if a urine test for microalbuminemia was performed. The CPT codes for these tests are: 82042, 82043, 82044.These include the 24 hour test, timed test, and spot urine for microalbuminemia.If done, place a check in the “yes” column (column 10).If not done, place a check in the “no” column (column 11).

You may find the elements noted above in the following areas: medical record: problem lists, office note, SOAP note, encounter form, telephone call record, diagnostic report, hospital discharge summary.

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Diabetes Physician Audit Tool Worksheet

Date of audit: ____________ Name of Person Performing Audit: _____________________

Patient ID Was an eye exam Tested for (do not Was a HbA1cHbA1c (A1c)done in last 24LDLC result microalbuminemia include (A1c) done?result months? names) More thanMore than 7.0 or100 or 7.0 (or not100 Yes No lessYes No LessYes No done) (ornot done) Column 1Column 2Column 3Column 4Column 5Column 6Column 7Column 8Column 9Column 10Column 11 1. 2. 3. 4. 5. 6. 7. 8. 9. 10. 11. 12. 13. 14. 15. 16. 17. 18. 19. 20. 21. 22. 23. 24. 25. Total TotalTotal TotalTotal Checked checkedchecked Checkedchecked

Column 1Column 2Column 3Column 4Column 5Column 6Column 7Column 8Column 9Column 10Column 11

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Your Diabetes Management results are calculated using the following formulas:

HEDIS measure

 HbA1ctested rate= resultfrom column # 2X 100% =  25

 HbA1ccontrolled rate = result from column # 4X 100% =  25

 Eyeexam rate = result from column # 6X 100% =  25

 LDLCcontrolled rate = result from column # 8X 100%=  25

 Microalbuminemiascreening rate = result from column # 10X 100 % =  25

Your ResultGoal 100 %

I certify that I followed the instructions on the attached pages and that the results are accurate:

Signature: _____________________________

Date: ______________

If you did not do as well as you wished, consider some of the following interventions:

· · · · · · · · ·

Verify the diagnosis Start a callback program to get the members not controlled into the office Changing the drugs of patients not controlled Sending out educational material to members Improved tracking (i.e. computerized) of patients with diabetes Asking every patient with diabetes to view a video. Developing a nurse diabetes management program Pill counts, or prescription verification of patients not controlled Refer the seriously uncontrolled to a specialist or diabetes nurse

100%

100%

100%

100%

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