This product was developed by the Better Self Management of Diabetes program Evaluation Team with grant support from the Missouri Foundation for

Transcription

1 This product was developed by the Better Self Management of Diabetes program Evaluation Team with grant support from the Missouri Foundation for Health.

2 Tracking Workbook Revisions M A R Y O T OOLE, P HD B S M O D E V A L U A T I O N T E A M

3 Sample Contact Information and Notes Missouri Foundation for Health's Better Self-Management of Diabetes (BSMOD) 6-Month Summary Tracking Workbook - Round 1 Contact Information Please complete the following contact information. Please be sure to include the name of your site and the contact information of the person completing the summary tracking form (in case we need to contact that person if we have any questions). If your site has more than one clinic and you have decided to track data for each clinic, separately, please assign a unique clinic identifier to each of your clinics and use that same clinic identifier for each clinic every time you submit your 6-month summary data. If you have decided to track individual clinics, please use a separate Tracking Workbook for each clinic. To do this, simply copy this Workbook and rename the new Workbook (file) by tagging on the clinic identifier at the end of the file name (e.g., "BSMOD Tracking Workbook for Self-Management Support - Clinic A"). Site Name Clinic Identifier (if applicable) Contact Person Name:Mary O'Toole XYZ Site, St. Louis, MO Local Clinic A motoole@dom.wustl.edu Phone: Please use the space below for any notes or comments you may have for the evaluation team about this data collection period. Sample: NOTES Jan 28-June 28: No comments to report. Jul 28-Dec 28: There has been a change in the person who fills out this workbook. Mary O'Toole is the new contact person.

4 I. Clinical Outcome Measures -- Summary Table INSTRUCTIONS: For the number of clinical measures you collected during this 6-month period, please enter in the yellow-shaded area in the first column the number meeting the target clinical outcome. In the second column, enter the total number of patient contacts from which this information was collected. Also, enter the mean for that outcome in the column provided. The percentage of patient contacts meeting the target clinical outcome measure will be calculated for you and appear in the green shaded area. A BMI calculator is provided at the end of this workbook for your convenience. (For those clinics using the quarterly tracking worksheets, you will simply need to transfer the numbers from the 6-month Summary Data Tables to this workbook). 1. Percentage of patient contacts with A1C <7 Number of patient contacts with A1c<7 From how many patient contacts did you collect this information? Mean a1c Percentage of patient contacts with current A1c<7 #DIV/! 2. Percentage of patient contacts with LDL<1 mg/dl ` Number of patient contacts with LDL<1 mg/dl From how many patient contacts did you collect this information? Mean LDL Percentage of patient contacts with LDL<1 mg/dl #DIV/! 3. Percentage of patient contacts with BP <13/8 mmhg Number of patient contacts with BP <13/8 mmhg From how many patient contacts did you collect this information? Percentage of patient contacts with BP <13/8 mmhg #DIV/! 4. Average BMI of patient contacts From how many patient contacts did you collect BMI? Average BMI Number of patient contacts with BMI > 25. Percentage of patient contacts with BMI > 25. #DIV/!

5 II. Clinical Procedure Outcome Measures -- Summary Table INSTRUCTIONS: For the number of clinical procedure measures you collected during this 6-month period, please enter in the yellowshaded area in the first column the number meeting the target clinical procedure outcome. In the second column, enter the total number of patient contacts from which this information was collected. The percentage of patient contacts meeting the target clinical procedure outcome measure will be calculated for you and appear in the green shaded area. (For those clinics using the quarterly tracking worksheets, you will simply need to transfer the numbers from the 6-month Summary Data Tables to this workbook). 1. Percentage of patient contacts with 2 A1c's within the last 12 mos AND at least 91 days apart Number of patient contacts with 2 Percentage of patient contacts with 2 From how many patient contacts did A1c's within the last 12 mos of date of A1c's within the last 12 mos of date of you collect this information? visit AND at least 91 days apart visit AND at least 91 days apart #DIV/! 2. Percentage of patient contacts with foot exam within the last 12 months Number of patient contacts with foot exam within the last 12 months of date of visit From how many patient contacts did you collect this information? Percentage of patient contacts with foot exam within the last 12 months of date of visit #DIV/! 3. Percentage of patient contacts with dilated eye exam within the last 12 months Number of patient contacts with dilated eye exam within the last 12 months of date of visit From how many patient contacts did you collect this information? Percentage of patient contacts with dilated eye exam within the last 12 months of date of visit #DIV/!

6 III. Documented Self-Management Support Goals -- Summary Table INSTRUCTIONS: For the patient contacts you had in your clinic during this 6-month period, enter in the yellow-shaded area in the first column the number of patient contacts with documented self-management goals that were set with a clinician. In the second column, enter the total number of patient contacts from which this information was collected. The percentage of patient contacts with documented selfmanagement goals will be calculated for you and appear in the green shaded area. Then, in the second table, enter the number of patient contacts with documented self-management goals and the number of patient contacts with a follow-up rating of "4" ("met or exceeded goal") in at least one of the goals. The percentage of patient contacts with documented self-management goals and a rating of "4" in at least one goal will be calculated for you. (For those clinics using the quarterly tracking worksheets, you will simply need to transfer the numbers from the 6-month Summary Data Tables to this workbook). 1. Percentage of patient contacts with documented self-management support goals Number of patient contacts with documented SMS goals From how many patient contacts did you collect this information? Percentage of patient contacts with documented SMS goals #DIV/! 2. Percentage of patient contacts with documented self-management support goals AND a follow-up rating of "4" in at least one goal Number of patient contacts with documented SMS goals Number of patient contacts with a follow-up rating of "4" ("met or exceeded goal") in at least one goal Percentage of patient contacts with documented SMS goals AND a follow-up rating of "4" in at least one goal #DIV/!

7 IV. Behavior Questions (Tell Us How You've Been Doing)-- Summary Table INSTRUCTIONS: For the number of Behavior Question forms filled out in your clinic during this 6-month period, enter in the yellow-shaded area the number of patient contacts falling into the specified categories for the behavior questions. The percentage of patient contacts falling into those categories will be calculated for you and appear in the green shaded boxes. (For those clinics using the quarterly tracking worksheets, you will simply need to transfer the numbers from the 6-month Summary Data Tables to this workbook). Q1. On how many of the last SEVEN DAYS have you followed your eating plan? Total number of Behavior Question forms filled out Number reporting following an eating plan for days Number reporting following an eating plan for 1 day Number reporting following an eating plan for 2 days Percentage reporting following an eating plan for days Percentage reporting following an eating plan for 1 day Percentage reporting following an eating plan for 2 days #DIV/! #DIV/! #DIV/!

8 Q2. On how many of the last SEVEN DAYS did you eat five or more servings of fruits and vegetables? Total number of Behavior Question forms filled out Number reporting eating five or more servings of fruits and vegetables for days during the last 7 days Number reporting eating five or more servings of fruits and vegetables for 1 day during the last 7 days Number reporting eating five or more servings of fruits and vegetables for 2 days during the last 7 days Percentage reporting eating five or more servings of fruits and vegetables for days Percentage reporting eating five or more servings of fruits and vegetables for 1 day Percentage reporting eating five or more servings of fruits and vegetables for 2 days #DIV/! #DIV/! #DIV/!

9 Q3. On how many of the last SEVEN DAYS did you do any physical activity of moderate intensity (for example: brisk walking, swimming, biking, gardening, or any other activity that causes increases in breathing and heart rate)? Total number of Behavior Question forms filled out Number reporting physical activity for days during the last 7 days Number reporting physical activity for 1 day during the last 7 days Number reporting physical activity for 2 days during the last 7 days Percentage reporting physical activity for days during the last 7 days Percentage reporting physical activity for 1 day during the last 7 days Percentage reporting physical activity for 2 days during the last 7 days #DIV/! #DIV/! #DIV/! Q4. During the last SEVEN DAYS, how many TOTAL minutes did you spend doing moderate intensity physical activity? Number of patient contacts reporting at least one day of physical activity per week Total number of minutes of physical activity across all patient contacts per week Average total number of minutes of physical activity per week for those patient contacts reporting physical activity #DIV/!

10 Q5. On how many of the last SEVEN DAYS did you test your blood sugar the number of times recommended by your health care provider? Total number of Behavior Question forms filled out Number reporting following the provider's recommendation for testing blood sugar for days Number reporting following the provider's recommendation for testing blood sugar for 1 day Number reporting following the provider's recommendation for testing blood sugar for 2 days Percentage reporting following the provider's recommendation for testing blood sugar for days Percentage reporting following the provider's recommendation for testing blood sugar for 1 day Percentage reporting following the provider's recommendation for testing blood sugar for 2 days #DIV/! #DIV/! #DIV/!

11 Q6. On how many of the last SEVEN DAYS, did you take your recommended diabetes medication (or insulin injections?) Total number of Behavior Question forms on which taking medication or insulin was reported Number reporting taking recommended diabetes medication for days during the last 7 days Number reporting taking recommended diabetes medication for 1 day during the last 7 days Number reporting taking recommended diabetes medication for 2 days during the last 7 days Percentage reporting taking recommended diabetes medication for days during the last 7 days Percentage reporting taking recommended diabetes medication for 1 day during the last 7 days Percentage reporting taking recommended diabetes medication for 2 days during the last 7 days #DIV/! #DIV/! #DIV/!

12 V. Provider Satisfaction with Patient Self-Management Support Survey Summary Table (Administered to the self-management support project core team at the end of each 6-month reporting period) INSTRUCTIONS: In the yellow-shaded cells to the right of the survey items, enter the total number of providers that answered in each response category for the survey items listed. The percentages of providers that fall into each response category will be calculated for you and appear in the green shaded area. If a cell has zero provider responses, please enter "" in that cell. Survey Item TOTAL number of providers answering survey item Number and % of providers answering "Not at All Satisfied" Number and % of providers answering "Somewhat Satisfied" Number and % of providers answering "Very Satisfied" Number and % of providers answering "Extremely Satisfied" EXAMPLE: How satisfied are you with your clinic s technology? % 25.% 37.5% 25.% 12.5% 1. How satisfied are you with how well you and your staff are helping your patients manage their chronic illness? #DIV/! #DIV/! #DIV/! #DIV/! #DIV/! 2. How satisfied do you think your patients are with how you are helping them manage their chronic illness? #DIV/! #DIV/! #DIV/! #DIV/! #DIV/! 3. How satisfied are you with how well you and your staff are involving patients in their own care? #DIV/! #DIV/! #DIV/! #DIV/! #DIV/! 4. How satisfied are you that your patients self-management goals and plans are assessed in a standardized manner? #DIV/! #DIV/! #DIV/! #DIV/! #DIV/! 5. How satisfied are you that the selfmanagement tools and protocols your clinic is using are making a difference in your patients clinical outcomes? #DIV/! #DIV/! #DIV/! #DIV/! #DIV/!