Disease Management, Version 3.0 -- Case File Review

An essential component of the onsite review in the DM accreditation process is a review of consumer files.  From a log of patient case files you'll provide the reviewer at the outset of the review, she will select 30 or more files to look over.  You may have these files in paper or electronic (or both) form, and that doesn't matter.  The key is that you be able to tell the reviewer where to find the various components of the file for which she is seeking.

Here is a list of the items on her checklist when she's reviewing the case files:

• Evidence of collaboration with treating provider (DM 4)
• Evidence of shared decision making, including goal setting (DM 5)
• Evidence that staff are conducting themselves properly based on their licensure status (DM 6)
• Evidence that referral patterns are consistent with DM 7
• Documentation of contacts with providers for urgent situations (DM 12)
• Documentation that rights and responsibilities have been conveyed (DM 14)
• Documentation that rights and responsibilities have been conveyed (if applicable)(DM 14)
• Documentation that eligibility criteria are implemented (DM 15)
• Demonstration of the assessment or stratification protocol (DM 16, 17)
• Verification of compliance with timelines for completing the process and conducting reassessment or re-stratification (could be through tracking system instead of consumer files)(DM 16, 17)
• Documentation of identified co-morbid conditions and individual consumer assessments in compliance with the applicant’s process (DM 16, 17)
• Documentation of compliance with time frames of DM 18
• Evidence that interventions are related to assessment/stratification data and are tracked (DM 20)

So, we recommend that, first, you conduct an audit of your case files to see that they demonstrate compliance with all these requirements.  If they do not, improve your record-keeping. 

Once you've assured that they do consistently contain this documentation, make it easy for the reviewer to find all the items in each file.  This can be accomplished in any of a number of ways, two of which are:

• sitting with the reviewer as she goes through the first few files until you are comfortable that she can find what she needs to find, and/or
• preparing a "key" that, for each requirement, tells her where in the file to look.

Remember, your reviewer is not familiar with your file system.  Make it easy for an outsider to find what she needs.