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Annual medical records audit is an opportunity for quality improvement

Every year, CareOregon’s Quality Improvement Department conducts a review of members’ medical records.

Although it is a requirement for Medicaid, Medicare and NCQA accreditation, it’s more than that, says Ann Blume, senior manager of quality improvement.

“We would do it anyway, because it’s the right thing to do,” she says. Chart reviews are a way to check on screenings, to see if guidelines are being followed, or even coded correctly.

“I see this as a way that health plans can help address patient safety issues. It’s part and parcel of the work. We like to be able to identify the best practices and then share it with clinics that have perhaps not identified that practice on their own.”

Ann notes that CareOregon’ providers tend to be high performers, with more than 95 percent of all charts having the needed components.

But changes in the standards do occur, and records review is an opportunity to advise providers of these changes.

There are four standards for which the department is especially interested in sharing changes of best practices this year:

  • Body Mass Index (BMI). For this measure, the chart needs to include a calculation of the BMI, not just a recording of a patient’s height and weight.
  • Smoking cessation. This year for the first time, medical record audits will look for an assessment of tobacco use at every visit. Quick advice from a provider is proven to be one of the most effective ways to increase the numbers of Americans who quit smoking.
  • Standard Developmental Screening. Starting last year, CareOregon and other health care organizations in the state added this screening for children at risk for possible developmental, behavioral or social delays.
  • Advance Directives. Starting at age 50, providers should discuss Advance Directives, as well as preventive measures such as colorectal cancer screening.

More detailed information and best practices guidelines are available at the links above.