Giving data about not-at-goal patients to providers for care plan development |
Pre-visit planning |
19 |
19 |
7 |
10 |
6 |
12 |
9 |
7 |
5 |
94 |
Create not-at-goal patient lists |
1 |
1 |
0 |
8 |
6 |
1 |
0 |
1 |
4 |
22 |
List review with provider |
9 |
5 |
4 |
2 |
3 |
12 |
2 |
7 |
2 |
46 |
Total |
29 |
25 |
11 |
20 |
15 |
25 |
11 |
15 |
11 |
162 |
Developing team roles, defining tasks |
Staff training |
6 |
3 |
1 |
3 |
9 |
3 |
1 |
2 |
5 |
33 |
Medical doctors/clinical services staff orientation |
6 |
2 |
0 |
9 |
5 |
4 |
11 |
7 |
3 |
47 |
Provider buy in |
3 |
1 |
0 |
2 |
4 |
4 |
5 |
3 |
5 |
27 |
Clinical services staff responsibilities |
2 |
0 |
0 |
3 |
1 |
2 |
4 |
5 |
6 |
23 |
Total |
17 |
6 |
1 |
17 |
19 |
13 |
21 |
17 |
19 |
130 |
Providing patient care, implementing care plan |
Protocols |
10 |
6 |
9 |
9 |
11 |
1 |
2 |
2 |
2 |
52 |
Recalls, patient follow-up |
4 |
5 |
2 |
7 |
9 |
6 |
1 |
1 |
10 |
45 |
After-visit care |
4 |
3 |
1 |
3 |
2 |
0 |
0 |
2 |
3 |
18 |
Active management |
0 |
1 |
0 |
0 |
0 |
3 |
1 |
3 |
2 |
10 |
Medication change or titration |
1 |
0 |
2 |
3 |
4 |
5 |
2 |
2 |
2 |
21 |
Treatment of low-density lipoprotein cholesterol, hypertension |
0 |
2 |
1 |
1 |
0 |
0 |
0 |
1 |
2 |
7 |
Total |
19 |
17 |
15 |
23 |
26 |
15 |
6 |
11 |
21 |
153 |
Providing technology support for getting usable, accurate data |
Electronic medical record/information technology issues |
4 |
5 |
1 |
8 |
5 |
11 |
6 |
7 |
5 |
52 |
Patient identification/registry |
9 |
6 |
5 |
1 |
3 |
5 |
2 |
2 |
1 |
34 |
Information technology system implementation |
1 |
0 |
0 |
1 |
1 |
2 |
0 |
0 |
0 |
5 |
Total |
14 |
11 |
6 |
10 |
9 |
18 |
8 |
9 |
6 |
91 |