2./3. Baseline performance measurement; numeric goal for improvement (From QI 01, QI 02 or QI 04) Baseline Start Date: Baseline End Date: Baseline Performance Measurement (% or #): Numeric Goal (% or #): 4. Actions to improve and work toward goal; dates of initiation (QI 08, QI 09, or QI 11) (Only 1 action required) Action: Date Action Initiated: Additional Actions: 5. Remeasure performance (QI 12) Start Date: End Date: Performance Re-Measurement (% or #): 6. Assess actions; describe improvement. (QI 12) Measure 2: 1. Measure selected for improvement; reason for selection Reason: 2./3. Baseline performance measurement; numeric goal for improvement (From QI 01, QI 02 or QI 04) Baseline Start Date: Baseline End Date: Baseline Performance Measurement (% or #): Numeric Goal (% or #): 4. Actions taken to improve and work toward goal; dates of initiation (QI 08, QI 09 or QI 11) (Only 1 action required) Action: Date Action Initiated: Additional Actions: 5. Remeasure performance (QI 12) Date: End Date:
Performance Remeasurement (% or #): 6. Assess actions; describe improvement. (QI 12) Measure 3: 1. Measure selected for improvement; reason for selection Reason: 2./3. Baseline performance measurement; numeric goal for improvement (From QI 01, QI 02 or QI 04) Baseline Start Date: Baseline End Date: Baseline Performance Measurement (% or #): Numeric Goal (% or #): 4. Actions taken to improve and work toward goal; dates of initiation (QI 08, QI 09 or QI 11) (Only 1 action required) Action: Date Action Initiated: Additional Actions: 5. Remeasure performance (QI 12) Date: End Date: Performance Remeasurement (% or #): 6. Assess actions; describe improvement. (QI 12)
Measure 4: 1. Measure selected for improvement; reason for selection Reason: 2./3. Baseline performance measurement; numeric goal for improvement (From QI 01, QI 02 or QI 04) Baseline Start Date: Baseline End Date: Baseline Performance Measurement (% or #): Numeric Goal (% or #): 4. Actions taken to improve and work toward goal; dates of initiation (QI 08, QI 09 or QI 11) (Only 1 action required) Action: Date Action Initiated: Additional Actions: 5. Remeasure performance (QI 12) Start Date: End Date: Performance Remeasurement (% or #): 6. Assess actions; describe improvement. (QI 12) Measure 5: 1. Measure selected for improvement; reason for selection Reason: 2./3. Baseline performance measurement; numeric goal for improvement (From QI 01, QI 02 or QI 04) Baseline Start Date: Baseline End Date: Baseline Performance Measurement (% or #): Numeric Goal (% or #): 4. Actions taken to improve and work toward goal; dates Action:
Use TWO Behavioral Health Measures Identified in BH 17 BH Measure 1: 1. Measure selected for improvement; reason for selection Reason: 2./3. Baseline performance measurement; numeric goal for improvement (From BH 17) Baseline Start Date: Baseline End Date: Baseline Performance Measurement (% or #): Numeric Goal (% or #): 4. Actions to improve and work toward goal; dates of initiation (BH 18) (Only 1 action required) Action: Date Action Initiated: Additional Actions: 5. Remeasure performance Note: Continuing QI is encouraged, but is not required for BH 18. Date: End Date: Performance Remeasurement (% or #): 6. Assess actions; describe improvement. Note: Continuing QI is encouraged, but is not required for BH 18.