For care coordination, the intent of QI 02A is to evaluate the communication/coordination that occurs between providers or providers and patients, so it's generally looking at closing the loop on care coordination tasks/processes. Some examples for care coordination may include but are not limited to:
– Reduced % of patients seeing multiple providers (3 or more)
– Medication reconciliation after care transition (MU)
– Follow up with patients or providers to ensure ordered lab or imaging tests were completed
– Follow up with patients following receipt of abnormal test results
– Outreach to patients not recently seen that result in an appointment
– Follow-up phone calls to check on the patient after an ER visit (or hospitalization)
– # patient calls received after hours by the call center were reconciled in the patient record and addressed by the care team the next business day
– Following up on pediatric visits to after-hours care
– Number of referrals sent
– % of patients who had a positive TB screen who had a FU Chest x-ray
– % of patients who had a positive GC/Chlamydia who were treated with antibiotics
The intent of QI 02B is for practices to use measures to help them understand how efficiently they're providing care and judiciously using resources. Examples of measures affecting health care costs may include but are not limited to:
– Total cost per patient
– Medical cost per medical visit
– # of medications prescribed
– Use of high cost medications
– Use of imaging for low back pain
– Redundant imaging or lab tests
– Emergency department utilization
– Hospital readmission rates
– Use of generic versus brand name medication
– # of Specialist referrals
– # of patients who went to urgent care during open office hours
– # of referrals/ED visits for needs that could be addressed in the office
– Appropriate testing for children with pharyngitis
– Appropriate treatment for children with URI
PCMH 2017