Date Action Initiated: of initiation (QI 08, QI 09 or QI 11) (Only 1 action required) Additional Actions: Start Date: End Date: 5. Remeasure performance (QI 12) Performance Remeasurement (% or #): 6. Assess actions; describe improvement. (QI 12) Use ONE Measure Identified for Disparity in Care or Service Vulnerable 1. Measure selected for Describe a comparison of a vulnerable population against the general population: improvement; reason for population in which the vulnerable population received care/service at a selection lower performance: Disparity: 2./3. Baseline performance Baseline Date: Baseline End Date: measurement, numeric goal Baseline Performance Measurement for Vulnerable Population (% or #): for improvement. (QI 05) Baseline Performance Measurement for General Population (% or #): Numeric Goal (% or #): 4. Actions taken to improve Action: and work toward goal; dates Date Action Initiated: of initiation (QI 13) (Only 1 action required) Additional Actions: 5. Remeasure performance. Start Date: End Date: (QI 14) Performance Re-Measurement (% or #): 6. Assess actions and describe improvement. (QI 14)
of initiation (QI 08, QI 09 or QI 11) (Only 1 action required) Date Action Initiated: Additional Actions: 5. Remeasure performance (QI 12) Start Date: End Date: Performance Remeasurement (% or #): 6. Assess actions; describe improvement. (QI 12) Use ONE Measure Identified for Disparity in Care or Service Vulnerable population: Disparity: 1. Measure selected for improvement; reason for selection Describe a comparison of a vulnerable population against the general population in which the vulnerable population received care/service at a lower performance: 2./3. Baseline performance measurement, numeric goal for improvement. (QI 05) Baseline Date: Baseline End Date: Baseline Performance Measurement for Vulnerable Population (% or #): Baseline Performance Measurement for General Population (% or #): Numeric Goal (% or #): 4. Actions taken to improve and work toward goal; dates of initiation (QI 13) (Only 1 action required) Action: Date Action Initiated: Additional Actions: 5. Remeasure performance. (QI 14) Start Date: End Date: Performance Re-Measurement (% or #): 6. Assess actions and describe improvement. (QI 14)
10.%20NCQA%20PCMH_Quality%20Measurement%20and%20Improvement%20Worksheet.docx