Download HCH Risk Stratification User Guide.pdf 2MB

1. Identification of Potential Health Care Home Patient

Potentially eligible HCH patients are identified from a Practice scan. The scan extracts anonymous patient data from the Practices clinical software database and produces a list of potentially eligible patients. The potential HCH patients list will not include patients with a deceased or inactive status.

1. Click on the Precedence Connector Icon (located in your Task bar next to the date and time) and select Extensions
2. Click Configure to enter your Precedence username and password
3. Click report Potential HCH Patients
4. Select a location to store the CSV file and the scan will begin.
5. Once complete, the CSV file can be opened in Excel and will show the list of potential patients.
6. The Practice can now use this list to recruit potentially eligible patients to the Health Care Home Program.

2. To start the HCH Assessment (HARP) 

1. To start the Assessment click Start Assessment from the Precedence Connector menu
2. A Browser window will now open, respond to the consent question to begin the assessment.

3. Patient Consent

Before beginning the assessment, patient consent to enrolling in the Health Care Home trial and the use of their anonymous data must be obtained.

1. After explaining the process to the patient, tick the check box
2. To start the Assessment click Continue

4. Completing the Assessment

The Hospital Admission Risk program Risk Calculator (HARP) Assessment can now be completed. Parts of the assessment are pre-filled where possible being information extracted from the Practice Software. 

1. Complete the remaining sections of the assessment using the check boxes.
2. To cancel the assessment, select Cancel. All patient information will be removed. To complete a HARP Assessment for the patient you will need to start the process again.
3. Once the Assessment is complete, select Finish to proceed to the HCH Risk Certificate.

5. Risk Stratification Certificate

An assessed HARP score of 5 or greater means the patient is eligible for the Health Care Home program. Once the assessment is complete, the Risk Stratification Tool will indicate if the patient is eligible for Health Care Home or not. If they are eligible, click Continue to confirm the patient consents to participate in Health Care Homes, and to view the Certificate.

After clicking Continue, the Health Care Homes certificate is displayed in the browser. This document confirms a patient’s eligibility and states the patient’s Risk Tier along with other information required for enrolment

1. Download the assessment and certiicate to your practice software by selecting Download Completed Assessment and Certificate
2. Please note for Goolge Chrome ‘Download Certificate’ and ‘Download Completed Assessment’ are two separate buttons. Please select Download Certificate and then click Download Completed Assessment. Downloading the certificate is compulsory for funding details.
3. The certificate and assessment has now been downloaded to your practice import folder within your practice software.
4. Select Close
5. Patient information has now been removed from the Risk Stratification Tool. This can now be actioned into the patient record in your practice software as per usual processes.

Patients with certificates

The Risk Stratification Tool can produce a list of assessed patients with Health Care Home certificates. This may assist you to compare lists of potential, assessed or enrolled patients.

1. Click on the Precedence Connector icon (located in your task bar next to the date and time) and select Extensions
2. Click Patients with Certificate
3. Select a location to store the CSV file of patients with certificates and the scan will begin.
This may take some time. The extension will show the progress.

4. Once complete, the CSV file can now be opened in Excel and will show the list of patients the practice has that have completed the assessment and received a Health Care Home certificate. This list includes the certificate number, expiry date and tier.

Assessing a patient who was not considered eligible

7. Click on the Precedence Connector Icon and select Start Assessment
8. As the patient was not determined to be at risk, the provider must mark that the consider them to be at risk and give a clinical reason before noting patient consent and beginning the assessment

Creating a Data Quality Report

The data quality report creates a list of your patients who have missing or out of range data. The report will include patients who have attended the practice in the previous 24 months and have at least one chronic disease as recognised by Precedence. The report will not include patients with a deceased or inactive status. This report can be generated at any time.

The data quality report is compatible with Best Practice, MedicalDirector, MedTech32, ZedMed and Communicare.

1. Select the Extensions option from the Precedence Connector menu
2. Scroll down to the bottom of the ‘Extensions’ window, and select the option to Start a Data Quality Report.Please note it is recommended that this report is run overnight.

3. Confirm where you would like this report to be located and select Save
4. The Precedence Connector will now generate and save the report as an CSV file in your desired location
5. The CSV report will list all your current patients with missing or faulty data

• An X in the field column indicates no value has been entered
• An O indicates the data is out of range