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Quality and Cost Programs

Medica Administrative Manual Home > Health Management and Quality Improvement > Medical Record Review

Medical Record Review

The Clinical & Service Quality Review (C&SQR) program is a continuous quality improvement program that measures and evaluates medical record documentation of care as well as timeliness and quality of service.

The C&SQR program is designed to assess the level of quality related to focused components of clinical care and services currently provided to Medica members by primary care practitioners in the Medica network. Clinical care is measured by review of medical records to compare documentation of care to measurable criteria. Service quality is measured by reviewing each clinic's process for assuring the timeliness and safety of appropriate patient care.

This includes emergency, urgent and non-urgent care. Measurement criteria for the C&SQR program are based on Medica's clinical and service quality priorities, Institute for Clinical Systems Improvement (ICSI) clinical practice guidelines, community standards of care, regulatory compliance and National Committee for Quality Assurance (NCQA®) accreditation requirements.


Quality Improvement Components

The following components are included in Medica’s Clinical Quality Improvement Program:

  • ADHD Management
  • General Chart Documentation
  • Health Promotion Adults (19-64 & 65-80)
  • Pain Assessment and Management 
  • Prenatal Risk Assessment
  • Well Child Visits (0-15 months & 3-20 years)

Clinical Quality Improvement Program

Medica has chosen specific quality standards on which to focus improvement efforts for the Clinical Quality Improvement Program. The established thresholds are based on the aggregate scores from the previous year's reviews. Clinics/clinic systems that score below the established threshold for any of these quality standards are asked to submit a written improvement plan within 30 days following the date of receiving the request.

At the end of each review year, clinic/clinic system reports are produced and given to each clinic/clinic system. These reports outline their specific results compared to plan aggregate scores of all the clinics reviewed for that specific measure. Strengths and opportunities for improvement are also addressed in the report.

View our member Quality Resources »


Clinical & Service Quality Review (C&SQR) Criteria

The following are review criteria (measurement questions): 


Provider Responsibility Policy

Medica has developed and adopted guidelines for Medica health care providers to follow for documentation in members’ medical records.

View our policy on medical record documentation »

Agency for Healthcare Research and Quality - Quality Indicators

The Agency for Healthcare Research and Quality's (AHRQ) Quality Indicators (QIs) are measures of health care quality that make use of readily available hospital inpatient administrative data. For more information, visit the AHRQ website.

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