Mohealthnet- Quarterlyhealthhomereport

TheattachedisaQuarterlySurveythatiscompletedbyMOHealthNet’sHealthHomes.

Revised January 2016

MoHealthNet- QuarterlyHealthHomeReport
INSTRUCTIONS­PLEASEREADCAREFULLYBEFOREPROCEEDING.
ThissurveyisdesignedtotrackchangestoyourHealthHomepracticeovertime.OnesurveyshouldbecompletedforEACHSITEthatisparticipatinginyourHealthHomeorganization.
Forconsistencyandreliability,pleasehavethesamepersoncompletethesurveyeachquarter.Pleaseanswerquestionsasaccuratelyasyoucan.Ifyoucannotansweraquestionforsomereason,pleaseprovideanexplanationintheCommentboxforthatquestion.
1.PleaseprovidethefollowinginformationaboutyourHealthHomeandthepersoncompletingthissurvey.
Nameofpersoncompletingsurvey:
HealthHomeName:SiteName:City/Town:
Emailofpersoncompletingsurvey:
Phoneofpersoncompletingsurvey:
2.Surveycoversquarterendingonwhichdate?
MMDDYYYY
QuarterEnds://
3.DoesyourHHhaveestablishedcriteriatoidentifyhigh­riskorcomplexpatients?
mlkjYes
mlkjNo
Comments(optional):
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MoHealthNet- QuarterlyHealthHomeReport
4.DoesyourHHassesspatients'preliminaryserviceneeds(e.g.,nutrition,durablemedicalequipment,transportation,etc.)?
mlkjYes
mlkjNo
Comments(optional):
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5.DoesyourHHprovideroutinementalhealthscreeningsforadultsandadolescentsusingastandardizedtool?
mlkjNo
mlkjYes,informally
mlkjYes,withastandardtool,butnotforallpatients
mlkjYes,withastandardtool,forallpatients
Comments(optional):
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6.ForwhichofthefollowinghealthconditionsisyourHHfollowingevidence­basedtreatmentguidelines?
Asthma/COPD
Cardiovascular Conditions/CHFDevelopmentalDisabilitiesDiabetes
Hypertension
Comments(optional):
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MoHealthNet- QuarterlyHealthHomeReport

7.ForwhatpercentageofpatientsdoesyourHHpatientrecordincludeinformationaboutreligionandculturalbackgroundasitrelatestohealthhomeactivities?(e.g.,foodrestrictionsforreligiousreasons,etc.)

mlkj

0­20%

mlkj

21­40%

mlkj

41­60%

mlkj

61­80%

mlkj

81­100%

Comments(optional):

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8.HowdoesyourHHofferlanguage/translationservicesforyourHHpatients?(Checkallthatapply)

PatientlanguagepreferenceisdocumentedinEHRtohelpplanfortranslationservicesduringappointmentsBilingualstaffareavailable(specifyhowmanystaffandwhatlanguagesspoken)

Language/Interpretationservice(specify)

Relyonassistancefrommember'sEnglish­speakingrelatives

Additionalinfo/Comments

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9.Whatpercentageofthetimedonon­Englishspeakingpatientshaveappointmentscanceledorseverelycompromisedbytheabsenceofadequatelanguagetranslationservices?

mlkj

0­20%

mlkj

21­40%

mlkj

41­60%

mlkj

61­80%

mlkj

81­100%

Comments(optional):

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MoHealthNet- QuarterlyHealthHomeReport
10.InhowmanydifferentlanguagesbesidesEnglishdoesyourHHofferprintedhealthmaterialsforHHpatients?
# ofLanguagesbesidesEnglish:
11.Pleaselistthelanguagesreferredtoabove.
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12.DoesyourHHreferpatientstosocialandcommunityresourcesforassistanceinsuchareasaslegalservices,housing,anddisabilitybenefits?
mlkjYes
mlkjNo
Comments(optional):
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13.IfYes,to#3above,doesyouragencydocumenttheadequacyofsuchreferrals?
mlkjYes
mlkjNo
Comments(optional):
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14.WhatpercentageofyourHHpatients/familiesreceiveeducationalresourcesorreferralsforeducationalresourcestoassistinself­managment?
mlkj0­20%
mlkj21­40%
mlkj41­60%
mlkj61­80%
mlkj81­100%
Comments(optional):
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MoHealthNet- QuarterlyHealthHomeReport
15.DoesyourHHprovideopportunitiesforhealtheducationprogramsspecifictoapatient'schronicconditions?
mlkjYes
mlkjNo
Comments(optional):
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16.IfYestoquestion#15above,doesyourpatienteducationprogramprovidespecificactiontotakeregardingillnessmanagement,andnotsimplyincludeinformationaboutanillnessorcondition?
mlkjNo
mlkjYesforsomeconditions
mlkjYesforallconditions
Comments(optional):
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17.ForHHpatientswithDevelopmentalDisabilities(DD)howoftendoesyourHHcoordinatewithDDcasemanagersforservicesrelatedtohabilitationandotherDD­relatedservices?
mlkjNever
mlkjOccasionally,forpatientsthatreallyseemtoneedit
mlkjSometimes,forabouthalfofthepatients
mlkjMostofthetime
mlkjAlways
Comments(optional):
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MoHealthNet- QuarterlyHealthHomeReport

18.WhatpercentageofyourHHpatientshaveindividualtreatment/careplansthatcontainallofthefollowing:patientgoals,treatmentpreferences,optimalclinicaloutcomes.

mlkj

0­20%

mlkj

21­40%

mlkj

41­60%

mlkj

61­80%

mlkj

81­100%

Comments(optional):

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19.WhatpercentageofyourHHpatientsmeetface­to­facewithrelevantHHteammembersforthedevelopmentandrevisionoftheirindividualtreatmentplans?

mlkj

0­20%

mlkj

21­40%

mlkj

41­60%

mlkj

61­80%

mlkj

81­100%

Comments(optional):

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20.WhatpercentageofyourHHmembershaveselectedaprimary care provider?

mlkj

0­20%

mlkj

21­40%

mlkj

41­60%

mlkj

61­80%

mlkj

81­100%

Comments(optional):

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MoHealthNet- QuarterlyHealthHomeReport
21.Whatisthetypicalpercentageofofficevisitsthatapatientisscheduledwithhis/her selectedprimary care provider?
mlkj0­20%
mlkj21­40%
mlkj41­60%
mlkj61­80%
mlkj81­100%
Comments(optional):
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22.DoesyourHHprovidesmoking/tobaccopreventionservices?
mlkjYes
mlkjNo
Comments(optional):
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23.DoesyourHHprovidesmokingcessationservices?
mlkjYes
mlkjNo
Comments(optional):
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24.DoesyourHHprovidesubstanceusepreventionservices?
mlkjYes
mlkjNo
Comments(optional):
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MoHealthNet- QuarterlyHealthHomeReport

25.DoesyourHHprovidenutritionalcounseling?

mlkj

Yes

mlkjNo

Comments(optional):

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26.DoesyourHHprovideobesitypreventionandweightreductionservices?

mlkj

Yes

mlkjNo

Comments(optional):

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27.DoesyourHHprovidephysicalexerciseactivities?

mlkj

Yes

mlkjNo

Comments(optional):

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28.DoesyouHHprovidesupportforimprovingsocialnetworks?

mlkj

Yes

mlkjNo

Comments(optional):

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MoHealthNet- QuarterlyHealthHomeReport
29.DoesyourHHusepatientinformation,clinicaldata,andevidence­basedguidelinestogeneratelistsofpatientsANDtoproactivelyremindpatients/families/cliniciansofneededservices?
mlkjYes
mlkjNo
Comments(optional):
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30.IfYestoquestion#29above,pleasecompletethefollowing:
Howmanydifferent preventivecareservicesareincluded?
Howmanydifferent chroniccareservicesareincluded?
DoesthisincludepatientsnotrecentlyseenbyyourHH?
Doesthisincludelapsedrefillsfor specificmedications?
31.Whatpercentageofappointmentshavethefollowingwaittimes?(Totalshouldaddupto100)
0­5minutes
6­15minutes
16­30minutes
31­60minutes
61+minutes
MoHealthNet- QuarterlyHealthHomeReport
32.DoesyourHHhaveadocumentedprocessforpermittingschedulingofsame­dayappointments?
mlkjYes
mlkjNo
Comments(optional):
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33.WhatpercentageofHHpatientswhophoneforsame­dayappointmentsisabletobeaccommodatedthatday?
mlkj0­20%
mlkj21­40%
mlkj41­60%
mlkj61­80%
mlkj81­100%
Comments(optional):
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34.Howmanyhoursperweekareappointmentsavailableonweekdaysafter5pmorbefore8amforyourHH?(Countonlyoperatinghours.E.g.,ifyouhave3staffwithappointmentslotsfrom5­6pm,that's1hour,not3hours.)
#ofhours:
35.HowmanyhoursperweekareappointmentsavailableonSaturdaysand/orSundaysforyourHH?(Countonlyoperatinghours.E.g.,ifyouhave3staffwithappointmentslotsfrom9­10amonSaturday,that's1hour,not3hours.)
#ofhours:

MoHealthNet- QuarterlyHealthHomeReport

36.DoesyourHHhaveadocumentedprocesstotracklabtestsuntiltheyareavailable,includingflaggingandfollowinguponoverdueresults?

mlkj

Yes

mlkjNo

Comments(optional):

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37.Whatpercentageofpatientlabresultsisreceivedwithinthetimeframespecifiedbyyouragency?

mlkj

0­20%

mlkj

21­40%

mlkj

41­60%

mlkj

61­80%

mlkj

81­100%

Comments(optional):

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38.DoesyourHHhaveadocumentedprocessforflaggingabnormallabresults,bringingthemtotheattentionoftheclinician?

mlkj

Yes

mlkjNo

Comments(optional):

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MoHealthNet- QuarterlyHealthHomeReport

39.Whatpercentageofsuchflaggedlabresultsisreviewedbytheclinicianwithinthetimeframerequiredbyyouragency?

mlkj

0­20%

mlkj

21­40%

mlkj

41­60%

mlkj

61­80%

mlkj

81­100%

Comments(optional):

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40.DoesyourHHhaveadocumentedprocessfortrackingthestatusofreferrals?

mlkj

Yes

mlkjNo

Comments(optional):

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41.Forwhatpercentageofreferralstospecialistsisthepatientseenwithin4weeksofthe referral?(excludereferralsforcommunityresources,classes,etc.)

mlkj

0­20%

mlkj

21­40%

mlkj

41­60%

mlkj

61­80%

mlkj

81­100%

Comments(optional):

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MoHealthNet- QuarterlyHealthHomeReport

42.Forwhatpercentageofreferralstospecialistsisthereportreceivedwithin2weeksof theappointment?

mlkj

0­20%

mlkj

21­40%

mlkj

41­60%

mlkj

61­80%

mlkj

81­100%

Comments(optional):

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43.DoesyourHHhaveadocumentedprocessforconsistentlyobtainingpatientdischargesummariesfromhospitals?

mlkj

Yes

mlkjNo

Comments(optional):

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44.Whatpercentageofsuchhospitaldischargesummariesisobtainedwithin2weeksofdischarge?

mlkj

0­20%

mlkj

21­40%

mlkj

41­60%

mlkj

61­80%

mlkj

81­100%

Comments(optional):

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MoHealthNet- QuarterlyHealthHomeReport
45.DoesyourHHhaveadocumentedprocessforconsistentlyobtainingpatientdischargesummariesfromEmergencyDepartmentsandUrgentCareclinics?
mlkjYes
mlkjNo
Comments(optional):
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46.WhatpercentageofsuchEDandUrgentCaredischargesummariesisobtainedwithin2weeksofdischarge?
mlkj0­20%
mlkj21­40%
mlkj41­60%
mlkj61­80%
mlkj81­100%
Comments(optional):
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47.DoesyourHHuseanymaterials,technology,ordevicesthatpromotepatientself­management(e.g.,alarmsortextmessagereminderstotakemedications,etc.)?
mlkjYes
mlkjNo
Comments(optional):
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MoHealthNet- QuarterlyHealthHomeReport

48.DoesyourHHuseanyelectronicorothermethodorencouragementorremindersforpatienthealthgoals(e.g.,emailorpostcardsofnutritionalorotherhealthnewsletters, remindersofhealthevents,etc.)?

mlkj

Yes

mlkjNo

Comments(optional):

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49.DoesyourHHhaveadocumentedprocessforprovidingtimelyclinicaladviceviatelephoneduringofficehours?

mlkj

Yes

mlkjNo

Comments(optional):

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50.DoesyourHHrequiremedicalrecorddocumentationofanyclinicaladviceprovidedbyphoneorsecureelectronicformat?

mlkj

Yes

mlkjNo

Comments(optional):

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51.Whatpercentageofyourpatientshaselectronicaccess(e.g.,viatheinternetorsecure patientportal,etc.)totheirhealthinformation?

mlkj

0­20%

mlkj

21­40%

mlkj

41­60%

mlkj

61­80%

mlkj

81­100%

Comments(optional):

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MoHealthNet- QuarterlyHealthHomeReport
52.Whichofthefollowingtypesofinformationcanyourpatientsreceiveviasecureinternetorpatientportal?
InteractiveresponsestohealthcarequestionsDiagnoses
Labresults
CurrentmedicationlistAllergylist
Treatment/CarePlanproblemlistsOther(pleasespecifybelow)
Other(pleasespecify)
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53.WhatpercentageofeligibleprescriptionsforHHmembersaretransmittedelectronicallytopharmacies?
mlkj0­20%
mlkj21­40%
mlkj41­60%
mlkj61­80%
mlkj81­100%
Comments(optional):
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MoHealthNet- QuarterlyHealthHomeReport

54.ForwhichofthefollowingdoesyourHHproduceanddisseminatereportstoHHstaffthatindicatestatustowardmeetingdesiredoutcomes?(checkallthatapply)

PatientSatisfactionHealthStatusServiceCostsServiceDelivery

Other(listanddescribebelow)

Other(pleasespecify)

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55.HowoftendoesyourentireHHteam(fromallsites)haveregularteammeetings

mlkj

Daily

mlkj

Weekly

mlkj

Atleasttwicemonthly

mlkj

Monthly

mlkj

LessthanMonthly

Comments(optional):

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56.HowoftendoyourHHteammembersfromallsitesmeettogethertodiscussimplementationandgeneralproceduralissuesNOTrelatedtoindividualpatients?

mlkj

Never

mlkj

Atleastquarterly

mlkj

Atleastmonthly

mlkj

Atleastweekly

mlkj

Daily

Comments(optional):

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MoHealthNet- QuarterlyHealthHomeReport
57.Whatpercentageofthemeetingsreferencedinquestion#56areface­to­faceandwhatpercentageareconferencecalls?(Totalshouldaddupto100)
Face­to­FaceConferenceCalls
58.DoesyourHHhaveadedicatedresourceforstructuredcommunicationamongallHHstaff(fromallsites)onrelevantissues(e.g.,alistserve,e­mailGroup,etc.)?
mlkjYes
mlkjNo
Comments(optional):
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59.PleasecheckanyofthefollowingthatyourHHteamREGULARLYusestopromoteeffectiveandefficientworkflow:
AccessorotherdatabaseExcelorotherspreadsheetOutlookorotherschedulerOthersoftware(specify)
Ifother,pleasespecify
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60.Whatpercentageofyourcurrentprimarycarestaff(allstaff,notjustHHstaff)hasreceivedformalorientationregardingtheHealthHomeprogram?
mlkj0­20%
mlkj21­40%
mlkj41­60%
mlkj61­80%
mlkj81­100%
Comments(optional):
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MoHealthNet- QuarterlyHealthHomeReport

61.HowdoesyourHHhandleorientationfornewemployees?

mlkj

Noorientationfornewemployees

mlkj

OrientationonlyfornewHHemployees

mlkj

Orientationforallnewemployees,butdoesn'tcoverHH

mlkj

OrientationforallnewemployeescoversHH

Comments(optional):

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62.HaveyouhiredadditionalHHstaffaboveandbeyondtherolesdescribedintheSPA(e.g.,pharmacist,dietician,etc.)?

mlkj

Yes

mlkjNo

IfYes,pleasespecify:

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63.AreyourHHteammemberstrainedinevidence­basedcareapproaches(e.g.,DialecticalBehaviorTherapy,MotivationalInterviewing,StanfordChronicDiseaseSelf­Management,DiabetesConversationMapping,AsthmaReadyCommunitiesTrainings,etc.)?

mlkj

Yes

mlkjNo

IfYes,pleasespecify:

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64.WhatisthetotalnumberofsickdaysrequestedbyyourHHstaffforthecurrentreviewperiod?(Justprovidethetotalcountforyoursite­we'llmatchittotheagencystaffinglevelsforcomparisonsacrossHHs.)

MoHealthNet- QuarterlyHealthHomeReport

65.TowhatdegreeareHHoperationsaffectedbyunscheduledstaffsickleave?(Answerthefollowingbasedonthetypicalimpactofonedayofunscheduledleaveforasinglestaffmember)

mlkj

Significantnegativeimpact(e.g.,4+appointmentsarecanceled,waittimesincreaseby50+%)

mlkj

Moderateimpact(e.g.,2­3appointmentscanceled,waittimesincreaseupto50%)

mlkj

Minimalimpact(e.g.,nomorethan1appointmentcanceled,waittimesincreasenomorethan25%)

Additionaldescription,ifdesired:

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66.Howmuch"protected"stafftimeisofferedbyyourHH(e.g.,uninterruptedblocksoftimewhenstaffcanbesurethattheywillnotbescheduledforappointmentsormeetingsandcanplanoncompletingpaperworkorotherHH­relatedtasks.)?

mlkj

None

mlkj

1hourweekly

mlkj

2hoursweekly

mlkj

3hoursweekly

mlkj

4+hoursweekly

Comments(optional):

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67.Doesyouragencyrequeststafftocompleteajobsatisfactionsurveyatleastannually?

mlkj

Yes

mlkjNo

Comments(optional):

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MoHealthNet- QuarterlyHealthHomeReport
68.IfYes,doesthesurveyaddressburnoutandworkingconditions?
mlkjYes
mlkjNo
Comments(optional):
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69.Whatpercentageofallstaff(notjustHHstaff)atyouragencysmoke?(estimateifnecessary)
mlkj0­20%
mlkj21­40%
mlkj41­60%
mlkj61­80%
mlkj81­100%
Comments(optional):
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70.Doesyourprimarycareorganizationhaveasmokingcessationprograminplaceforstaff?
mlkjYes
mlkjNo
Comments(optional):
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71.Doesyourprimarycareorganizationhaveotherhealthpromotionprogramsinplaceforstaff(e.g.,nutrition,exercise,etc.)?Pleasedescribethem.
mlkjYes
mlkjNo
IfYes,pleasedescribe:
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MoHealthNet- QuarterlyHealthHomeReport

72.DoesyouragencyleadershipcommunicateaclearunderstandingandvisionforyourHHprogram?

mlkj

Yes

mlkj

Somewhat

mlkjNo

Comments(optional):

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73.IsyouragencyleadershipeffectiveinprovidingusefulfeedbacktotheHHteamregardingissuesthatarebeingstruggledwith?

mlkj

Yes

mlkj

Somewhat

mlkjNo

Comments(optional):

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74.IsyouragencyleadershipinvolvedwithyourHHteamintheproblemsolvingprocessforsystemissues?

mlkj

Yes

mlkjNo

Comments(optional):

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75.TowhatdegreeareHHstaffinvolvedinpolicyandproceduredevelopment?

mlkj

Notatall

mlkj

Minimally

mlkj

Involvedabouthalfthetime

mlkj

Usuallyinvolved

mlkj

Alwaysinvolved

Comments(optional):

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MoHealthNet- QuarterlyHealthHomeReport
76.Areagencypoliciesandproceduresdevelopedbyamultidisciplinaryteam?
mlkjNo,senioradministratorsmakeallpolicydecisions
mlkjYes,occasionally
mlkjYes,often
mlkjYes,always
Comments(optional):
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77.DoesyourHHdemonstrateongoingmonitoringoftheeffectivenessofyourqualityimprovementprocessbytrackingresultsovertimeandassessingtheeffectofyourqualityimprovementactions?
mlkjYes
mlkjNo
Comments(optional):
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78.DoesyourHHinvolvecareteamstaffinyourperformanceevaluationandqualityimprovementactivities?
mlkjYes
mlkjNo
Comments(optional):
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79.DoesyourHHhaveaqualityimprovementteam(orsimilar)totroubleshootcriticalissuesastheyarise?
mlkjYes
mlkjNo
Comments(optional):
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MoHealthNet- QuarterlyHealthHomeReport
80.DoesyourHHuseanongoingqualityimprovementprocessthatinvolvespatients/familiesonqualityimprovementteamsoronyourHH'sadvisorycouncil?
mlkjYes,bothQIteamsandadvisorycouncilmlkjYes,eitherQIteamsORadvisorycouncilmlkjNo
Comments(optional):
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81.PleasedescribesomechallengesthatyourHHfacedthisquarter.
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82.PleasedescribesomeofthesuccessesthatyourHHhasenjoyedthisquarter!
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