2017 - Competency KM-A

Table of Contents

Move to KM-B

KM 01 (Core): Documents an up-to-date problem list for each patient with current and active diagnoses

Description	Example/Screenshot/Documentation	Source	Date Added
Use PCC MU Report “Stage 1 - Problem List”	MU Report Example - Problem List	PCC	8/10/17

KM 02 (Core): Comprehensive health assessment includes (all items required):

• A. Medical history of patient and family.

Collects patient and family medical history (e.g., history of chronic disease or event [e.g., diabetes, cancer, surgery, hypertension]) for patient and “first-degree” relatives (i.e., who share about 50% of their genes with a specific family member).

• B. Mental health/substance use history of patient and family.

Collects patient and family behavioral health history (e.g., schizophrenia, stress, alcohol, prescription drug abuse, illegal drug use, maternal depression).

• C. Family/social/cultural characteristics.

Evaluates social and cultural needs, preferences, strengths and limitations. Examples include family/household structure, support systems, and patient/family concerns. Broad consideration should be given to a variety of characteristics (e.g., education level, marital status, unemployment, social support, assigned responsibilities).

• D. Communication needs.

Identifies whether a patient has specific communication requirements due to hearing, vision or cognition issues.

• E. Behaviors affecting health.

Assesses risky and unhealthy behaviors that go beyond physical activity, alcohol consumption and smoking status and may include nutrition, oral health, dental care, risky sexual behavior and secondhand smoke exposure.

• F. Social functioning.

Assesses a patient’s ability to interact with other people in everyday social tasks and to maintain an adequate social life. May include isolation, declining cognition, social anxiety, interpersonal relationships, activities of independent living, social interactions and so on.

• G. Social determinants of health.

Collects information on social determinants of health: conditions in a patient’s environment that affect a wide range of health, functioning and quality-of-life outcomes and risks. Examples include availability of resources to meet daily needs; access to educational, economic and job opportunities; public safety, social support; social norms and attitudes; food and housing insecurities; household/environmental risk factors; exposure to crime, violence and social disorder; socioeconomic conditions; residential segregation (Healthy People 2020).

• H. Developmental screening using a standardized tool. (NA for practices with no pediatric population under 30 months of age.)

For newborns through 3 years of age, uses a standardized tool for periodic developmental screening. If there are no established risk factors or parental concerns, screens are done by 24 months.

• I. Advance care planning. (NA for pediatric practices.)

As a pediatric practice, you get credit for this component and can claim "N/A"

KM 03 (Core): Conducts depression screenings for adults and adolescents using a standardized tool

The documented process includes the practice’s screening process and approach to follow-up for positive screens. The practice reports screening rate and identifies the standardized screening tool.

Description	Example/Screenshot/Documentation	Source	Date Added
Use PCC CQM Report “Screening for Clinical Depression and Follow-Up Plan”	CQM Report Example	PCC	8/11/17