URAC DTM -- Case File Review

An essential component of the onsite review in the DTM 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:

• Were eligibility criteria met? (DTM 2, 11)
• Can organization coordinate care with case management plans?  (Who are the providers with whom information shoul be shared?  What kind of communication tools and techology are available for information sharing?  Can one provider refer a consumer to another provider?). (DTM 5)
• Did the organization send the consumer targeted education materials? (DTM 8, 9)
• Is there documentation of the organization's services and interventions? (DTM 12)
• Is there evidence of shared decision-making, including goal setting, provision of decision support tools, etc.? (DTM 14)
• Is there evidence of communication with providers if needed or appropriate? (DTM 17)

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.