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Tools for Managing Care Plus & CCM Information

Here are four tool sets for your use in managing your Care Plus / CCM programme. CCM –as you know – is the short reference to the Counties-Manukau Chronic Care Management programme which you use as part of your MT32-based Care Plus patient management (Module/Recall-Screening/Chronic Care Management).

Each tool set is contained in one or more files that you can download from this web site.

Tool Sets for Care Plus.doc

Tool Set 1 Identifying patients with chronic conditions – This file holds instructions and SQL code designed to let you list patients with one or more of the following diagnoses: COPD, diabetes, ischaemic and cerebrovascular disease, and congestive heart failure.

Chronic Conditions Patient List.doc

Tool Set 2 Identifying patients on specific medications – This MT32 query will help you to select patients who have been prescribed selected medications. For example, you may want a list of patients on anticoagulant therapies so that you can begin a specific therapy monitoring clinic.

Specific Meds Patient List.doc

Tool Set 3 Developing & using customised documents in MT32 – This tool set contains one instruction file and 5 .MTD files designed for import into MT32. All should be copied to your computer but only the instruction file can be opened using your word processing programme. The others can only be opened in MT32.

This instruction file tells you how to import the files below and how to design your own documents. Custom documents in MT32.DOC
This is the 1st part of the patient’s wellness plan covering patient consent to participate.

WELL1 Wellness Plan Intro.MTD
This part covers the use of patient information. WELL2 Wellness Info.MTD
This form provides a review of the patient’s history and current status. WELL3 Wellness Status.MTD
This final part covers the patient’s goals & health targets. WELL4 Wellness Targets.MTD
This form provides a list of the patient’s long-term diagnoses and medications. DXRX Patient long term Rx.MTD

Tool Set 4 Counties-Manukau CCM materials – These materials have been designed for the Counties-Manukau CCM programme – which differs from our Care Plus programme in its financing and administration but is clinically similar. Watch for references that might be unique to the Counties-Manukau programme.

Diabetes Manual.doc Diabetes inserts.doc
CHF Manual.doc CHF inserts.doc
COPD Manual.doc COPD inserts.doc
CVD Manual.doc CVD inserts.doc
   
Maori and Pacific Perspectives.doc Smoking and stress inserts.doc

If you need any help with this, get in touch with your PHO.

 

 

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