Form #2 Form #2 Extraction of medical record data

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Form Approved
OMB No. 0935-XXXX
Exp. Date XX/XX/20XX

TTACHMENT C: EXTRACTION OF MEDICAL RECORD DATA

Data Extraction 1: Create sample frame for adolescent behavior and communication survey

Each participating practice will create a dataset with one record for every patient aged 13 through 18 as of May 1, 2010 who has been seen in the practice from November 1, 2008 (18 months prior) through May 1, 2010. Each record will contain the following fields:

1. Patient first name

2. Patient last name

3. Street address

4. City

5. State

6. Zip code

Data Extraction 2: Create sample frame for chart review by the research team

Each participating practice will create a dataset consisting of all patients aged 13 through 18 who have had at least one visit in the 12 months pre-implementation and also at least one visit in the 12 months post-intervention. Each record will contain the following fields:

1. Visit date

2. Patient first name

3. Patient last name

4. Medical record number

5. Age on date of visit

Additional fields, where possible using the practice’s practice management system, will include:

6. Type of visit (e.g. well child visit, follow-up, acute)

7. Clinician associated with the visit

The research team will use a random number generator to select a random sample of 50 patients from each dataset. At each practice, for each of the 50 patients selected, the practice will pull paper charts, or, if electronic medical records are used, will print clinic notes (and any other associated forms for that encounter) for all visits in the pre-intervention and post-intervention periods.

While onsite at each practice, the research team will review the visit notes and associated forms for these 50 patients. For each patient, the pre-intervention visit to be reviewed will be the first visit in the pre-intervention period. The post-intervention visit to be reviewed will be the visit with the highest number of points, with one point being given (as permitted by data available) for (a) the first visit in the post-implementation period, (b) a visit of the same type as the pre-intervention visit, and (c) a visit with the same clinician as the pre-intervention visit. In the event of a tie, the earliest visit in the post-intervention period will be selected.

Public reporting burden for this collection of information is estimated to average 4 hours per response, the estimated time required to complete the data extraction. An agency may not conduct or sponsor, and a person is not required to respond to, a collection of information unless it displays a currently valid OMB control number. Send comments regarding this burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden, to: AHRQ Reports Clearance Officer Attention: PRA, Paperwork Reduction Project (0935-XXXX) AHRQ, 540 Gaither Road, Room # 5036, Rockville, MD 20850.

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