Site-Specific Data Collection and Management Protocol

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Domenic Singleton
8 years ago
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1 Site-Specific Data Collection and Management Protocol Client Interview and Chart Data- Baseline 1 Study explained 2 Consent obtained Responsible party(ies) Location Protocol Staff NIH certified? Where are consents stored? How will you do this if client has no number? 3 Obtain client's medical/dental record number 4 Interview administered prior to visit date (up to 2-4 weeks) Direct web entry or paper forms first? 4a If direct web entry Where are paper forms stored? When will web entry occur? Who will do the web entry? 4b If collected on paper 5 3 questions asked later during dental visit* How are responses delivered to person doing web entry? Protocol for timing of this web entry 5a 3 questions data entered 6 Interview administered on the visit date 6a If direct web entry Where are paper forms stored? When will web entry occur? Who will do the web entry? 6b If collected on paper * Questions V1, V2, and V3 (formerly 32): How did you get here today, how long did it take, what brings you here today? 1

3 Obtain client's medical/dental record number 4 Interview administered prior to visit date (up to 2-4 weeks) Direct web entry or paper forms first?

2 Client Interview and Chart Data- Baseline, cont'd. Responsible party(ies) Location Protocol Data source? What method is used? Anonymous of HIPAA preparatory to research? 7 Does pre-screening occur? If yes Who makes decision locally? If dentist is not available, what is the protocol? 8 If unsure about eligibility due to dental treatment in past year - what is the protocol for determining if that was emergency care? Where does this information come from? 9 Chart information requested Where is this information stored in your files? 10 CD4 and VL data abstracted from source 11 CD4 and VL data entered into web-based system address Phone number 12 Contact person for data management questions 2

8 If unsure about eligibility due to dental treatment in past year - what is the protocol for determining if that was emergency care? Where does this information come from?

3 Client Interview - Follow up Responsible party(ies) Location Protocol Data security measures 1 Compile list of clients and follow-up window dates Follow up contact protocol 2 Initiate contact for follow-up interview 3 Documentation of follow-up attempts 4 Conduct follow-up interview What is the source of 6, 12 month chart data? Where kept? When will you do this? What is your protocol? 5 Chart information requested 6 CD4 and VL data abstracted from charts 7 Data entered into web-based system How will information about why no interview was completed be communicated to the person doing data entry? 8 Complete data tracking form if interview is not conducted 9 Check web-based data reports weekly Protocol for respond to reports 10 Respond to requests for missing data, data error messages 3

5 Chart information requested 6 CD4 and VL data abstracted from charts 7 Data entered into web-based system How will information about why no interview was completed be communicated to the person

4 Clinic Utilization Data - Part 1 1 Method of Completion 1a If completed on paper Responsible party(ies) Protocol Direct web entry or on paper first? When is data collected? Where are paper forms stored? When will web entry occur? Who will do the web entry? 2 How is patient ID# obtained? 3 How is payment source identified? 4 How is visit type determined? 5 How is treatment plan information obtained? 6 How is date of next recall visit determined? 7 8 How do you know if patient is referred to a specialist? How do you know if patient has received any ancillary services? 4

2 How is patient ID# obtained? 3 How is payment source identified? 4 How is visit type determined? 5 How is treatment plan information obtained?

5 Clinic Utilization Data - Part 2 Responsible party(ies) Protocol 1 Electronic system: 1a Client ID/record list generated 1b Dates generated 2 Method used to obtain utilization data 2a If report requested Describe method - direct web entry, from report print-out, etc.. Who receives it? Where is the utilization report kept? What are the data security measures? 2b Report run 2c Circle/highlight date-appropriate visit codes 2d Add provider and insurance notes 3 Data entered into web-based system address. Phone number 4 Contact person for data management questions 5

Where is the utilization report kept? What are the data security measures?

6 Ancillary Service Utilization Responsible party(ies) Protocol E.g. direct web entry or paper forms 1 Method used to collect ancillary service data How do staff access these numbers? 2 Client ID# s obtained by staff When is this done? What is the protocol? 3 If direct web entry 4 If paper forms used: 4a Paper forms distributed to staff 4b Forms collected Where? Data security measures 4c Forms stored until data entry 4d Check-in with staff re completion of forms 4e Data entered into web-based system 6

2 Client ID# s obtained by staff When is this done? What is the protocol?

Oral Health Care: Dental Insurance Program

Oral Health Care: Dental Insurance Program Approved: November 2009 Oral Health Care includes diagnostic, preventive, and therapeutic services provided by general dental practitioners, dental specialists,