Department of Human Services Bureau of Maternal and infant Health FY18 Better Birth Outcomes Clinical Review Agency Name: Review Date: MCH Nurse Consultant: Agency Contact: Number of Active Charts Randomly Selected for Review: Assigned Caseload = Active Caseload = BBO Indicator # of Charts Reviewed Number Expected # Done % Compliance Performance Report Quarter Quarterly Data from Cornerstone Report % Performance Standard Started BBO 1st Trimester: PA15 75% Face-to-Face (1/month): SV02 80% Other Contact Percent: SV02 100% Home Visit each trimester: SV02 75% First Trimester Enrollment in Prenatal Care: PA07 75% PNC Visits: Adequacy of Prenatal Care: (Kotelchuch) SV01;802 90% Reproductive Live Plan/Last Trimester Reproductive Life Plan/Post Partum 95% PEWW/Well Women Education 95% Number of women receiving SNAP benefits who received documented discussion related to employment at the newborn visit. ( SV01:913) Job Training/Employment Counsel 90% Risk Assessment: AS01:707G 100% Assessments: AS01:700, 701, 703, 704, 705, 706, 707D 90% Primary Care Provider/ Medical home: PA03 100% Depression Screening: SV01:825 Prenatal 100% Postpartum 100% Individual Care Plan: CM02-03 90% Referred or enrolled in WIC: PA15, RF01 or 707D 100%
Referrals documented: RF01 100% F/U to documented: RF01 100% Demonstrates evidence of care coordination. 100% March of Dimes “Becoming a Mom” Curriculum delivered 100% Agency Name: Review Date: MCH Nurse Consultant: Agency Contact: Evaluation Element Citation Evaluation Mechanism Met Not Met N/A Findings The agency has an outreach policy and procedure in place that demonstrates outreach activities that will identify and recruit high-risk, hard-to-engage women during their 1st trimester of pregnancy. BBO Contract Exhibit C Review of local agency policy and procedure The agency has a written quality assurance process with internal policies and practices specific to quality improvement. BBO Contract Exhibit B Review of local agency QA process 3. Risk factor eligibility for BBO is determined by administration of 707G assessment prior to enrollment. BBO Contract Exhibit B Case manager observation; chart review 4. Agency is required to give written notification to BBO clients’ medical care provider: name of BBO agency; name and contact information of BBO case manager. BBO Contract Exhibit B Chart review; local agency policy and procedure
The agency is required to conduct a home visit each trimester of pregnancy during client’s enrollment period. BBO Contract Exhibits B and D Performance Report The agency is required to complete a minimum of one face-to-face visit and one other contact each month of client’s enrollment period. BBO Contract Exhibits B and D Performance Report Case managers utilize Motivational Interviewing techniques in interactions with BBO clients. Case manager observation The agency is required to arrange transportation services for health-related appointments as indicated by client need. BBO Contract Exhibit B Chart review; case manager observation All BBO case managers complete required assessments within 45 days of client enrollment in BBO (700, 701, 703, 704, 705, 707D]). Agency to complete a minimum of one 706 assessment during enrollment. BBO Contract Exhibit B Chart review; case manager observation
Case managers develop care plans with client goals and planned services that correlate to assessment results; goals reflect client’s highest priority needs. MCH Code Chart review; case manager observation Services provided or scheduled at agency reflect highest priority and are appropriate to needs identified by assessment(s). MCH Code Chart review; case manager observation 16. Referrals made reflect highest priority and are appropriate to needs identified by assessment(s); clients receive copies of referrals. MCH Code Chart review; case manager observation Disposition of all referrals is documented; i.e. completion or failure to follow through on referral. BBO Contract Exhibit B Chart review Case manager communication with clients’ prenatal care provider occurs monthly. BBO Exhibit B Chart review; local agency policy and procedure C. Delivery of Prenatal Education
23. The agency is required to provide or refer BBO clients for childbirth education. BBO Contract Exhibit B Chart review; case manager observation 24. The agency is required to provide or refer BBO clients for parenting classes. BBO Contract Exhibit B Chart review; case manager observation 25. The agency is required to assist BBO clients in the development of a Reproductive Life Plan BBO Contract Exhibit B Chart review; case manager observation Performance Report 26. The agency is required to educate BBO clients on the importance of prenatal care medical visits and track prenatal care visits. Adequacy of prenatal care visit. BBO Contract Exhibit B Quarterly Performance Report 27. The agency is required to discuss with women receiving SNAP benefits plans, intentions and barriers to employment at the newborn visit. (SV01, code 913) BBO Contract Exhibit E Chart review case manager observation 28. The agency documentation demonstrates evidence of care coordination. (CM04, RF01, SV01) BBO Contract Exhibit F Chart review