- CQI Tool
- Data Collection Forms
- Authors: Linda Juszczak, MS, MPH, DNS; Doris Pastore, MD; Christopher J. Reif, MD, MPH, MA
School-based health centers (SBHCs) are designed to detect and address the significant health problems and health risks of each age group among school-age children, i.e. elementary, middle or junior high, and senior high students. A comprehensive annual risk assessment (and biennial physical exam) is essential to detecting and addressing all important health concerns of the students at each level of school. Within each age group there are certain conditions that stand out because they represent typical health risks for that age and because they may serve as a measure of good health care delivered. This chart presents seven “Sentinel Conditions” for each school age group.
It is important to highlight several points about the sentinel conditions. First the sentinel conditions are clinically based. That is, they represent those conditions of health commonly encountered and treatable in a SBHC setting. Next, a limited number of conditions were chosen for several reasons. It allows each health center to focus on a meaningful evaluation. It facilitates local and national comparisons between sites and it allows for additions and changes to the list of conditions in future years as success is achieved with the initial measures.
Thus the list of sentinel conditions is purposefully not comprehensive. Rather, they are intended to be the “core measure” of quality in school-based health centers. It is understood that SBHCs will be subject to quality measures from other sources and agencies and depending on the services provided (e.g. dental, prenatal, well child care). For these added services, additional quality measures will necessarily be developed and applied.
The sentinel condition column identifies the sentinel condition to be monitored. The reference column includes references that support the inclusion of the condition and act as references to access for best practices on diagnosing and treating the condition. Resources are the minimum requirements (policies, equipment, information, relationships) that need to be in place in order to provide clinical services relative to the condition. The markers column describes the data to be collected from the medical record in order to evaluate the quality of care for the sentinel condition. The final column is the marker column and it is the score assigned to the data gathered from the medical record review. The measurement scale from 1 to 5 is designed with a value of 3 as the threshold or minimum standard of care. A score of 1 or 2 is below threshold and 4 or 5 are above threshold.
The foundation for each age grouping is an annual risk assessment and a biennial physical examination for registered students. The risk assessment may be conducted several ways including with student completed paper and pencil assessment forms, computerized assessment forms, interviews by the SBHC staff done separately from the physical examination and interviews done by the provider the time of physical examination. They can be conducted on an individual basis or in as part of classroom screenings. The SBHC may construct its own form or may elect to use forms that have been developed by nationally recognized organizations such as the AMA’s GAPS.
Each SBHC will need to determine how it prefers to operate however, there are come guidelines to keep in mind especially for those programs that elect to design their own materials. The biennial history and physical examination should be thorough and should include in addition to a history of current complaints and review of systems, a past medical history, family history, and behavioral/developmental history. The physical should include height, weight, blood pressure, vision screen, physical assessment of all systems, and appropriate laboratory testing. An annual risk assessment that is developmentally appropriate is expected to cover: injury, safety, and violence, diet and exercise, dental, substance use and passive exposure, abuse, family relationships, school, friends, mood and emotional health, and sexuality. The risk assessment can be incorporated into the biennial physical or done separately but should be included in the registrants medical record.
CQI Version 1 September 1, 2001
Sentinel Conditions Elementary School |
References |
Resources |
Markers |
Measurement 1 |
Annual risk assessment 2 Biennial physical exam |
Bright Futures HEDIS AAP USPHSTF PPIP |
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1= 0-25% of charts with both markers documented 2= 26-50% ” 3= 51-75% ” 4= 76-95% ” 5= >95% “ |
Asthma, Chronic |
AAAAI NHLBI AAP |
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1= 0-40% of charts have asthma plan 2= 41-60% ” 3= 61 -100%” 4= Above plus 50-75% of visits show the student in green zone or stable 5= Above plus >75% of visits show student in green zone or stable |
Incomplete Immunizations |
AAP Red Book State Registries Local Health Department |
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1= 0-25% of records show that students behind in recommended intervals for immunizations required for school entry are brought up to date 2= 26-50% ” 3= 51-75% ” 4= 76-95% ” 5= >95% “ |
High Risk for Unintentional Injury |
Bright Futures AAP CDC Safe Students Children’s Safety Network PPIP |
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1= 0-25% show evidence of prevention materials sent home or student education 2= 26-50% ” 3= 51-75% ” 4= 76-95% ” 5= >95% “ |
Poor school performance |
Bright Futures Mental Health DSM-PC |
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1= 0-50% of charts show record of medical and mental evaluation 2= 51-95% ” 3= >95% ” 4= Above plus 50-75% have evidence of plan, and referral for academic services 5= Above plus >75% “ |
Sentinel Conditions Elementary School |
References |
Resources |
Markers |
Measurement 1 |
Mental Health 3 Students being treated for ADHD |
AAP AHCPR DSM-PC NIMH |
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1= 0-20% of charts with plan 2= 21-50% of charts with plan 3=>50% of charts with plan 4= Above plus 50% of charts with compliance check and effectiveness evaluation 5= Above plus >50% of charts with compliance check and effectiveness evaluation |
Child Abuse |
State regulations School policy AAP Guidelines for professional disciplines |
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1= 0-50% of students identified are connected to appropriate agency 2= 51-95% ” 3= >95% of students identified are connected to appropriate agency 4= Above plus 50-75% of students remaining in school are receiving ongoing case management 5= Above plus >75% of students remaining “ |
Sentinel Conditions Middle/ Junior High |
References |
Resources |
Markers |
Measurement 1 |
Annual risk assessment 2 biennial physical exam |
Bright Futures HEDIS AAP USPHSTF PPIP GAPS |
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1= 0-25% of charts with both markers documented 2= 26-50% ” 3= 51-75% ” 4= 76-95% ” 5= >95% “ |
Tobacco Use |
USPHS Clinical Practice Guideline for Treating Tobacco Use & Dependence in JAMA ALA AMA AAP ETR PPIP |
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1= 0-50% receive intervention 2= 51-95% receive intervention 3= >95% receive intervention 4= Above plus 50% compliant with plan 5= Above plus 1-20% report smoking cessation |
Risk of Pregnancy |
GAPS Bright Futures AMA Planned Parenthood SEICUS PPIP ETR |
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1= 0-50% of at risk students have documented prevention plan 2= 51-95% ” 3= >95% ” 4= Above plus 1-50% of charts have documented a risk reduction 5= Above plus >50% of charts have documented a risk reduction |
Poor school performance |
Bright Futures Mental Health DSM-PC |
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1= 0-50% of charts show record of medical and mental evaluation 2= 51-95% ” 3= >95% ” 4= Above plus 50-75% have evidence of plan, and referral for academic services 5= Above plus >75% “ |
Sentinel Conditions Middle/ Junior High |
References |
Resources/Tools |
Markers |
Measurement 1 |
Parent-child conflict |
Bright Futures GAPS DSM-PC |
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1= 0-50% evaluated and assessed 2= 51-95% ” 3= >95% ” 4= Above plus >75% have a plan 5= Above plus >35% show reduction in conflict |
Mental Health 3 Students being treated for ADHD |
AAP AHCPR DSM-PC NIMH |
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1= 0-20% of charts with plan 2= 21-50% of charts with plan 3= >50% of charts with plan 4= Above plus 1-50% of charts with compliance check and effectiveness evaluation 5= Above plus >50% of charts with compliance check and effectiveness evaluation |
At Risk for Depression |
GAPS DSM-PC AHCPR SAMHSA |
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1= 0-50% with completed evaluation, referral and plan 2= 51-95% ” 3= >95% ” 4= Above plus 25%-%50 show improvement 5= Above plus >50% show improvement |
Sentinel Conditions High School |
References |
Resources |
Markers |
Measurement 1 |
Annual risk assessment 2 biennial physical exam |
Bright Futures HEDIS AAP USPHSTF PPIP GAPS HEADSS |
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1= 0-25% of charts with both markers documented 2= 26-50% ” 3=51-75% ” 4= 76-95% ” 5= >95% “ |
Alcohol use |
GAPS NIDA SAMHSA AAP ETR PPIP USPHSTF |
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1= 0-50% evaluated for abuse 2= 51-95% ” 3= >95% ” 4= Above plus 50% of those evaluated with evidence of intervention plan or referral 5= Above plus 10% report drinking cessation |
Risk of Personal Violence |
CDC Hamilton Fish Institute SAMHSA PPIP GAPS |
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1= 0-50% with intervention, plan and referral 2= 51-95% ” 3= >95% ” 4= Above plus 25%-50% reduced risk 5= Above plus >50% reduced risk |
Risk of STI |
GAPS CDC Guidelines IOM PPIP |
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1= 0-50% with appropriate assessment and treatment 2= 51-95% ” 3= >95% ” 4= Above plus 25%-50% report reduced risk at next visit 5= Above plus >50% report reduced risk at next visit |
Sentinel Conditions High School |
References |
Resources/Tools |
Markers |
Measurement 1 |
Poor school performance |
Bright Futures Mental Health DSM-PC |
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1= 0-50% of charts show record of medical and mental evaluation 2= 51-95% ” 3= >95% ” 4= Above plus 50-75% have evidence of plan, and referral for academic services 5= Above plus >75% “ |
Mental Health 3 Students being treated for ADHD |
AAP AHCPR DSM-PC NIMH |
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1= 0-20% of charts with plan 2= 21-50% of charts with plan 3= >50% of charts with plan 4= Above plus 50% of charts with compliance check and effectiveness evaluation 5= Above plus >50% of charts with compliance check and effectiveness evaluation |
At Risk for Depression |
GAPS DSM-PC AHCPR SAMHSA |
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1= 0-50% with completed evaluation, referral and plan 2= 51-95% ” 3= >95% ” 4= Above plus 25%-50% show improvement 5= Above plus >50% show improvement |
1 Scale of markers: 1 and 2= below threshold; 3=at threshold; 4 and 5= above threshold 2 Annual Risk Assessment and results of Biennial Physical Exam should be in the chart by the third visit. 3 Each program should choose one of the two Mental Health conditions for evaluation. |