The Clinical & Service Quality Review (C&SQR) program is a continuous quality improvement program that measures and evaluates medical record documentation of care as well as timeliness and quality of service.
The C&SQR program is designed to assess the level of quality related to focused components of clinical care and services currently provided to Medica members by primary care practitioners in the Medica network. Clinical care is measured by review of medical records to compare documentation of care to measurable criteria. Service quality is measured by reviewing each clinic's process for assuring the timeliness and safety of appropriate patient care. This includes emergency, urgent and non-urgent care. Measurement criteria for the C&SQR program are based on Medica's clinical and service quality priorities, clinical practice guidelines, community standards of care, regulatory compliance and National Committee for Quality Assurance (NCQA®) accreditation requirements.
In an effort to streamline the efficiencies of this multifaceted program, unique subset programs have been created to support the overall plan. These subset groups are listed below:
- Commercial Quality Improvement (CQI)
- Medicare Quality Improvement (MQI)
- Choice Care Quality Improvement (CCQI)
- Service Quality (SQ)
Each subset of the C&SQR program uses a mix of up to ten separate review components that are reviewed annually as a part of their respective programs. The following components are included in the C&SQR programs indicated:
- Adult Cervical Cancer Screening: CCQI
- Adult Colorectal Cancer Screening: MQI CCQI
- Adult Breast Cancer Screening: MQI, CCQI
- Adult Health Promotion: CQI, MQI, CCQI
- Child & Teen Checkup: CCQI
- Childhood Asthma: CQI, CCQI
- Chlamydia Screening: CQI, CCQI
- General Chart Documentation: CQI, MQI, CCQI
- Service Quality: SQ
Medica has chosen specific quality standards on which to focus improvement efforts for our Clinical & Service Quality Review programs of 2008. The established thresholds are based on calculation of the 95% confidence interval for each health plan level C&SQR program measure in comparison to clinic group scores from 2007 reviews. Clinics or clinic groups scoring below the established threshold for any question indicated below are asked to submit a written improvement plan for each deficient standard to Medica within 30 days following the date of receiving and improvement plan request.
- General Chart Documentation: Is there a separate, up-to-date problem list documented?
Threshold: 71%
- General Chart Documentation: Is the medication list, including OTC’s, updated at the last visit?
Threshold: 77%
At the end of each review year (December), or the beginning of the next year (January or February), the C&SQR program produces clinic group-specific reports. These reports outline each group's results compared to plan aggregate scores. Clinic group strengths as well as opportunities for improvement are also addressed.
Comparative review results, as well as links to other quality resources, are available to Medica Members on the
Quality Resources Web page.
The links below are provided for further details related to medical record documentation tools promoted by our program, review criteria (measurement questions), and Medica's policy on medical record documentation.
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View Chart Documentation ToolsView C&SQR CriteriaView Medical Records: Provider Responsibility PolicyHospital Quality
AHRQ Quality Indicators: The Agency for Healthcare Research and Quality (AHRQ) Quality Indicators (QIs) are measures of health care quality that make use of readily available hospital inpatient administrative data.