| QP
TOOL |
CATEGORY |
DESCRIPTION |
REFERRING
CASE STUDY |
|
Asthma - Patient Action Plan |
Chronic
Illness |
a worksheet for plan members to complete that will help improve treatment compliance. |
ASTHMA
DISEASE MANAGMEMENT - Pursuing Patient Involvement
|
|
Practice Guideline - Adult Asthma
|
Chronic
Illness |
An assessment chart to be used to guide the management of Acute Pediatric Asthma Episodes. |
ADULT
ASTHMA INPATIENT ADMISSIONS - Reducing Hospitalizations
With Better Outpatient Care |
|
Patient Education - Asthma |
Chronic
Illness |
An educational piece for patients offering instructions on using an inhaler. |
ADULT
ASTHMA INPATIENT ADMISSIONS - Reducing Hospitalizations
With Better Outpatient Care |
|
Provider Information Sheets - Asthma
|
Chronic
Illness |
This document has daily inhaler dosages and refill schedule. |
ADULT
ASTHMA INPATIENT ADMISSIONS - Reducing Hospitalizations
With Better Outpatient Care |
|
Member Survey - Diabetes |
Chronic
Illness |
a sample survey tool for nurses to use when contacting patients with diabetes. |
DIABETIC
RETINAL EXAMS - Upfront Barrier Analysis Leads
to Strong Interventions |
|
Patient Education - Diabetes |
Chronic
Illness |
A brochure about diabetes and eyesight. |
DIABETIC
RETINAL EXAMS - Upfront Barrier Analysis Leads
to Strong Interventions |
|
Member Mailings - Diabetes |
Chronic
Illness |
A sample letter to plan members about diabetes management. |
DIABETIC
RETINAL EXAMS - Upfront Barrier Analysis Leads
to Strong Interventions |
|
Provider Mailings - Diabetes |
Chronic
Illness |
Sample letters to providers about new diabetes care programs and their role therein. |
DIABETES
MANAGEMENT PROGRAM - Improving Multiple Aspects
of Diabetes Care |
|
Provider Mailings - Diabetes |
Chronic
Illness |
See above. |
DIABETES
MANAGEMENT PROGRAM - Improving Multiple Aspects
of Diabetes Care |
|
Provider Mailings, Foot Clinic Form
- Diabetes |
Chronic
Illness |
A sample letter and form to providers alerting them about a new foot clinic. |
DIABETES
MANAGEMENT PROGRAM - Improving Multiple Aspects
of Diabetes Care |
|
Provider Letter and Score Sheet - HIV/AIDS
|
Chronic
Illness |
This is a sample letter to doctors, along with sample score sheets for a study of HIV/AIDS care. |
HIV/AIDS
TREATMENT AND QUALITY OF CARE - Measuring
and Improving Compliance With Practice Guidelines
|
|
Member Newsletter - HIV/AIDS |
Chronic
Illness |
A newsletter profiling an HIV + patient and her therapy options. |
HIV/AIDS
TREATMENT AND QUALITY OF CARE - Measuring
and Improving Compliance With Practice Guidelines
|
|
Tracking Sheet - HIV/AIDS |
Chronic
Illness |
A checklist for an HIV/AIDS patient's treatment over several years. |
HIV/AIDS
TREATMENT AND QUALITY OF CARE - Measuring
and Improving Compliance With Practice Guidelines
|
|
Healthy Pregnancy Program - HIV/AIDS
|
Women's
Health |
This document contains an overview of a Healthy Pregnancy program. |
PREGNANCY
MANAGEMENT - Pursuing Better Care During Pregnancy
|
|
Sample Fliers - Flu Vaccination
|
Preventive
Care |
These are sample fliers for members about a flue vaccination program. |
INFLUENZA
VACCINATION FOR SENIORS - Access and Awareness:
Dedicated Flu Clinics and Member Outreach
|
|
Standing Orders - Flu Vaccination
|
Preventive
Care |
A list of dosages and procedures for flue vaccination. |
INFLUENZA
VACCINATION FOR SENIORS - Access and Awareness:
Dedicated Flu Clinics and Member Outreach
|
|
Log Sheet - Flu Vaccination |
Preventive
Care |
A log for recipients of flu vaccinations. |
INFLUENZA
VACCINATION FOR SENIORS - Access and Awareness:
Dedicated Flu Clinics and Member Outreach
|
|
Member Outreach/Education - Flu Vaccination
|
Preventive
Care |
This sample letter to plan members includes a fact sheet and press release about a flue vaccination program. |
INFLUENZA
VACCINATION FOR SENIORS - Access and Awareness:
Dedicated Flu Clinics and Member Outreach
|
|
Admission and Discharge Form - Follow-up
After Hospitalization for Major Affective
Disorder |
Behavioral
Health |
A patient admission/discharge form, a tracking form and therapy follow-up sheets, all related specifically to major affective disorder. |
MANAGEMENT
OF MAJOR AFFECTIVE DISORDER - Working With
Vendors to Improve Coordination of Behavioral
Health Services |
|
Discharge Planning - Follow-up After
Hospitalization for Major Affective Disorder
|
Behavioral
Health |
A discharge planning and coordination checklist for providers. |
FOLLOW-UP
AFTER HOSPITALIZATION FOR MAJOR AFFECTIVE
DISORDER - Establishing a Zero Defects Tracking
Process |
|
Provider Communication - Follow-up
After Hospitalization for Major Affective
Disorder |
Behavioral
Health |
Guidelines and forms for behavioral health providers about communicating with patients. |
FOLLOW-UP
AFTER HOSPITALIZATION FOR MAJOR AFFECTIVE
DISORDER - Establishing a Zero Defects Tracking
Process |
|
Survey - Childhood Asthma |
Chronic
Illness |
This document is a childhood asthma survey to be completed by plan members. |
IMPROVING
PEDIATRIC ASTHMA OUTCOMES - Systematically
Strengthening Interventions |
|
Health Assessment - Asthma |
Chronic
Illness |
A general asthma assessment survey for plan members. |
IMPROVING
PEDIATRIC ASTHMA OUTCOMES - Systematically
Strengthening Interventions |
|
Disease Profile - Asthma |
Chronic
Illness |
An asthma profile form to be used at the physician level. |
IMPROVING
PEDIATRIC ASTHMA OUTCOMES - Systematically
Strengthening Interventions |
|
Medical Group Disease Profile - Asthma
|
Chronic
Illness |
An asthma profile that might be used by group practices. |
IMPROVING
PEDIATRIC ASTHMA OUTCOMES - Systematically
Strengthening Interventions |
|
Minimum Practice Recommedation Flow Sheet
- Asthma |
Chronic
Illness |
A tracking sheet physicians to use with asthma patients. |
IMPROVING
PEDIATRIC ASTHMA OUTCOMES - Systematically
Strengthening Interventions |
|
Medical Record Abstracting Instruction
- Coronary Artery Disease |
Chronic
Illness |
An instruction sheet for abstracting medical records of patients with comprehensive coronary artery disease. |
CORONARY
ARTERY DISEASE - Supporting and Rewarding
Improved Performance |
|
Program Description - Coronary Artery
Disease |
Chronic
Illness |
A document containing the purpose, goals, principles, eligibility requirements, communications and components of the coronary artery disease program. |
CORONARY
ARTERY DISEASE - Supporting and Rewarding
Improved Performance |
|
Member Outreach/Education - Coronary
Artery Disease |
Chronic
Illness |
A heart disease fact sheet and check list for patients. |
CORONARY
ARTERY DISEASE - Supporting and Rewarding
Improved Performance |
|
Practice Recommendations Flow Sheet
- Diabetes Care Management |
Chronic
Illness |
A list of practice recommendations for diabetes management. |
DIABETES
CARE MANAGEMENT - Broad Improvement Across
a Set of Comprehensive Measures |
|
Member Outreach/Education - Diabetes
Care Management |
Chronic
Illness |
A diabetes care fact sheet and services tracking sheet for health plan members. |
DIABETES
CARE MANAGEMENT - Broad Improvement Across
a Set of Comprehensive Measures |
|
Medical Group Disease Profile - Diabetes
Care Management |
Chronic
Illness |
A diabetes patient profile sheet at the group provider level. |
DIABETES
CARE MANAGEMENT - Broad Improvement Across
a Set of Comprehensive Measures |
|
Medical Director's Disease Profile
- Diabetes Care Management |
Chronic
Illness |
A diabetes provider profile sheet for medical directors. |
DIABETES
CARE MANAGEMENT - Broad Improvement Across
a Set of Comprehensive Measures |
|
Provider Mailings - Diabetes Care Management
|
Chronic
Illness |
These are sample mailings to providers and patients about a diabetes management program. |
DIABETES
CARE MANAGEMENT - Aggressive Interventions
Leading to Incremental Improvement |
|
Member Education - Diabetes Care Management
|
Chronic
Illness |
A checklist of educational goals for a diabetes health education program. |
DIABETES
CARE MANAGEMENT - Putting All the Pieces Together
for Diabetes |
|
Member Education - Diabetes Care Management
|
Chronic
Illness |
A diabetes education form to be completed by the provider or educator. |
DIABETES
CARE MANAGEMENT - Putting All the Pieces Together
for Diabetes |
|
Policy and Procedure - Diabetes Care
Management |
Chronic
Illness |
A listing of the policy and procedures for treating diabetes. |
DIABETES
CARE MANAGEMENT - Putting All the Pieces Together
for Diabetes |
|
Diabetes Care Management Record - Diabetes
Care Management |
Chronic
Illness |
This is a diabetes treatment form to be completed by the provider. |
DIABETES
CARE MANAGEMENT - Putting All the Pieces Together
for Diabetes |
|
Patient Registry - Diabetes Care Management
|
Chronic
Illness |
This is a sample registry of diabetes patients. |
DIABETES
CARE MANAGEMENT - Putting All the Pieces Together
for Diabetes |
|
Chart Overiew - Sinusitis |
Chronic
Illness |
This document contains a symptoms, testing and treatment checklist for sinusitis patients. |
TREATMENT
OF ACUTE SINUSITIS - Optimizing Antibiotic
Therapy |
|
Fishbone Diagram - Sinusitis |
Chronic
Illness |
This fishbone diagram for sinusitis outlines treatment, education, environmental, and other issues. |
TREATMENT
OF ACUTE SINUSITIS - Optimizing Antibiotic
Therapy |
|
Practice Guidelines - Sinusitis
|
Chronic
Illness |
A fact sheet listing the various practice guidelines for sinusitis. |
TREATMENT
OF ACUTE SINUSITIS - Optimizing Antibiotic
Therapy |
|
Provider Mailings/Practice Guidelines
- Sinusitis |
Chronic
Illness |
A sample letter to accompany the sinusitis guidelines sent to providers. |
TREATMENT
OF ACUTE SINUSITIS - Optimizing Antibiotic
Therapy |
|
Provider Mailings/Provider Profile
- Sinusitis |
Chronic
Illness |
A sample letter to providers discusses antibiotic therapy. |
TREATMENT
OF ACUTE SINUSITIS - Optimizing Antibiotic
Therapy |
|
Member Mailings - Sinusitis |
Chronic
Illness |
A sample letter that provides general information about sinusitis to plan members. |
TREATMENT
OF ACUTE SINUSITIS - Optimizing Antibiotic
Therapy |
|
Member Mailings - Sinusitis |
Chronic
Illness |
The document is a fact sheet for plan members about sinusitis prevention and treatment. |
TREATMENT
OF ACUTE SINUSITIS - Optimizing Antibiotic
Therapy |
|
Fishbone Diagram - Cervical Cancer
Screening |
Women's
Health |
This fishbone diagram for cervical cancer screening outlines preference, education, network, and referral issues. |
CERVICAL
CANCER SCREENING - Improving High-Volume Screening
in an Expanding Population |
|
Member Survey - Cervical Cancer Screening
|
Women's
Health |
This file contains basic cervical cancer survey to be completed by plan members. |
CERVICAL
CANCER SCREENING - Improving High-Volume Screening
in an Expanding Population |
|
Member Mailings - Cervical Cancer Screening
|
Women's
Health |
A sample letter to plan members announces a rewards program to encourage cervical and breast cancer screening. |
CERVICAL
CANCER SCREENING - Improving High-Volume Screening
in an Expanding Population |
|
Member Outreach - Cervical Cancer Screening
|
Women's
Health |
A postcard to be used in a cancer screening rewards program. |
CERVICAL
CANCER SCREENING - Improving High-Volume Screening
in an Expanding Population |
|
Member Education - Cervical Cancer
Screening |
Women's
Health |
A cervical cancer fact sheet for plan members. |
CERVICAL
CANCER SCREENING - Improving High-Volume Screening
in an Expanding Population |
|
Telephone Script - Breast Cancer Screening
|
Women's
Health |
This phone script can be used when calling to remind plan members to schedule mammograms. It has answer to questions and responses a caller might get. |
BREAST
CANCER SCREENING - Improving Access and Awareness
|
|
Member Mailing - Breast Cancer Screening
|
Women's
Health |
This mailing would be used as a follow up to a mammogram call drive and includes screening locations, contact information and office hours. |
BREAST
CANCER SCREENING - Improving Access and Awareness
|
|
Member Survey - Breast Cancer Screening
|
Women's
Health |
This sample letter provides encourages plan members to schedule a mammogram and includes facts and a question/answer sheet. |
BREAST
CANCER SCREENING - Improving Access and Awareness
|
|
Provider Education - Breast Cancer
Screening |
Women's
Health |
This is a sample letter to providers with patient names dates of their last mammograms is part of a screening promotion program. |
BREAST
CANCER SCREENING - Improving Access and Awareness
|
|
Member Education - Breast Cancer Screening
|
Women's
Health |
A sample letter to plan members encouraging routine breast cancer screening + a fact sheet. |
BREAST
CANCER SCREENING - Improving Access and Awareness
|
|
Provider Survey - Breast Cancer Screening
|
Preventive
Care |
This document is a short survey to providers about childhood immunizations. |
CHILDHOOD
IMMUNIZATIONS - Tailoring Interventions with
Analysis and Feedback |
|
Member Outreach - Childhood Immunization
|
Preventive
Care |
A bilingual postcard to plan members about needed childhood immunizations. |
CHILDHOOD
IMMUNIZATIONS - Identifying and Addressing
Specific Barriers |
|
Physician Survey - Childhood Immunization
|
Preventive
Care |
a physician survey about childhood immunization practices. |
CHILDHOOD
IMMUNIZATIONS - Identifying and Addressing
Specific Barriers |
|
Member Survey - Flu Shots for Older
Adults |
Preventive
Care |
A reminder card for plan members about flu shots. |
FLU
SHOTS FOR OLDER ADULTS - Collaborating to
Reduce Missed Opportunities |
|
Immunization Record - Flu Shots for
Older Adults |
Preventive
Care |
This document is a vaccine record for adults. |
FLU
SHOTS FOR OLDER ADULTS - Collaborating to
Reduce Missed Opportunities |
|
Program Overview - Flu Shots for Older
Adults |
Preventive
Care |
This document is directed at plan members and details preventative care programs in general. |
FLU
SHOTS FOR OLDER ADULTS - Measuring the Effect
of Specific Interventions |
|
Member Mailing - Flu Shots for Older
Adults |
Preventive
Care |
This file has a scanned image and the text from a flu shot mailer to plan members. |
FLU
SHOTS FOR OLDER ADULTS - Measuring the Effect
of Specific Interventions |
|
Member Mailing - Flu Shots for Older
Adults |
Preventive
Care |
This file has a scanned image and the text from a flu shot mailer to plan members. |
FLU
SHOTS FOR OLDER ADULTS - Measuring the Effect
of Specific Interventions |
|
Provider Mailing - Flu Shots for Older
Adults |
Preventive
Care |
This sample letter to providers encourage flu shots for older patients. Also included would be a list of patients assigned to the provider. |
FLU
SHOTS FOR OLDER ADULTS - Measuring the Effect
of Specific Interventions |
|
Member Mailing - Flu Shots for Older
Adults |
Preventive
Care |
a sample letter to plan members over 65 encouraging them to get flu shots. |
FLU
SHOTS FOR OLDER ADULTS - Measuring the Effect
of Specific Interventions |
|
Member Mailing - Flu Shots for Older
Adults |
Preventive
Care |
A sample newsletter with facts about the flu and flu shots for adults. |
FLU
SHOTS FOR OLDER ADULTS - Measuring the Effect
of Specific Interventions |
|
Medical Record Abstracting Instructions
- Preventive Services and Counseling |
Preventive
Care |
This file uses tobacco assessment and tobacco advice in an example of record abstracting. |
PREVENTIVE
SERVICES AND COUNSELING - Keeping Members
Well with Information and Incentives |
|
Program Overview - Preventive Services
and Counseling |
Preventive
Care |
This document outlines the various elements of a preventive care financial rewards program. |
PREVENTIVE
SERVICES AND COUNSELING - Keeping Members
Well with Information and Incentives |
|
Case Management Plan - Reducing Inpatient
Mental Health Admissions |
Behavioral
Health |
This document contains a case management tracking form to be completed by the provider. |
REDUCING
INPATIENT MENTAL HEALTH READMISSIONS - Reengineering
Case Management |
|
Patient Log - Reducing Inpatient Mental
Health Admissions |
Behavioral
Health |
This patient log contains a chart and a scoring key to determine admission, discharge and exclusion criteria. |
REDUCING
INPATIENT MENTAL HEALTH READMISSIONS - Reengineering
Case Management |
|
Member Mailing - Reducing Inpatient
Mental Health Admissions |
Behavioral
Health |
This is a sample letter to plan members from their behavioral health case manager. |
REDUCING
INPATIENT MENTAL HEALTH READMISSIONS - Reengineering
Case Management |
|
Program Overview - Reducing Inpatient
Mental Health Admissions |
Behavioral
Health |
This file provides an overview of a behavior health case management program. |
REDUCING
INPATIENT MENTAL HEALTH READMISSIONS - Reengineering
Case Management |
|
Authorization to Release Member Information
- Reducing Inpatient Mental Health Admissions
|
Behavioral
Health |
A sample form to be completed by the plan member authorizing the release of health records. |
REDUCING
INPATIENT MENTAL HEALTH READMISSIONS - Reengineering
Case Management |
|
Complaint Report - Member Complaints
|
Service |
An example of a complaint database. |
REDUCTION
OF COMPLAINTS ABOUT MEMBER INFORMATION - Empowering
Staff with Tools and Training |
|
Fishbone Diagram - Member Complaints
|
Service |
This fishbone diagram for member complaints outlines people, equipment, material and methods. |
REDUCTION
OF COMPLAINTS ABOUT MEMBER INFORMATION - Empowering
Staff with Tools and Training |
|
Telephone Script - Member Complaints
|
Service |
A call script used to welcome members to a Medicare program. |
REDUCTION
OF COMPLAINTS ABOUT MEMBER INFORMATION - Empowering
Staff with Tools and Training |
|
Member Mailing - Member Complaints
|
Service |
This document for plan members contains a diagram explaining the Medicare program ID card. |
REDUCTION
OF COMPLAINTS ABOUT MEMBER INFORMATION - Empowering
Staff with Tools and Training |
|
Member Mailing - Member Complaints
|
Service |
This is a sample letter to plan members explaining changes to an existing health plan including drug coverage and co-pay increases. |
REDUCTION
OF COMPLAINTS ABOUT MEMBER INFORMATION - Empowering
Staff with Tools and Training |
|
Training Description and Schedule -
Member Satisfaction |
Service |
This is a sample newsletter to plan employees and providers about training programs. |
MEMBER
SATISFACTION - Reducing Complaints Through
Improved Communication |
|
Complaint Tracking - Member Satisfaction
|
Service |
This document contains a sample line chart used to a track the number of complaints over a given time period. |
MEMBER
SATISFACTION - Reducing Complaints Through
Improved Communication |
|
Physician Selection Form - Selecting
a PCP |
Service |
This is a primary care physician selection form to be completed by plan members. |
SELECTING
A PRIMARY CARE PROVIDER - Making Choosing
a Physician Easier |
