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digital.ahrq.gov/sites/default/files/docs/resource/Dataform_2_Chart_Review.pdf
June 16, 2021 - Dataform 2: Chart Review Version 0. 11
DATAFORM 2
Chart Review Form
Collect at 4 months … Evidence in chart of any of the following health conditions in the last 3 months:
(Charlson Co-Morbidity … 6 months)
Page 3 of 7
Center for Excellence for Patient Safety Research and Practice 5/27/ … 2 Yes
8.18 NON-HODGKIN’S LYMPHOMA ____ 1 No
(within the last 6 months) … with “probable” 2 Yes
AIDS (within the last 6 months)
8.21 HIV POSITIVE, ARC, OR
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meps.ahrq.gov/data_files/publications/st494/stat494.pdf
October 01, 2016 - Insurance
Table 2 presents insurance coverage among non-elderly adults during the last 6 months of each … Insurance Coverage of Ambulatory Care Visits in the Last Six Months of
2011–13 and 2014, by Medicaid … Service use is from any time
during the last 6 months of the calendar year. … in the Last Six Months of 2011-13 and 2014,
by Medicaid Expansion Status 5
Percentage of last 6 … A person with 3 uninsured months during last 6 months of year was counted as being uninsured 50 percent
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digital.ahrq.gov/sites/default/files/docs/page/2006Cullen_051111comp.pdf
June 16, 2021 - 68.0%
88.8%
Undetermined
# w/ Viral Load
(in last six months)
1
18
5.0%
72.0%
EXAMS … 12 months) 14 56.0%
TREATMENT: (past 6 mos … 0.0%
PCP Prophylaxis given
(if CD4 ≥50 and <200
in last six months)
MAC Prophylaxis given
(if … CD4 <50
in last six months)
7
1
87.5%
33.3%
Undetermined 3 15.0% RISK FACTORS: # %
# w/ … Gonorrhea Screen
(in the last 12 months) 8 32.0%
Tobacco Use Screening
Current Tobacco User
19
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www.ahrq.gov/sites/default/files/wysiwyg/cahps/cahps-database/2018_cg_cahps_chartbook.pdf
January 01, 2018 - Q10/Q11
In the last 6 months, when you contacted this provider’s office during
regular office hours … Q12/Q13 In the last 6 months, how often did this provider listen carefully to you? … Q14/Q15 In the last 6 months, how often did this provider show respect for what
you had to say? … Q15/Q16 In the last 6 months, how often did this provider spend enough time
with you? … In the last 6 months, did you see a specialist for a particular
health problem?
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www.ahrq.gov/sites/default/files/wysiwyg/pqmp/measures/outcomes/chipra-146-section-2.pdf
September 01, 2011 - In the last 12 months, how many times did
you visit this provider? … In the last 12 months, how often did you
schedule your own appointments with this
provider? … In the last 12 months, did you take any
prescription medicine? … In the last 12 months, how many times did
you visit this provider? … In the last 12 months, did you take any
prescription medicine?
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www.ahrq.gov/sites/default/files/wysiwyg/cahps/cahps-database/2019_hpchartbook.pdf
January 01, 2019 - Response Options
• Never
• Sometimes
• Usually
• Always
In the last 6 months, how often was it … Response Options
• Never
• Sometimes
• Usually
• Always
In the last 6 months, how often did you … In the last 6 months, how often did your personal doctor show respect for what
you had to say? … In the last 6 months, how often did your personal doctor spend enough time
with you? … Response Options
• Never
• Sometimes
• Usually
• Always
In the last 6 months, how often did you
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www.ahrq.gov/sites/default/files/wysiwyg/cahps/cahps-database/2020_hp_chartbook.pdf
January 01, 2020 - Response Options
• Never
• Sometimes
• Usually
• Always
Getting Care Quickly
In the last 6 months, … In the last 6 months, how often did your personal doctor listen carefully to
you? … In the last 6 months, how often did your personal doctor show respect for what
you had to say? … In the last 6 months, how often did your personal doctor spend enough time
with you? … In the last 6 months, how often did your child’s personal doctor listen carefully
to you?
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www.ahrq.gov/sites/default/files/wysiwyg/professionals/quality-patient-safety/hais/tools/surgery/modules/sustainability/sustainability_sustscorecard.pptx
December 01, 2017 - SAY:
The last item covers safety culture. … After you have recorded the number of team meetings held in the last 6 months, the dashboard columns … score the results: Anything less than four is below target, maybe four in the last 6 months is OK, and … Overall, the scorecard should help you reflect on the last 6 months. … SAY:
Next, consider the defects that your team has addressed in the last 6 months.
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www.ahrq.gov/sites/default/files/wysiwyg/pqmp/toolkits/asthma-data-collection-form.pdf
May 21, 2019 - 12 Yes
months? … 12 months? … 12
months? … Yes
No
20b When was the Asthma Action Plan last updated? … Tobacco Use Assessment
21 Was tobacco smoke exposure /use assessed in the last
12 months?
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www.ahrq.gov/sites/default/files/wysiwyg/cahps/surveys-guidance/cancer/suppl-items-cancer-access-english-557-1a.docx
June 02, 2025 - In the last 6 months, did you contact this cancer center with a medical question after regular office … In the last 6 months, when you contacted this cancer center after regular office hours, how often did … In the last 6 months, how often did you see the person you came to see within 15 minutes of your appointment
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www.ahrq.gov/cahps/surveys-guidance/item-sets/cg/suppl-perceived-bias-cg30-adult.html
December 01, 2023 - In the last 6 months, how often have you been treated unfairly at this provider's office because of your … In the last 6 months how often have you been treated unfairly at this provider's office because of the … In the last 6 months, how often were you treated unfairly at this provider's office because you did not
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cahpsdatabase.ahrq.gov/files/2017CAHPSHealthPlanChartbook.htm
October 01, 2017 - Getting Care Quickly
In the last 6 months, when you needed care right away, how often did you … Getting Care Quickly
In the last 6 months, when your child needed care right away, how often … In the last 6 months, how often did your child’s personal doctor show respect for what you had to say … In the last 6 months, how often did your child’s personal doctor explain things in a way that was easy … In the last 6 months, how often did your child’s personal doctor spend enough time with your child?
-
www.ahrq.gov/sites/default/files/wysiwyg/cahps/cahps-database/2024-health-plan-chartbook.pdf
January 01, 2024 - Response Options
• Never
• Sometimes
• Usually
• Always
In the last 6 months, how often was it … Response Options
• Never
• Sometimes
• Usually
• Always
In the last 6 months, how often did you … In the last 6 months, how often did your personal doctor show respect for what
you had to say? … In the last 6 months, how often did your personal doctor spend enough time
with you? … In the last 6 months, how often was it easy to get this treatment or counseling for your
child?
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www.ahrq.gov/research/findings/nhqrdr/chartbooks/access/elements2.html
June 01, 2018 - unable to get or delayed in getting needed medical care, dental care, or prescription medicines in the last … 12 months
People who were unable to get or delayed in getting needed medical care, dental care, or … prescription medicines in the last 12 months
Usual Source of Care
Age-sex adjusted percentage … 12 months was 11.7%. … 12 months for any insurance or age group, except people ages 0-17.
-
www.ahrq.gov/sites/default/files/wysiwyg/research/findings/nhqrdr/2022qdr-appendix-combined.pdf
October 25, 2022 - 2021
Adults who needed to see a specialist in the last 6 or 12 months
who sometimes or never found … managed care NCBD 2021
Adults who had a doctor's office or clinic visit in the last 6 or 12
months … health care providers talked with
them about the side effects of medicines in the last 2 months of … 12 months who
received treatment for depression in the last 12 months NSDUH 2020
Suicide deaths among … 12 months, Medicaid NCBD 2021
Adults who had a doctor's office or clinic visit in the last 6 months
-
www.ahrq.gov/cahps/surveys-guidance/item-sets/cancer/suppl-access-items.html
March 01, 2017 - In the last 6 months, did you contact this cancer center with a medical question after regular office … In the last 6 months, when you contacted this cancer center after regular office hours , how often … In the last 6 months, how often did you see the person you came to see within 15 minutes of your appointment
-
www.ahrq.gov/research/findings/nhqrdr/chartbooks/personcentered/pcc-slides.html
June 01, 2018 - Children who had a doctor’s office or clinic visit in the last 12 months whose parents reported poor … Children who had a doctor's office or clinic visit in the last 12 months. … Adults [Children] who had a doctor’s office or clinic visit in the last 12 months whose health providers … Adults [Children] who had a doctor’s office or clinic visit in the last 12 months whose health providers … Overall Rate: The percentage of adults who had a doctor’s office or clinic visit in the last 12 months
-
www.ahrq.gov/sites/default/files/wysiwyg/research/findings/nhqrdr/2023-NHQDR-appendixes-ACDE.pdf
January 01, 2023 - about when to take medicines in the last 2 months of care
HHCAHPS 2022
Adults who reported that … reported that home health care providers always
listened carefully to them in the last 2 months of … contacted their home health care providers in the last 2
months of care
HHCAHPS 2022
Adults who … 2022
Adults who needed care right away for an illness, injury, or
condition in the last 6 months … 12 months, Medicaid
NCBD 2022
Adults who had a doctor’s office or clinic visit in the last 6
months
-
www.ahrq.gov/sites/default/files/wysiwyg/research/findings/nhqrdr/2023-NHQDR-appendixes-ACDE-rev.pdf
January 01, 2023 - about when to take medicines in the last 2 months of care
HHCAHPS 2022
Adults who reported that … reported that home health care providers always
listened carefully to them in the last 2 months of … contacted their home health care providers in the last 2
months of care
HHCAHPS 2022
Adults who … 2022
Adults who needed care right away for an illness, injury, or
condition in the last 6 months … 12 months, Medicaid
NCBD 2022
Adults who had a doctor’s office or clinic visit in the last 6
months
-
www.ahrq.gov/research/findings/nhqrdr/chartbooks/personcentered/measures.html
June 01, 2018 - 12 months who had poor communication with health providers, by insurance, ages 18-64 and age 65 and … 12 months. … Overall Rate: The percentage of adults who had a doctor’s office or clinic visit in the last 12 months … 12 months who had poor communication with health providers, by ethnicity and education, 2002-2013 … 12 months.