PCMH3A: Difference between revisions

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The practice maintains continuous relationships with patients through care management processes based on evidence-based guidelines. A key to successful implementation of guidelines is to embed them in the practice’s day-to-day operations and by using registries that proactively identify and engage patients who are lacking important services (as in PCMH 2, Element D).
The practice maintains continuous relationships with patients through care management processes based on evidence-based guidelines. A key to successful implementation of guidelines is to embed them in the practice’s day-to-day operations and by using registries that proactively identify and engage patients who are lacking important services (as in PCMH 2, Element D).


The practice implements evidence-based guidelines through point of care reminders for patients with:
The practice implements evidence-based guidelines through point of care reminders for patients with 3 important conditions.
 
=3.A.1 The first important condition=


When selecting conditions, you should consider the following:
When selecting conditions, you should consider the following:
*Diagnoses and risk factors prevalent in patients seen by the practice (data from PCMH 2, Elements B and C)
*Diagnoses and risk factors prevalent in patients seen by the practice (data from [[Main_Page#PCMH_2:_Identify_and_Manage_Patient_Populations_.2816_points.29|PCMH 2]], Elements [[Main_Page#PCMH2B_-_Clinical_Data_.284_points.29|B]] and [[Main_Page#PCMH2C_-_Comprehensive_Health_Assessment_.284_points.29|C]])
*Pick conditions where care management, medication management, and self-management support play a role in reducing complications
*Pick conditions where care management, medication management, and self-management support play a role in reducing complications
*Pick conditions for which there are evidence-based clinical guidelines
*Pick conditions for which there are evidence-based clinical guidelines
*Patients with the conditions selected in factors 1–3 will be used for the medical record review required in Elements C and D, and in PCMH 4, Element A.
*Patients with the conditions selected in factors 1–3 will be used for the medical record review required in Elements [[Main_Page#PMCH3C_-_Care_Management_.28Must_Pass.29_.284_points.29|3.C]] and [[Main_Page#PMCH3D_-_Medication_Management_.283_points.29|3.D]], and in [[Main_Page#PMCH4A_-_Support_Self-Care_Process_.28Must_Pass.29_.286_points.29|PCMH 4, Element A]].
 
=3.A.1 The first important condition=
 
{| border = "1"
! style="background:#8facd9; width:40%;" |'''Description'''
! style="background:#8facd9; width:20%;" |'''Example/Screenshot/Documentation'''
! style="background:#8facd9; width:20%;" |'''Source'''
! style="background:#8facd9; width:20%;" |'''Date Added'''
|-
|Corporate diagram, job descriptions, and weekly administrative schedule
||[[Media:PCMH_3_A_1.pdf | Asthma Example]]
||TPC
||03/25/13
|-
|}


=3.A.2 The second important condition=
=3.A.2 The second important condition=
{| border = "1"
! style="background:#8facd9; width:40%;" |'''Description'''
! style="background:#8facd9; width:20%;" |'''Example/Screenshot/Documentation'''
! style="background:#8facd9; width:20%;" |'''Source'''
! style="background:#8facd9; width:20%;" |'''Date Added'''
|-
|Corporate diagram, job descriptions, and weekly administrative schedule
||[[Media:PCMH_3_A_2.pdf | Well Child Example]]
||TPC
||03/25/13
|-
|}


=3.A.3 The third condition, related to unhealthy behaviors or mental health or substance abuse (critical factor)=
=3.A.3 The third condition, related to unhealthy behaviors or mental health or substance abuse (critical factor)=


At least one identified condition must be related to unhealthy behaviors (e.g., obesity, smoking), substance abuse (e.g., drug addiction,
At least one identified condition must be related to unhealthy behaviors (e.g., obesity, smoking), substance abuse (e.g., drug addiction, alcoholism) or a mental health issue (e.g., depression, anxiety, ADHD).
alcoholism) or a mental health issue (e.g., depression, anxiety, ADHD).
 
{| border = "1"
! style="background:#8facd9; width:40%;" |'''Description'''
! style="background:#8facd9; width:20%;" |'''Example/Screenshot/Documentation'''
! style="background:#8facd9; width:20%;" |'''Source'''
! style="background:#8facd9; width:20%;" |'''Date Added'''
|-
|Corporate diagram, job descriptions, and weekly administrative schedule
||[[Media:PCMH_3_A_3.pdf | ADHD Example]]
||TPC
||03/25/13
|-
|}

Revision as of 01:17, 26 March 2013

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The practice maintains continuous relationships with patients through care management processes based on evidence-based guidelines. A key to successful implementation of guidelines is to embed them in the practice’s day-to-day operations and by using registries that proactively identify and engage patients who are lacking important services (as in PCMH 2, Element D).

The practice implements evidence-based guidelines through point of care reminders for patients with 3 important conditions.

When selecting conditions, you should consider the following:

  • Diagnoses and risk factors prevalent in patients seen by the practice (data from PCMH 2, Elements B and C)
  • Pick conditions where care management, medication management, and self-management support play a role in reducing complications
  • Pick conditions for which there are evidence-based clinical guidelines
  • Patients with the conditions selected in factors 1–3 will be used for the medical record review required in Elements 3.C and 3.D, and in PCMH 4, Element A.

3.A.1 The first important condition

Description Example/Screenshot/Documentation Source Date Added
Corporate diagram, job descriptions, and weekly administrative schedule Asthma Example TPC 03/25/13

3.A.2 The second important condition

Description Example/Screenshot/Documentation Source Date Added
Corporate diagram, job descriptions, and weekly administrative schedule Well Child Example TPC 03/25/13

3.A.3 The third condition, related to unhealthy behaviors or mental health or substance abuse (critical factor)

At least one identified condition must be related to unhealthy behaviors (e.g., obesity, smoking), substance abuse (e.g., drug addiction, alcoholism) or a mental health issue (e.g., depression, anxiety, ADHD).

Description Example/Screenshot/Documentation Source Date Added
Corporate diagram, job descriptions, and weekly administrative schedule ADHD Example TPC 03/25/13
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