Performance and Quality Improvement (PQI) 4: Case Record Review
The organization conducts case record reviews at least quarterly for each of its services to:
minimize the risks associated with poorly maintained case records;
document the quality of the services being delivered; and
identify barriers and opportunities for improving services.
COA is not prescriptive about who can conduct case record reviews. While a peer review model is recommended, it is acceptable for PQI staff, a consultant, or another person or combination of persons to conduct the reviews. Please note that, regarding PQI 4.03, persons with clinical or service delivery experience may be needed to obtain the relevant qualitative data from the case records.
NA The organization is a network management entity.
NA The organization provides only Early Childhood Education (ECE) and/or Out-of-School Time Services (OST).
NA The organization provides only non-clinical group, crisis intervention, and/or information and referral services.
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Closed Cases: COA does not define the percentage of closed cases that must be included in the sample. The majority of cases the organization reviews should be open, but the organization must include a sample of closed cases to evaluate documentation related to discharge planning, case closing, aftercare, and the condition of the case record including whether or not records have been expunged as required by PRG 1.06.
Examples: Organizations can get more from the case record review process by stratifying the random sample of open cases to account for length of service. For example, a program that serves clients for up to six months could divide the sample proportionally between cases that have been open less than one month, one to three months, three to six months, and more than six months.
For generating random numbers, the Research Randomizer is an easy to use tool that is made available for free by the Social Psychology Network and includes short tutorials.
The organization's practices reflect full implementation of the standard.
Practices are basically sound but there is room for improvement; e.g.,
One of the standard's elements is not sufficiently developed, e.g., cases are not selected randomly for more than half of the organization's programs or services but includes both open and closed cases.
Practice needs significant improvement; e.g.,
At least two of the standard's elements are not sufficiently developed, e.g., sample size is insufficient to enable the organization to draw conclusions from the data; or
The organization only reviews open cases; or
Little effort is being made to ensure objectivity, e.g., supervisors frequently were the sole reviewers of supervisee cases.
Implementation of the standard is minimal or there is no evidence of implementation at all.
Quarterly reviews of case records evaluate the presence, clarity, quality, continuity, and completeness of required documents.
Examples: Quality of services is a very broad category and varies according to the program, service population, service mandates, and any number of other factors and can include criteria for evaluating the appropriateness and/or effectiveness of the services provided to persons served.
Examples of common qualitative measures include:
timeliness and comprehensiveness of individualized assessments;
length of service;
need for continued service;
family involvement; and
achievement of service goals, etc.
Some organizations take a utilization management approach to case record review and, rather than review case records quarterly, conduct more frequent or ongoing reviews. A utilization management approach looks at the key decisions and process milestones including, for example:
appropriateness of admissions and authorization decisions;