Domain 4: Community Outreach: For CSHCN and Their Families THEME: Level 1 Level 2 Level 3 Level 4 #4.1 Community PCP awareness of the population The practice learns about issues In addition to Level 2, providers raise In addition to Level 3, at least one of children with special health and needs related to CSHCNs from their own questions regarding the clinical practice provider participates in a Assessment of care needs CSHCN in their key community informants; population of CSHCN in their practice community-based public health need for CSHCN community is directly related to providers blend this input with community; they seek pertinent data assessment about CSHCN, integrates the number of children for whom their own personal observations to and information from families and results into practice policies, and shares the provider cares. make an informal and personal local/state sources and use data to conclusions about population needs assessment of the needs of CSHCN inform practice care activities. with community & state agencies. in their community. PARTIAL COMPLETE PARTIAL COMPLETE PARTIAL COMPLETE PARTIAL COMPLETE Domain 5: Data Management: For CSHCN and Their Families Level 1 Level 2 Level 3 Level 4 #5.1 PCPs retrieve information/data Electronic recording of data is An electronic data system includes In addition to 3, an electronic data by individual chart review; limited to billing & scheduling; identifiers and utilization data about system is used to support the Electronic Data electronic data are available and data are retrieved according to children with special health care needs documentation of need, monitoring of Support retrievable from payer sources diagnostic code in relation to CSHCN; these data are used for clinical care, care plan and related only. billing and scheduling; these data monitoring, tracking, and for coordination and the determination of are used to identify specific indicating levels of care complexity. outcomes (e.g. clinical, functional, patient groupings. satisfaction and cost outcomes). PARTIAL COMPLETE PARTIAL COMPLETE PARTIAL COMPLETE PARTIAL COMPLETE Instructions: A) Please select and circle one level from Levels 1, 2, 3, or 4 for each theme above (circle one). B) Then indicate whether you your practice at a PARTIAL or COMPLETE ranking within that level (circle one). Note: Any italicized words are defined in the glossary on page 11.
Domain 4: Community Outreach: For CSHCN and Their Families THEME: Level 1 Level 2 Level 3 Level 4 #4.1 Community Assessment of for CSHCN PCP awareness of the population of children with special health care needs CSHCN in their community is directly related to the number of children for whom the provider cares. The practice learns about issues and needs related to CSHCNs from key community informants; providers blend this input with their own personal observations to make an informal and personal assessment of the needs of CSHCN in their community. In addition to Level 2, providers raise their own questions regarding the population of CSHCN in their practice community; they seek pertinent data and information from families and local/state sources and use data to inform practice care activities. In addition to Level 3, at least one clinical practice provider participates in a community-based public health need assessment about CSHCN, integrates results into practice policies, and shares conclusions about population needs with community & state agencies. PARTIAL COMPLETE PARTIAL COMPLETE PARTIAL COMPLETE PARTIAL COMPLETE Domain 5: Data Management: For CSHCN and Their Families Level 1 Level 2 Level 3 Level 4 #5.1 Electronic Data Support PCPs retrieve information/data by individual chart review; electronic data are available and retrievable from payer sources only. Electronic recording of data is limited to billing & scheduling; data are retrieved according to diagnostic code in relation to billing and scheduling; these data are used to identify specific patient groupings. An electronic data system includes identifiers and utilization data about children with special health care needs CSHCN; these data are used for monitoring, tracking, and for indicating levels of care complexity. In addition to 3, an electronic data system is used to support the documentation of need, monitoring of clinical care, care plan and related coordination and the determination of outcomes (e.g. clinical, functional, satisfaction and cost outcomes). PARTIAL COMPLETE PARTIAL COMPLETE PARTIAL COMPLETE PARTIAL COMPLETE Instructions: A) Please select and circle one level from Levels 1, 2, 3, or 4 for each theme above (circle one). B) Then indicate whether you your practice at a PARTIAL or COMPLETE ranking within that level (circle one). Note: Any italicized words are defined in the glossary on page 11.
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