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Share Your Care Gap Closure STORY! - both sucesses and failures are helpful!
1.
Your name
2.
Your role
PCP
Office Manager
MA
Clerk
HIT
Internal QI staff
Practice facilitator
Other (please specify)
3.
The practice name
4.
What care gap (or HEDIS Metric) did the practice work on?
5.
Why did the practice select this one?
6.
What care gap closure approach/s does the practice use for this one? (check all that apply)
At-visit
Between visit with outreach/follow-up/navigation
Referral/lab order inititated at visit
Referral/lab order initiative between visit
Single issue campaign
Single issue campaign with outreach
Mailed based care gap closure (FIT kit etc)
Remote monitoring (BP etc)
Administrative gap closure (upload supplemental data, confirm closure, etc)
Other (please specify)
7.
Describe the care gap process -what is its starting point, ending point, who does what when?
8.
What data resource/s are they using for the new process to identify the gap?
Data hand abstracted from EHR
Automated EHR dashboard or alert
Data from a PHM platform (Cozeva, Azara, Innovacer, other)
an IPA report
a health plan report
Faxed ADT reports
e-ADT reports/alerts
a QHIO portal
an integrated service from a QHIO
Other (please specify)
9.
What special tools/processes are used:
Gap report printed on paper or previsit checklist
Clinical reminders or health maintenance dashboard
Clinical reminders EHR alert or similar
Standing orders
Pre-visit checklists
Manual patient reminders
Automated patient reminders
Pre-visit checklist
Pre-visit huddle
Call scripts
Patient education or engagement
Patient incentives
None
Other (please specify)
10.
Who are key players in this process at the practice and why?
11.
How effective is the process in closing the focus care gap/s?
Not at all
Somewhat
Average
Very
Extremely
12.
How do you know this:
13.
What 3 "tips" would you give to another PF or practice trying to make improvements to their care gap closure process/es? And any other thoughts and recommendations?
14.
Whose names should be listed as authors of this example and their emails so they can review the draft?