MDHHS Tobacco Section: Tobacco Use Reduction for PLWH

CAREWare Guide

FY 18

ContentsCAREWare FY 18......................................................................................................................................2

Add Client................................................................................................................................................3

Demographics..........................................................................................................................................4

Annual Review.........................................................................................................................................5

Services....................................................................................................................................................6

Screenings...............................................................................................................................................8

CAREWare Reports................................................................................................................................11

Performance Measures.....................................................................................................................11

Custom Reports.................................................................................................................................14

Financial Report.................................................................................................................................16

FAQs......................................................................................................................................................20

Appendix...............................................................................................................................................21

Consent/confidentiality form............................................................................................................21

CAREWare New User Request...........................................................................................................22

CAREWare FY 18

All funded contractors will use CAREWare to report tobacco dependence treatment services. Staff will report Tobacco Use as a service and a screening for active tobacco users. The other services (Advise, Assess, Assist, Arrange, Completed Interventions, Quit Attempts, Tobacco Intake/ Quit Plan) will all be tracked as a service.

Clients added to CAREWare, who do not receive other Ryan White services, must give consent to being in CAREWare prior to receiving tobacco dependence treatment services. For an example consent form, please see the CAREWare Guide appendix and TURP TTS Standard Operating Procedures Manual.

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Definitions of the tobacco dependence treatment services, steps for how to document the services, and instructions for running reports are included in the CAREWare Guide. The reports required for FY18 are the following: Performance Measures for Tobacco Ask, Tobacco Advise, and Tobacco Assess; Financial Report; Tobacco Use (Ask) Custom Report.

If you have additional questions, need access to CAREWare, or are locked out of CAREWare, please contact your consultant.

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Add ClientEnter client Last Name, First Name, Middle Name, Gender, and Birthdate and select Add Client. If when entering a new client, and the Possible Duplicate Client List appears, click view more information about the selected client to identify if the client being added is already in CAREWare.

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DemographicsUnder the Demographics tab, enter client demographics pertinent to tobacco services such as Street Address, City, State, Zip Code, County, Phone Number, Phone Type, Race and Ethnicity, Enrollment Status, Enrollment Date, Eligibility History* and Vital Status. The Client ID field is not required but may be helpful in facilitating the internal management of client files.

The Enrollment Date must be before the date of the first service or else the client will not be included in any of the tobacco reports.

As a supplement to documented proof of HIV status on file for each client, record HIV Status and HIV+ Date.

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Annual ReviewAs a supplement to documented proof of income and insurance information on file for each client, complete both the Insurance and Federal Poverty Level fields under the Annual Review tab.

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ServicesTo record a new tobacco service unit, select the New Service link under the Service tab.

Service units must be recorded for every tobacco service provided. 1 service unit equals 15 minutes of time spent on tobacco services. It is important that service units are recorded for every tobacco service provided to ensure accurate tobacco reporting. Service units can be entered through Service New Service.

Date: Enter the date the tobacco service was providedService Name: Select the appropriate service unit for the service being recorded. See list of service units belowContract: Tobacco FY17-18Units: Enter the number of service units for the tobacco session. 1 service unit = 15 minutes.

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Service Unit Options Include: Ask- Yes, Ask- No, Ask- Former, Advise, Assess-Ready, Assess-Not Ready, Assist- Individual Counseling, Assist- TDT Group Counseling, Assist- Michigan Tobacco Quitline, Assist- TDT Educational Class, Assist- TDT Medication, Assist-Referral to Provider for TDT Medication, Assist- Thinking About Quitting, Arrange Follow Up, Successful Quit Attempt, Quit Attempt Relapse, Quit Attempt Not Initiated, Quit Attempt- Slip, CI- Individual TDT Counseling, CI- TDT Support Group, CI- Michigan Tobacco Quitline, CI- TDT Educational Class, CI- Thinking about Quitting, CI- TDT Medication.

See the Service Unit Definitions section of this guide to learn more about these service units.

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Screenings Tobacco screening is only for current tobacco users. To record the type and length of tobacco use for current tobacco users, select Encounters Screenings Rapid Entry. This should be recorded once for every client who reports being a tobacco user or updated as this information changes.

To add an Ask screening, click Rapid Entry then select the Add button.

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To complete the Tobacco Ask screening, select the Tobacco Use Ask from the drop-down list in the Test section.

Date: Enter date of interaction with clientResult: Select the type of tobacco the client usesAction: Select the length of time the client has used tobacco

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To record when clients decrease or taper down tobacco use, select Tobacco Use Decreasing from the dropdown list in the test section of the Screenings.

Date: Enter date of interaction with clientResult: Select yes or noAction: Percentage they are decreasing

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CAREWare ReportsPerformance MeasuresTo run a performance measure, select the Administrative Options button on the home screen.

Next, select the Performance Measures button on the Administrative Options menu.

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The Performance Measure reports are for Tobacco Ask, Tobacco Advise, Tobacco Assess. Click on the specific report for your agency. Be sure to select the as of date as the last date of the quarter for the work plan report.

To run a report that will include all three performance measures, click on Multiple Performance Measure Report and then select the tobacco reports for your specific agency. Be sure to select the as of date as the last date of the quarter for the work plan report. Wait briefly for the data to populate, then click run report.

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Example of Performance Measure Report (Ask Advise Assess)

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Custom ReportsTobacco use is the only custom report. This will report how many clients have been screened for tobacco use with the type of tobacco product and how long they have used the tobacco product specified. Click on Reports Custom Reports Tobacco Use (Ask) Screening.

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Make sure to select the date range for the reporting quarter.

Example Custom Tobacco Use (ASK) Report

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Financial ReportReporting for the other Tobacco Dependence Treatment Services will be compiled in one financial report. To run the financial report, click on Reports Financial Report

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Make sure to select the date range for the reporting quarter, and select the funding source as Tobacco

To run the report, choose the date range, click on the boxes Include Subservice Detail and Include Provider Information. Then click Run Report.

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Example of Financial Report

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Service Unit Definitions

Ask- Yes- Client was asked about tobacco use and is a current user

Ask- No- Client was asked about tobacco use and is not a current or former user

Ask- Former- Client was asked about tobacco use and is a former user

Advise- Client was advised on the risks of using tobacco

Assess-Ready- Client was assessed for readiness to quit and is ready

Assess-Not Ready- Client was assessed for readiness to quit and is not ready

Assist- Individual Counseling- Client developed a quit plan which includes individual counseling

Assist- TDT Group Counseling- Client developed a quit plan which includes individual counseling

Assist- Michigan Tobacco Quitline- Client developed a quit plan which includes the Michigan Tobacco

Quitline

Assist- TDT Educational Class- Client developed a quit plan which includes a TDT Educational class

Assist- TDT Medication- Client developed a quit plan which includes TDT medication

Assist-Referral to Provider for TDT Medication- TTS referred client to provider for TDT medication

Assist-Thinking About Quitting-TTS referred client to Thinking About Quitting workshop

Arrange Follow Up – TTS/Agency Staff has arranged a follow up call or meeting with client

Successful Quit Attempt- Client has been tobacco free for 24 hours or longer

Quit Attempt Relapse- Client has relapsed to former/continued tobacco use

Quit Attempt Slip- Client has brief return to tobacco use after a period of abstinence

Quit Attempt Not Initiated- Client did not attempt to quit

CI- Individual TDT Counseling- Completed Intervention: Client completed 1 individual counseling session

CI- TDT Support Group- Completed Intervention: Client completed 1 TDT Support Group

CI- Michigan Tobacco Quitline- Completed intervention: Client completed 1 call with the Michigan

Tobacco Quitline

CI- TDT Educational Class- Completed Intervention: Client completed 1 educational class

CI- Thinking about Quitting- Completed Intervention: Client completed 1 Thinking about Quitting class

CI- TDT Medication- Completed Intervention: Client received a prescription for or purchased TDT

medication

Tobacco Intake-TTS meets with client to screen for Ryan White eligibility and conduct assessment of client quit history, medical history, motivation for quitting, etc.

Tobacco Quit Plan- TTS works collaboratively with client to develop or update individualized client quit plan.

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FAQsIf a client has already been asked about tobacco use before, do they need to be asked again at their next visit and does it need to be recorded again? Yes, the 5A’s are a cycle. Clients must be asked at every visit. Every time a client is asked, it also must be recorded in CAREWare. If a client is a tobacco user, be sure that the type of tobacco and length of use is being recorded under the screenings section of CAREWare. This only needs to be recorded in one of the domains. It does not have to be recorded in the tobacco domain AND the agency main domain.

How do I record a group session if it is part support group and part educational session? If you host a session that is both educational and has a support group component, you would record the Assist and Completed Intervention as one of each.

Do I need to log a service unit for every tobacco encounter? Yes, one service unit equals 15 minutes of time or less. This includes Ask, Advise, Assess, and Assist, as well as, tobacco interventions. If you spend more than 15 minutes on TDT with your client ensure that you are recording appropriately; for example, 45 minutes = 3 service units. If you spend less than 15 minutes with a client, still record 1 unit. You cannot record half units in CAREWare.

What is the difference between Assist and Completed Interventions? Assist is the act of assisting a client in a treatment plan. This is the initial stage of planning and serves as a referral or plan of action and takes place prior to the intervention. Completed Intervention refers to TDT interventions that have been successfully completed by the client and are logged once they have completed their intervention.

Should service units for completed interventions capture the amount of time the client spent participating in that intervention? Yes. Tor example, if a client participated in a support group that lasted for one hour, the CI- TDT Support Group service would be selected at 4 units.

What is the difference between the CAREWare reports: Performance Measure Report, Custom Report, Financial Report?

Performance Measure Reports: The performance measure reports have a numerator (clients who satisfy the measure) and denominator (clients who are eligible for the service that is being reported). The TDT services that are performance measures are: Tobacco Ask, Tobacco Advise, Tobacco Assess. Grantees must indicate the “As of Date” for the last day in the reporting quarter.

Custom Reports: The custom reports are created to account for screening and demographic information. The custom report for the TURP project is Tobacco Ask. Grantees must indicate the date range for the reporting period.

Financial Reports: The financial report provides an overview of all service categories and subservices that were provided and specifies how many clients were served. Grantees must submit the Financial report for their specific agency and indicate the date range for the reporting period.

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AppendixIncluded in the appendix are sample consent/confidentiality form and New CW User contract. If you do not have a username or never used CAREWare, you must complete the New CW User contract and the CW Agreement Form.

Consent/confidentiality form

[INSERT AGENCY LETTERHEAD HERE]

Consent for the collection and sharing of patient information to providers for persons who have HIV under the Tobacco Use Reduction Project

____________________________ (Name of Agency) is mandated to collect certain personal information that is entered and saved in a database system called CAREWare. CAREWare records are maintained in an encrypted statewide database, in a secure server in Lansing. CAREWare aggregate reports will be used for documentation of tobacco dependence treatment services, and any client information used will be done so without revealing names or other information that would identify any specific client.

The CAREWare database program allows for certain medical and support service information to be shared among providers who are funded for the Tobacco Use Reduction Project; this includes, but is not limited to: medical visits, lab results, demographic data, annual review information, and tobacco dependence treatment services. All providers who have access to the tobacco domain must sign confidentiality agreement forms and are committed to keeping client information secure.

You have a right to opt out of this electronic sharing; however, you may be unable to receive some tobacco dependence treatment services.

I______________________________ (Client Name) hereby provide my consent and authorization for ____________________________ (Name of Agency to enter my client specific information in the encrypted CAREWare database which is operated and maintained by MDHHS.

___________________________ ___________________________

Client signature Date

____________________________ ___________________________

Witness Signature Date

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CAREWare New User RequestMICHIGAN CAREWARE NEW USER REQUESTMichigan Department of Health and Human Services

Technical Support EmailMDHHS-CareWareSupport@michigan.gov

517-335-7718

Agency Date           Program

Ryan White Part A Ryan White Part B Ryan White Part C Ryan White Part D Care Coordination Data to Care Tobacco Cessation Other      

Name (Last, First) Phone Email Address                 User Permissions Group (Select one)

Data Entry User (view client info, add and edit services and clinical, and run custom reports)

General User (all of the above and: add and edit client info; run all reports; create and edit custom client reports, clinical encounters, and follow-up referrals; and set client sharing status)

Management User

(all of the above and: delete services [dependent on funder]; create and edit all reports; export all reports; view contracts; and terminate/remove user accounts)

Comments     

Requester’s Name Requester’s Signature Date

           Supervisor’s Name Supervisor’s Signature (Required) Date

           

For Administrative Use OnlyNotes/Comments Date received           

Completed by Signature Date completed

           

The Michigan Department of Health and Human Services (MDHHS) does not discriminate against any individual or group because of race, religion, age, national origin, color, height, weight, marital status, genetic information, sex, sexual orientation, gender identity or expression, political beliefs or disability.

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