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FY 2009 Audit Instructions

5. PERFORMING A MANUAL AUDIT

b. Inclusions and Exclusions

The diabetes register will often include people who are not considered active patients of the clinic and thus should not be audited. These charts should be identified early in the audit process and excluded. Table 2 outlines the charts which are to be included and excluded.

Table 2 - Patients to Include and Exclude in the Chart Audit

Include patients who:

· Attend regular clinics or diabetes clinics.

· Sometimes refuse care or have special motivational problems (e.g., alcoholism).

· Are not attending clinic, but you do not know if they have recently moved or have found another source of care.

Exclude patients who:

· Have not had at least one primary care visit during the past 12 months.

· Receive primarily referral or contract care, paid by IHS.

· Have arranged other MD care, paid with non-IHS monies.

· Receive their primary care at another IHS or Tribal health facility.

· Live in a jail, and receive care there.

· Live in a nursing home, and receive care there.

· Attend an off-site dialysis unit and receive the majority of their primary care there.

· Have gestational diabetes.

· Have prediabetes (IFG or IGT) only.

· Have moved -- permanently or temporarily (should be documented)

· You are unable to contact, defined as 3 tries in 12 months (should be documented in the chart).

· Have died.

Keep in mind that unless your diabetes register is frequently updated, up to 10% or more of the people in the diabetes registry may not qualify to be included in the audit. To make sure you have an adequate sample at the end of the audit, increase the chart sample by at least 10%. In the example of 63 charts used above, this would mean an additional 6 charts, or a total of 69, would need to be pulled for the audit.

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