2015 Data Training SessionsTraining for CCS HRIF Program Web-Based Reporting System

Erika GrayCPQCC HRIF-QCI Project Manager

1979 CCS Standards for “Tertiary” NICUs were developed addressed CCS HRIF examinations. “CCS may pay for follow-up examination of high risk NICU graduates even though a CCS eligible condition does not exist“.

July 1, 2006 restructured CCS HRIF Program went into effect

Core Diagnostic ServicesComprehensive History & Physical Exam with Neurologic AssessmentDevelopmental AssessmentFamily Psychosocial AssessmentHearing AssessmentOphthalmologic AssessmentCoordinator Services

CCS & CPQCC designed the High Risk Infant Follow-up Quality Care Initiative (HRIF-QCI) Reporting System to:

Identify quality improvement opportunities for NICUs in

the reduction of long term morbidity

Allow HRIF programs to compare their activities with all

sites throughout the state

Allow the state to assess site-specific successes

Support real-time case management

CCS-approved HRIF Programs are required to complete and

submit reports to CPQCC using the web-based HRIF-QCI

Reporting System for infants and children enrolled in a CCS-

approved HRIF Program as of January 1, 2009, and thereafter.

CCS-approved NICUs are responsible for ensuring that all high-

risk eligible infants discharge from the NICU are referred to

their CCS-approved HRIF Program or have a written agreement

for the provision of these services by another CCS-approved

HRIF Program.

Reference: CCS Program Letter (PL): 01-0611

https://www.ccshrif.org/download.html

This web-based Reporting System

was developed for CCS HRIF Program

medically eligible infants, regardless of

insurance status or CPQCC eligibility.

68/116 (58%) CCS NICUs have a HRIF Program

65/68 (95%) HRIF Programs reporting online (*)

◦ 22/23 Regional

◦ 42/44 Community

◦ 1/1 Intermediate

25/48 (50%) referring CCS NICUs reporting online

◦ 20/32 Community

◦ 5/16 Intermediate

◦ * 2 HRIF Programs Closed | 1 New HRIF Program 2014

BIRTH YEAR

2010 2011 2012 2013 2014

Ref/Registration 7054 7517 7545 6848 175

Standard #1 4981(70)

5134(68) 5100(67) 4013 162

Closed/ Not Seen

1182 1343 1537 1975 11

Standard #2 3695(52)

3799(50) 3574(47)

Closed/ Not Seen

1729 1996 2333

Standard #3 2682 (38)

2714(45)

Closed/ Not Seen 910 1035

September 2014

Total Registrations = 7054

HRIF Programs without Errors/Warnings = 27 (41%)

HRIF Programs with NO Priority Case = 49 (75%)

HRIF Programs follow-up rates to the 1st visit:

◦ Greater than 80% = 26

◦ Greater than 90% = 9

SV #1 SV#2 SV#3

1389 (<1000 g) 1118 (80) 918 (66) 725 (52)

3580 (<=1500 g) 2696 (75) 2123 (59) 1600 (44)

3474 (>1500 g) 2285 (66) 1572 (45) 1082 (31)

Complete the Reporting System User Contact Form and fax to 650-721-5751, Attention: HRIF-QCI Support Staff. Available on the www.ccshrif.org Homepage.

USER ACCESS ACCOUNTS (contacts can have multiple accounts):

Data User: CCS-approved HRIF Program staff submits all data forms (Referral/Registration, Standard Visit, Additional Visit and Client Not Seen/Discharge) for infants/children receiving follow-up services from their own HRIF Program. Data Users can generate HRIF Program and Patient Summary reports.

Referral User: CCS-approved NICU and/or HRIF Program staff refers HRIF eligible infants to a CCS HRIF Program and only has access to submit the “Referral/Registration Form”. Currently no access to generate/view reports.

NICU User: CCS-approved NICU staff (read-only access) generate/view NICU reports.

*User Interface Access Accounts Overview – available for download: https://www.ccshrif.org/download.html

Effective June 2014, in order to access the online HRIF-QCI Reporting System, you will have to use the Duo Two-Factor Authentication security software. Two-factor authentication enhances the security of your online accounts by using your phone to verify your identity. This prevents anyone but you from accessing your accounts, even if they know your password. For more information about Duo Security visit: http://guide.duosecurity.com/.

Passwords are becoming increasingly easy to compromise. They can often be stolen, guessed, and hacked — you might not even know who else has your password and is accessing your account.

Two-factor authentication adds a second layer of security to your account to make sure that your account stays safe, even if someone else knows your password. And you'll be alerted right away (on your phone) if someone does know your password and tries to log in with it.

This second factor of authentication is separate and independent from the username and password step — Duo never sees your password.

(Mobile and/or Landline Phone)

(Request Bypass Codes)

Only links records of infants discharged to home from your NICU, who are:

◦ VLBW (<=1500 grams)

◦ ELBW (<1000 grams)

◦ GA < 28 weeks

◦ With Moderate/Severe HIE or Cooling

◦ With ECMO

The report is updated every 1st of the month

Table H - CCS CPQCC (NICU) Annual Report

Effective November 1st – HRIF Programs can obtain access to view the Report, available at www.cpqccreport.org

Each CPQCC NICU may request HRIF NICU user access to cpqccreport.org. HRIF NICU user access to cpqccreport.org is designed for a NICU's HRIF coordinator and provides access to the HRIF summary and HRIF infant status reports only. It does not give access to any of the other reports available on cpqccreport.org.

Per request from HRIF, a new NICU report option was added that shows HRIF registration status for each infant coded as initially discharged home or discharged home from the reporting center after one prior transfer out and re-admission. If available, the report lists the basic information that should always be included in an infant's HRIF.

NOTE: that this report is only available for centers, not for regions.

"Surprise CPQCC/CCS HRIF Linkage Award" for referring 100% of discharged to home eligible infants to a HRIF Program for year 2013 (per the August 1st, CPQCC-CCS Linked HRIF Referral Summary for Infants Discharged Home Report).

Congratulations to the following Centers -

Anaheim Regional Medical Center

Antelope Valley Hospital

Bakersfield Memorial Hospital-

34th Street

Children's Hospital Central

California

Children's Hospital Of Orange

County At Mission Hospital

Community Memorial Hospital Of

Ventura

Doctors Medical Center

Garfield Medical Center

Glendale Adventist Medical

Center - Wilson Terrace

Good Samaritan Hospital-San

Jose

Grossmont Hospital, Women's

Health Center

Harbor-UCLA Medical Center

Hollywood Presbyterian Medical

Center

Kaiser Fnd Hosp - Downey

Kaiser Fnd Hosp - Fontana

Kaiser Fnd Hosp - Orange County

- Anaheim

Kaiser Fnd Hosp - Panorama City

Kaiser Fnd Hosp - San Diego

Kaiser Fnd Hosp - Woodland Hills

Kaiser Permanente -

Sacramento/Roseville-Eureka

Kaiser Permanente - San Leandro

(Hayward)

Kaweah Delta Medical Center

Kern Medical Center

Los Robles Hospital & Medical

Center

Memorial Hospital Medical Center

- Modesto

Miller Children's Hospital At Long

Beach Memorial Hospital

Olive View-UCLA Medical Center

Providence Little Company Of Mary

MC - Torrance

Providence Tarzana Medical Center

Redlands Community Hospital

Salinas Valley Memorial Hospital

San Antonio Community Hospital

Scripps Mercy Hospital

Scripps Mercy Hospital - Chula Vista

Sequoia Hospital (LPCH At Sequoia)

Sharp Chula Vista Medical Center

St. Agnes Medical Center (CHCC At

St. Agnes)

St. John's Regional Medical Center

St. Joseph's Medical Center Of

Stockton

St. Mary Medical Center

Sutter Memorial Hospital

Tri-City Medical Center

University Of California Irvine

Medical Center

University Of California San

Diego Medical Center

Ventura County Medical Center

Washington Hospital - Fremont

(LPCH At Washington)

Western Medical Center - Santa

Ana

https://www.ccshrif.org/download.html

Referral/Registration Form

It is the responsibility of the discharging to home California Children’s Services (CCS) Neonatal Intensive Care Unit (NICU)/Hospital OR the last CCS NICU/Hospital providing care to make the referral to the High Risk Infant Follow-up (HRIF) Program. Upon referring an infant to the High Risk Infant Follow-up (HRIF) Program, a “Referral/Registration Form” is completed (except HRIF I.D. Number) by the discharge/referring NICU/Hospital at time of discharge to home. 

HRIF Program Referral Process:Communication is between the CCS-approved NICU and HRIF Program.

The discharging/referring NICU / Hospital will refer eligible infants to the HRIF Program at time of discharge to home, and complete the “Referral/Registration Form” via the web-based HRIF-QCI Reporting System.

The discharging/referring NICU / Hospital or HRIF Program will submit a Service Authorization Request (SAR) to the Local CCS Office for HRIF services. (Service Code Group [SCG] 06, should be requested). http://www.dhcs.ca.gov/services/ccs/cmsnet/Pages/SARTools.aspx

The discharging/referring NICU / Hospital will send a copy of the Discharge Summary to the HRIF Program.

The HRIF Program will accept the infant’s case and all applicable information will be carried forward to the “Standard Visit Form” as appropriate in order to decrease entering data that is already in the system.

Standard Visit FormThe HRIF Program has three core visits that take place during the following time periods: Visit #1 (4-8 months), Visit #2 (12-16 months) and Visit #3 (18-36 months).

During the third and final core visit (18-36 months) a developmental test, such as a Bayley III Scales of Infant and Toddler Development, must be performed and reported. It is highly recommended that an Autism Spectrum Screening tool such as the MCHAT be performed between 16-30 months of age.

Incomplete Standard VisitsIf you cannot obtain a neurologic or developmental assessment during the core visit, schedule a return visit for the infant to complete the assessment(s) and indicate the reason why the assessment was not performed. When the infant returns the missing neurologic or developmental assessment data can be entered on the incomplete “Standard Visit Form.” The date of the return visit should be entered into the “Date Performed” field(s).

 

Additional Visit FormIf an infant requires additional visits for further assessment, an “Additional Visit Form” must be completed. Additional visits may occur before, between and/or after the recommended time frames for Standard Visits.

This form only captures the date, reason (Social Risk, Case Management, Concerns with Neuro/Developmental Course or Other) and disposition for the additional visit.

 

Client Not Seen/Discharge Form

Used for the following 5 case scenarios:

1. Infant referred to your HRIF Program, but your staff was unable to contact the infant’s parent (primary caregiver) to establish an initial core visit.

2. No Show: parent (primary caregiver) rescheduled (less than 24 hours) of a scheduled appointment or did not come to a scheduled core visit appointment.

3. Infant eligible for HRIF Program, but parent (primary caregiver) declines service.

4. Infant expired prior to core visit, family relocated, insurance denial, etc.

5. Infant transferred/referred to another HRIF Program for follow-up services.

This form captures only the date, category, reason and disposition for the client not seen visit. This form captures only the date, category, reason and disposition for the client not seen visit.

Who is responsible for referring HRIF eligible infants?

The CCS NICU who is discharging the infant home.

What is the HRIF ID Number?

A computer generated 8-digit number assigned to the infant/child after submitting the “Referral/Registration Form” in the web-based Reporting System.

How do you obtain a CPQCC Patient ID Number?

Contact the CPQCC Data Contact person from the birth/discharge NICU to obtain the CPQCC Patient ID #.

When do you use the “Still in Hospital” check box?

Use the “Still in Hospital” check box, If the infant/child is still hospitalized in the NICU or other unit in the hospital at 8 months chronological age.

Searching for Records in the System:

Use only 1 search field:1. HRIF ID #2. Date of Birth3. Birth Year

Not Sure if the Infant Qualified for CPQCC Patient ID#:

Enter “00000” as the CPQCC Network Patient ID Number, if your not sure if the infant met the CPQCC NICU Eligibility Criteria or a CPQCC ID Number has not been assigned to the infant.

Infant eligible for HRIF, but family lives out of state/country:

Register the infant in the system – close the form

Submit a Client Not Seen/Discharge Form - indicate family moved out of state and close the form

How to view all records:

On the “Find Patient – Quick Patient Search” page, click ONLY the “Search” button.

If you check the “Unable to Complete Form” box on the Referral/Registration Form – Submit a CNS/D Form to indicate the reason (Infant Expired, Lost to Follow-up or Parent Refused) why your unable to complete the form

Use the HRIF ID Number to reference records in the Reporting System

Review the HRIF Tracker and Errors and Warning tools on a quarterly basis to keep your records up-to-date

Universal Duplicate Record FeatureIdentifies existing records in the entire HRIF-QCI database.

1. Contact the HRIF Program with the duplicate case to review the records.

2. Make sure all data variables are captured on the Referral/Registration Form (CPQCC Reference Number, Birth Mother’s Date of Birth, Discharge Date to Home, etc).

3. *Combine all data forms (Standard Visit, Additional Visit and Client Not Seen/Discharge) into one record.

4. The HRIF Program not currently following the patient should use the orange "Delete" button located at the bottom of the Referral/Registration Form entry screen to remove their record from the system.

*TIP: Use the "Patient Data Quality Self-Audit Instrument Report" located in the "Patient's Case History" page to review the details of the record.

1. Contact the CCS HRIF Program Coordinator where the patient will be transferred for follow-up care, to inform them of the patient.

1. Submit a “Client Not Seen/Discharge Form”, before requesting to transfer the patient’s record:

Category:  "Discharged”Reason: "Infant Referred to Another HRIF Program"Disposition: "Will be Followed Elsewhere" 

2. Submit a “HELP TICKET” to request the record transfer to another CCS HRIF Program. Include in the ticket request the patient’s “HRIF ID Number”, “Date of Birth” and the “HRIF Program, where the patient will be transferred”.

NOTE: Records are transferred every Friday; request received on Friday will be transferred the following week.

SV FORM

Is the Infant/Child Currently Receiving Breastmilk?Select one option that applies at the time of core visit.

Select “Exclusively”, if the infant/child receives only breastmilkSelect “Some”, if the infant/child receives breastmilk and formulaSelect “None”, if the infant/child receives only formula

CNS/D FORM

Reasons (*Required Field) – Revised

Select “Family Moved Within California”, if the family can not make the appointment due to moving from their primary residence and have changed city and county within California.

Select “Family Moved Out of State”, if the family lives or is moving out of state/country.

SV, AV AND CNS/D FORMS

Disposition (*Required Field) – Updated

Select “Discharged – Family Moving Out of State/Country”, when the

family is moving out of state/country or receiving follow-up care out of

state. No further data will be submitted to CMS/CCS.

Select “Discharged, Will Be Followed Elsewhere”, when the

infant/child will be receiving follow-up care from a NON CCS HRIF Program

in California. No further data will be submitted to CMS/CCS

“Infant Birth Year” added to Quick Patient Search

Total Number of Error/Warning and Priority Cases – Added to the Notice on the Find Patient page

New Validations:

◦ Mother’s DOB must be greater than 12 years

◦ Discharge to Home Date can not be more than 1 year from infant’s DOB

•Data Quality Self Audit Instrument (DQSAI) ReportData Quality Self Audit Instrument (DQSAI) Report•HRIF Summary ReportHRIF Summary Report•NICU Summary ReportNICU Summary Report•HRIF CCS ReportHRIF CCS Report

HRIF Summary ReportsLocated under the “Report” tab

Allows HRIF Programs to view HRIF follow-up outcome data and compare to all HRIF Programs. Users are able to view their own HRIF Program or “All”, and filter based on “Discharge NICU”, “Infant’s Birth Year”, “Infant’s Birth Weight”, “Report Name: Referral/Registration, Standard Visits (1, 2, or 3) or by age range” and “Report Section Name”.

NICU Summary Reports

Located under the “Report” tab

Allows CCS NICUs to view HRIF follow-up outcome data for infants cared for in their NICU and compare to all CCS NICUs. Users are able to view their own NICU hospital or “All”, and filter based on “Infant’s Birth Year”, “Infant’s Birth Weight”, “Inborn/Outborn”, and “Standard Visit (1, 2, or 3) or Adjusted Age Range” at follow up. NOTE: In order to view this report, you must have “NICU User” access.

HRIF CCS Report (Annual)

Located under the “Report” tab

This annual report serves a dual purpose: Fulfills the CCS requirement to report on all CCS-accredited HRIF Program activity and Efficiently presents an annual compliations of the site-specific longitudinal outcomes. Users are able to view their own NICU hospital or “All”, and filter based on “Infant’s Birth Year” and “Infant’s Birth Weight”.

•Parent QuestionnaireParent Questionnaire•HRIF TrackerHRIF Tracker•CPQCC Reference Number CPQCC Reference Number •Errors and WarningErrors and Warning•CPQCC & HRIF-QCI DirectoryCPQCC & HRIF-QCI Directory

Parent Questionnaire FormTo collect social-demographic information about High Risk Infant Follow-up (HRIF) patients and their families to determine the specific needs of this patient population and develop better standards of care for California HRIF Programs.

The purpose of the HRIF Record Tracker tool is to help HRIF Programs track and finalize/close patient records.

The system will display the “Date Expected” for when the patient should have been seen for Standard Visit #1, #2 and #3, based on the recommended time frames. The “Date Expected” is calculated by using the patient’s gestational age.

Once the Standard Visit is submitted the “Visit Date” and the visit “Disposition” will override the “Date Expected”.

NOTE: The HRIF Record Tracker is located under the “Tools” tab and is updated in real-time.

HRIF Record TrackerHRIF Record Tracker

Priority Cases are patient records with current adjusted age => 37 months and has one of the following:

1. Only has a Referral/Registration Form in the system (No visit forms submitted)

2. Open Forms = the “This Form is Closed” check box has not been checked3. Non “discharged” disposition selected to close the case

NOTE: Priority Cases are highlighted in RED.

 Warning Cases are patient records with current adjusted age < 37 months with a non “discharged” disposition selected to close the case and has one of the following:

1. Open Forms – the “This Form is Closed” check box has not been checked2. Missing Standard Visit Form(s) 3. NOTE: Warning Cases are highlighted in YELLOW

 Closed Cases are patient records with the following:

◦ All forms are Closed – the “This Form is Closed” check box has been checked

◦ A “discharged” disposition has been selected to close the case

CPQCC Reference Number ReportLocated under the “Report” tabPurpose to update/enter multiple CPQCC ID Numbers and verify data

entry.

Purpose of the Error and Warning Report tool is to alert HRIF Programs of missing or incorrect data entries and to help aid them in completing and finalizing their data.

The system will display patient records with any of the following issues: “Duplicate Record”, “Missing CPQCC ID Number”, “No Forms”, “Transfer Record Incomplete”, “Met Age Limit for Program”, “Missing Birth Date of Mother”, “Incorrect Date of Visit”, and “Duplicate Core Visit” and an action plan to resolve the issue.

NOTE: The Errors and Warning Report tool is located under the “Tools” tab and is updated in real-time.

Errors & Warning ToolErrors & Warning Tool

• Located on the CPQCC and HRIF-QCI Websites:

www.cpqcc.orgwww.ccshrif.org

• Password to open directory: datacontact

• Contact the CPQCC/HRIF-QCI Office, if any of the information is inaccurate or needs to be updated: support@ccshrif.org

• Biannual update (new version available in January and July)

The purpose of this finalization process is to assist HRIF Programs with complete and accurate data submission of records for infants born in 2011 AND referral/registrations for infants born in 2014.

Finalization ProcessFinalization Process

Finalization ProcessFinalization Process

Data Finalization Process Schedule for 2015

JAN - FEB

APR1st

APR – MAY

JUN 1st

JUN 2nd

JUN 15th

AUG 1st

AUG 2nd

SEP - DEC

Data Review

Super Star HRIF Program Award

Data Review

DEADLINE

HRIF Follow-up

Rate Award

HRIF CCS

Report Availabl

e

DEADLINE

CPQCC/CCS HRIF Linkage Award

Data Review

Utilize Reporting System

Tools

No Priority or Error

and Warning Cases for 2011 Born

Infant Records

Utilize Reporting System

Tools

Data Final for 2011

Born Infants

Core Visit F/U Rates for 2011

Born Infants:

1st => 80%2nd => 65%3rd => 50%

2011 Born

Infants

Register ALL 2014

Born Infants

100% of VLBW

Born 2014 Infants

Referred to a HRIF Program

Utilize Reporting System Tools

Objective: To determine the overall rate of referral to the

CCS HRIF Program for VLBW infants born in 2010 and 2011, and surviving discharge to home.

Evaluate medical, sociodemographic, regional, and NICU-level factors associated with referral and non-referral to HRIF.

Evaluate unadjusted and risk-adjusted rates of referral and non-referral across regions and NICUs.

NOTE: CCS NICU Provider Standards – ensure that all high-risk infants discharged from the NICU are referred to a HRIF Program.

2010 2011 2010-2011

Number of VLBWs

4,042 4,029 8,071

HRIF Referral Received

3,135 (78%)

3,284 (82%)

6,419 (80%)

Failure to refer to HRIF is associated with increasing EGA

Failure to refer to HRIF is associated with increasing BW

Variable Level Adjusted OR (95% CI)

P-value

Maternal race African American (vs. White)

0.6 (0.5-0.7) <.0001

Hispanic 0.7 (0.6-0.8) <.0001

Birth weight 750g and less (vs. 1251-1499g)

1.9 (1.5-2.5) <.0001

751-1000g 1.7 (1.4-2.0) <.0001

1001-1250g 1.2 (1.1-1.5) 0.006

SGA Status SGA <= 32 wks (vs. AGA)

0.8 (0.7-0.9) 0.003

SGA >= 33 wks 0.4 (0.3-0.5) <.0001

Oxygen at 36 wks 0.8 (0.7-0.9) 0.005

Discharging NICU Regional (vs. Intermediate)

3.1 (2.3-4.3) <.0001

Community 2.1 (1.5-2.8) <.0001

NICU Volume 2nd quartile (vs. Lowest quartile)

2.0 (1.5-2.7) <.0001

3rd quartile 1.6 (1.2-2.1) 0.0006

4th quartile 1.6 (1.3-2.1) 0.0003

Outborn 1.6 (1.3-2.0) <.0001

Congenital anomalies

0.8 (0.7-1.0) 0.039

Referral of eligible infants to HRIF is the critical and necessary first step toward achieving best outcomes for high risk infants.

Disparities and barriers to HRIF referral exist –

◦ Some likely related to perceptions of risk (i.e., EGA, BW), and other resources (i.e., congenital anomalies).

◦ Some may be associated with sociodemographic disparities, and/or indicative of resource challenges and imbalances within NICUs and across the state.

◦ Potentially unmeasured indicators of medical risk. Findings present opportunities toward targeted QI

initiatives to improve HRIF referral - - HRIF referral rate has been included as a quality indicator in

CPQCC reports

• Website: HomepageWebsite: Homepage• Website: Download PageWebsite: Download Page• Website: Resource CornerWebsite: Resource Corner• HRIF-QCI Manual: Web-based Reporting System HRIF-QCI Manual: Web-based Reporting System

ReviewReview• CPQCC NewsletterCPQCC Newsletter• CCS HRIF (State) Website: Center DirectoryCCS HRIF (State) Website: Center Directory

CPQCC Monthly Announcements

Include 3-5 Topics pertaining to CPQCC and HRIF-QCI data systems:

• System Improvements• Ticket System• Reports• Tools

• Upcoming Event/Conferences• Center Awards• Quality Improvement

Collaborative Updates (Learning Sessions)

• Delivery Room Management• Length of Separation

• Articles• Data Finalizations• Data Trainings

http://www.dhcs.ca.gov/services/ccs/Pages/HRIF.aspx

Erika GrayCPQCC HRIF-QCI Project ManagerEmail: eegray22@stanford.edu