Systematic Case Review (SCR) Effectiveness Checklist
Item
Set agenda to organize and
prioritize case
presentations.
Timekeeper assigned with
expected time for case
presentations established
(time for new cases and for
follow-ups).
Standard
Variations
Less Effective Practice
First 1-3 minutes used to
determine the number of
new cases and number of
follow-ups to present. Time
divided to meet needs.
Cases collected from care
managers by SCR organizer
day before meeting.
Organizer creates case list
with order of presentation
and priorities.
Care manager starts at the
top of the list and works
down.
When this time is
approaching, timekeeper
notes this, with team
decision to continue or to
table some questions for
next SCR.
Time determined in larger
segments such as 1 hour for
new cases, 30 minutes for
follow-ups. Or by care
managers (if more than 1
presenting to SCR).
No standard practice or
habits for timekeeping.
Where multiple care
managers, go in round robin
fashion with mix of old,
new, COMPASS and nonCOMPASS patients
presented.
The time for cases
determined both by
workload and by past
SCR’s where time was kept.
1 Item
Recommendations are
specific for medications
and/or other interventions.
Entire SCR Team is
viewing the same
information together.
Standard
Less Effective Practice
Consultants make a
recommendation that is of
same specificity as if he/she
were to be writing the order.
Recommendations made for
class of drug, or several
alternatives recommended
without prioritization.
This may include
alternative
recommendations, if the
care manager (CM) learns
more from PCP team or
from patient.
No non-medication
recommendations made
EHR and registry are
projected on screens. As
information is sought in
EHR, all can see what is
found.
All can see what is in the
registry.
Variations
Summary sheet with key
information is handed out to
team with includes
prioritization and order of
case presentations. (Patient
list with parameters, new
patients highlighted green,
follow-ups yellow).
Each team member with
laptop, looking up
information that he/she may
be interested in. These
teams may have long
stretches of waiting or
silence where no work is
being done.
2 Item
Standard
Variations
Less Effective Practice
Missing information is
noted as an action step to be
presented at the next SCR.
If information is not readily
available in the EHR, the
question and specific
information is noted for the
CM.
CM’s may bring specific
notes or test results they do
not know how to interpret
or are unsure of relevance
to the meeting for the MD
consultants to review.
Information is sought from
the EHR during the SCR.
CM’s do not learn the skills
to find needed info or do
not learn what information
is needed when as quickly.
Teams do not spend lots of
time in the meeting looking
for info, especially info that
is buried in consult notes
and other hard to scan
documents.
Time for next expected
review of the patient is
specified.
Part of the recommendation All cases are routinely
is when the case will next
reviewed at least monthly.
be expected to come to
SCR. This is determined by
the treatment
recommendations made.
Follow-ups are dependent
on CM bringing cases as
he/she has contact with the
patient.
This is noted in registry or
other panel management
tool.
3 Item
Team has a plan to assure
that all cases are reviewed
on a regular (monthly)
basis.
Standard
This includes cases where
there may have been no
contact, if this is not
expected.
Variations
Less Effective Practice
Team reviews all patients at
each SCR.
Only patient cases with
active contact are reviewed.
No plan for those who have
been “lost” (not answering
the phone).
Consultants remember cases
with only a short reminder
presentation. (This may
become less effective as the
caseload grows, but is likely
MD dependent.)
Consultants ask questions
about old cases, until they
have enough baseline
information to recommend
next steps.
Cases where the
expected/specified followup may be longer than a
month, it may be noted and
not discussed.
Consultant physicians have
method of keeping track of
specific cases.
Some MD’s use registry.
Others have 3x5 cards or
other notes to help them
remember cases and
recommendations.
Others use summary list
prepared for the each SCR.
Consultants review the
CMTS ahead of the SCR
meeting. (This is not
common, most MD’s do not
prepare for the SCR).
4 Item
Standard
Clinic leader or other
problem-solver attends
SCR’s regularly, to attend
to workflow changes, other
accountabilities.
CM supervisor and/or clinic
managers attend and make
or champion organizational
changes needed to support
COMPASS, the CM and the
SCR.
CM’s use a standard
presentation format,
including specifying the
questions needed to be
answered at the SCR.
SBAR is one such format,
the others have been
established.
Using a format allows the
listener to listen, knowing
what information will be
presented. There are fewer
interruptions and more
complete information.
SCR teams work on this
together, it does not arise
without planning.
Variations
Cases are sent out to SCT
team the day before the
meeting, and the MD
consultants review the case
ahead of the meeting,
coming with questions and
draft recommendations.
Less Effective Practice
Each CM presents cases in
his/her preferred style.
Consultant MD’s ask lots of
questions, in no specific
order or without context.
SCR teams regularly
discuss their processed and
use tests of change to
improve their work.
5 Item
Standard
Variations
Less Effective Practice
Teams continue to seek
novel interventions for
patients who have not
engaged with the system in
traditional ways.
They do not easily give up
on patients out of control.
Teams remain focused on
the diseases/conditions for
COMPASS.
Social/economic and other
conditions are addressed as
needed, while continuing to
treat to target.
SCR teams have regular
membership, and all attend
weekly meetings routinely.
Where team members need
to be absent, there is a back
up plan in place.
Each team member has a
backup designated who is
comfortable and
knowledgeable about
COMPASS process as well
as the subject matter.
Short-term absence (1
meeting) may be covered by
the remainder of the team,
but the team does meet.
6 Item
SCR teams meet in person
during the
development/team building
phase.
Where a single SCR team
covers multiple
clinics/practice sites, the
team rotates locations.
Standard
Variations
Less Effective Practice
Video conferencing and
phone conferencing have
worked well when team
members already had
established relationships or
were part of the design team
for COMPASS.
Pragmatic considerations
have dictated other
solutions and weather/travel
hazards and time will likely
drive more teams to
convene on line or on the
phone.
7 Item
Standard
Variations
Less Effective Practice
A team member is assigned
the task of scribing.
The scribe is not the person
who is presenting a given
case. A single person
writes the recommendations
and next steps for both
MD’s and the CM in either
the CMTS or EHR.
The written report is either
projected for all to see, or a
read-back process is
instituted to assure
accuracy.
Information from
subspecialists and others
involved in the patient’s
care of COMPASS diseases
is sought, reviewed and
recommendations made.
CM takes notes, reads them
back and creates her followup note with
recommendations to the
PCP teams after the SCR
meeting.
Each MD writes a note in
the CMTS. Since only one
person can be in the system
at once, making the
sequential note writing a bit
slow.
Both IM/FP and psychiatry
provide recommendations,
regardless of the other
physicians involved in the
patient care.
Psychiatrists defer all
treatment recommendations
to the patient’s psychiatrist.
IMFP defer all treatment
decisions to endocrine,
cardiology, etc.
This includes
recommendations that
might best be implemented
outside of the PCP team
(i.e., outside psychiatrists,
or endocrinologists).
8