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1 | TBI_UserInterface.zip\TBI_UserInterface\documents | TBIAPPLICATIONFIELDDEFINITIONS.doc | Mon Nov 14 15:34:56 2016 UTC |
2 | TBI_UserInterface.zip\TBI_UserInterface\documents | TBIAPPLICATIONFIELDDEFINITIONS.doc | Tue Nov 22 15:25:15 2016 UTC |
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2 | TRACKING A PPLICATION | |
3 | DATA DEFIN ITIONS | |
4 | August 14, 2008 | |
5 | Facility I D | |
6 | ||
7 | Facility w here the T BI screen was comple ted | |
8 | Name/SS# o f Patient with + scr een and de siring eva l | |
9 | ||
10 | Patient id entifier f or the OEF /OIF veter an that ha d a positi ve TBI scr een, and | |
11 | agreed to a comprehe nsive TBI evaluation . | |
12 | Date of sc reening | |
13 | ||
14 | Date TBI s creening w as complet ed. Value is listed as a date range fro m April | |
15 | 2007 to pr esent date . | |
16 | Date of Co nsult/Refe rral | |
17 | ||
18 | Date when a consulta tion was s ubmitted/r eferral ma de for the comprehen sive TBI | |
19 | evaluation . Value i s listed a s a date r ange from April 2007 to presen t date. | |
20 | Not Applic able | |
21 | ||
22 | Check box that shoul d be selec ted when a consultat ion or ref erral was not | |
23 | submitted. Selecti on of this check box will acti vate the ‘ Other Cons ult/Referr al | |
24 | Status’ fi eld for fu rther clar ification. | |
25 | Other Cons ult/Referr al status | |
26 | ||
27 | Consult no t submitte d | |
28 | ||
29 | ||
30 | Should be selected w hen a cons ult was no t submitte d/referral was not | |
31 | ||
32 | ||
33 | made for t he compreh ensive TBI evaluatio n. Select ion of thi s field wi ll | |
34 | ||
35 | ||
36 | prompt the user to t ake follow up action , and the status of this case cannot | |
37 | ||
38 | ||
39 | move to ‘c ompleted’ until appr opriate ac tion has b een taken and indica ted | |
40 | ||
41 | ||
42 | on the web applicati on. | |
43 | ||
44 | Evaluation without r eferral/co nsult | |
45 | ||
46 | ||
47 | Should be selected w hen the co mprehensiv e TBI eval uation was | |
48 | ||
49 | ||
50 | ||
51 | completed without su bmission o f a consul t/making a referral due to | |
52 | ||
53 | ||
54 | facility p ractice pa tterns. | |
55 | Attempts t o Contact Patient fo r Scheduli ng Purpose s | |
56 | ||
57 | Unable | |
58 | ||
59 | ||
60 | The initia l attempt to contact the patie nt for sch eduling ne eds to occ ur | |
61 | ||
62 | ||
63 | within 5 d ays of rec eipt of th e consult/ referral f or a compr ehensive T BI | |
64 | ||
65 | ||
66 | evaluation . Two add itional at tempts mus t occur wi thin 14 da ys from | |
67 | ||
68 | ||
69 | positive s creen. If all three attempts to contact the patie nt within the first | |
70 | ||
71 | ||
72 | 14 days of the posit ive screen are unsuc cessful, a certified letter is sent to | |
73 | ||
74 | ||
75 | the patien t providin g contact informatio n should t hey desire to call f or an | |
76 | ||
77 | ||
78 | appointmen t. This l etter must be sent w ithin 14 d ays of the positive | |
79 | ||
80 | ||
81 | screen. A ll efforts to contac t the pati ent should be docume nted in th e | |
82 | ||
83 | ||
84 | patient's health rec ord. | |
85 | ||
86 | Refused | |
87 | ||
88 | ||
89 | Patient wa s successf ully conta cted for s cheduling purposes, but the pa tient | |
90 | ||
91 | refused th e offer of a compreh ensive TBI evaluatio n. | |
92 | ||
93 | Scheduled: Date offe red by fac ility | |
94 | ||
95 | ||
96 | Patient wa s successf ully conta cted, and the patien t agreed t o an | |
97 | ||
98 | ||
99 | ||
100 | appointmen t schedule d on the d ate offere d by the f acility. | |
101 | ||
102 | Scheduled: Date requ ested by p atient | |
103 | ||
104 | ||
105 | Patient wa s successf ully conta cted, and the appoin tment was made on a | |
106 | ||
107 | ||
108 | date reque sted by th e patient. | |
109 | ||
110 | Unavailabl e | |
111 | ||
112 | ||
113 | Patient is not avail able for s cheduling due to rea sons beyon d their co ntrol | |
114 | ||
115 | ||
116 | (i.e. inca rceration, death, or redeploym ent). | |
117 | Date Sched uled with TBI Evalua tion Team | |
118 | ||
119 | Correspond s with app ointment d ate for co mprehensiv e TBI eval uation tha t is | |
120 | scheduled in CPRS/Vi sta. Valu e reflects date rang e from Apr il 2007 to present | |
121 | date. | |
122 | Time to Sc heduled Ap pt with TB I Evaluati on Team | |
123 | ||
124 | Calculated value tha t is the d ifference in days be tween the date of th e positive | |
125 | TBI screen and the d ate of the scheduled appointme nt with th e TBI eval uation | |
126 | team. | |
127 | Delay in C ompleting Evaluation (Response reflects any reason for a del ay in comp leting the comprehen sive TBI e valuation. ) | |
128 | ||
129 | No Show | |
130 | ||
131 | ||
132 | Patient di d not show for their scheduled appointme nt for the | |
133 | ||
134 | ||
135 | ||
136 | comprehens ive TBI ev aluation. | |
137 | ||
138 | Cancellati on by pati ent | |
139 | ||
140 | ||
141 | Patient ca ncelled th eir schedu led appoin tment for the compre hensive TB I | |
142 | ||
143 | ||
144 | evaluation . | |
145 | ||
146 | Cancellati on by clin ic | |
147 | ||
148 | ||
149 | Clinic can celled the scheduled appointme nt for the comprehen sive TBI | |
150 | ||
151 | ||
152 | evaluation . | |
153 | ||
154 | ||
155 | **This res ponse does not justi fy not com pleting th e evaluati on, | |
156 | ||
157 | ||
158 | ||
159 | and will c reate a ne w entry be ginning wi th the 'Co ntact' fie lds. | |
160 | ||
161 | Delay in c onsult/ref erral subm ission | |
162 | ||
163 | ||
164 | The time d elay in co mpleting t he TBI eva luation wa s impacted by a dela y | |
165 | ||
166 | ||
167 | in submiss ion of the consultat ion or ref erral to t he TBI eva luation te am. | |
168 | ||
169 | No delay i n completi ng evaluat ion | |
170 | ||
171 | ||
172 | Option is selected i f the TBI evaluation process f ell within 30 days o f the | |
173 | ||
174 | ||
175 | positive T BI screen. | |
176 | ||
177 | Clinic Cap acity | |
178 | ||
179 | ||
180 | Option is selected i f your ava ilable cli nic slots do not mee t the dema nd | |
181 | ||
182 | Delay in S uccessful Patient Co ntact | |
183 | ||
184 | ||
185 | Option is selected w hen the cl inic makes multiple attempts t o contact | |
186 | ||
187 | ||
188 | patient be fore succe ssfully es tablishing contact a nd schedul ing the | |
189 | ||
190 | ||
191 | ||
192 | appointmen t | |
193 | ||
194 | ** Multipl e Patient No Show/Ca ncellation -- Cases for which an entry o f ‘Cancell ed by Pati ent’ or ‘N o Show’ re quire furt her attemp ts at sche duling an appointmen t by the c linic, whi ch should be indicat ed on this form begi nning with the ‘Atte mpts to Co ntact Pati ent for Sc heduling P urposes’ f ield. Thi s applicat ion will c apture up to 3 attem pts to sch edule and complete t he TBI eva luation. Cases wher e a total of 3 cance llations b y the pati ent and/or no shows will satis fy the req uirements of this tr acking app lication. | |
195 | Date Evalu ation Comp leted | |
196 | ||
197 | Entry of d ate when t he compreh ensive TBI evaluatio n was | |
198 | completed by the TBI | |
199 | evaluation Team. C alendar pr ovides dat e range fr om April 2 007 to pre sent date. | |
200 | From this entry, the Time to C ompleted E valuation value is c alculated as the | |
201 | difference in days b etween the date of t he positiv e TBI scre en and the date the | |
202 | TBI evalua tion was c ompleted. | |
203 | Time to Co mpleted Ev aluation | |
204 | ||
205 | Calculated value tha t is the d ifference in days be tween the date of th e positive | |
206 | TBI screen and the d ate the TB I evaluati on was com pleted. | |
207 | Definitive TBI Diagn osis | |
208 | ||
209 | Value is a Yes/No/Un certain re sponse ind icating if the resul ts of the | |
210 | ||
211 | comprehens ive TBI ev aluation r esulted in a definit ive diagno sis of TBI . | |
212 | Responsibl e TBI Eval uation Tea m (Service /Clinic) | |
213 | ||
214 | Response r epresents the Servic e/Clinic r esponsible for compl eting the TBI | |
215 | evaluation . Values can be PM& R, Neurolo gy, Behavi oral Healt h, Primary Care | |
216 | with Speci alty Train ing in TBI , or Other . | |
217 | ||
218 | **A select ion of ‘Ot her’ will open a fre e text box where the responden t | |
219 | describes the treatm ent TBI ev aluation t eam scenar io that is different from | |
220 | the availa ble select ions above . For ins tance, a f acility ma y use Fee Basis | |
221 | providers or provide rs from an affiliate d facility to comple te the com prehensive | |
222 | ||
223 | TBI evalua tion. | |
224 | ||
225 | **Polytrau ma Point o f Contact Facilities would sel ect ‘Other ’ and | |
226 | then indic ate if | |
227 | they refer red their patient to a Polytra uma Suppor t Clinic T eam site o r | |
228 | Polytrauma Network S ite for th eir TBI ev aluation. | |
229 | Assistance : | |
230 | ||
231 | VSSC Help Desk- http:// DNS . URL /FAQ/HD_re quest.asp | |
232 | ||
233 | Douglas Bi delspach- PII |
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