Long Term Outcomes

Question: What is the best way to document the LTO for patients in the registry who are discharged with follow-up at another facility/clinic? This happens sometimes because of insurance requirements, or because a patient is being discharged with family who live closer to another burn center, and follow-up is arranged there. It seems odd to say "lost to follow-up" because they have been arranged to receive follow-up elsewhere, but the other options of "follow-up continued/ongoing" and "follow-up complete" don't seem to fit either.

Answer: If you send them to another facility for follow up, then you should check "Lost to Follow Up" because the patient is no longer coming to your facility, and you are no longer doing the follow-up on the patient.  This is not a negative for your facility as there are many facilities that must refer patients to other facilities for follow-up because of distance and other issues.

Question: Should LTOS be tracked for non-burns too?

Answer: Yes, LTOs should be collected on all patients entered into the registry that continue to be followed by the Burn Service.

Question: For patients who have clinic procedures and then are later admitted for an initial inpatient stay for care of their initial injury, would you include those procedures under Hospital Procedures in LTOs or only those that occur after the initial admission?

Answer: Include Hospital Procedures performed only after the discharge from their initial inpatient stay.

Question: Will there be reporting available in BCQP for registrars to keep track of patient registry records that have ongoing LTO follow-up vs. those that have been lost to follow-up? It would be helpful if this were available as a standard report already built for us in the reporting environment and available for use at the time of the LTO roll-out.

Answer: Yes, once bData releases the fields in data entry they can develop reporting. They will follow up with everyone in Spring 2024 so you can see a couple reports they will be adding to our library: 1) To keep track of worklist (ongoing follow up on) and 2) summarizing those metrics and evaluation data.

Question: Are LTO entered for patients who are admitted or for all burn patients seen in the outpatient clinic at a burn center (therefore including patients who have not and may never be admitted)?

Answer: Enter LTO only for patients who were originally inpatients and entered in your registry.

Question: If a patient was an outpatient and was admitted to have a procedure, we are not required to document LTO data for these patients since they were not originally inpatients?

Answer: If the patient has been entered in your registry, which they would be for an inpatient procedure, then yes, you would enter LTO data on them.

Question: Do LTOs (Long Term Outcomes) need to be completed on all patients in the registry or only burn patients.

Answer: All patients should have Long Term Outcomes entered. If the patient has a non-burn injury such as friction/ road rash, you should complete the data point.

Question: A was patient admitted to burn service for a burn injury, but surgery is done by another service (i.e. hand surgery done by the hand surgery service) and then at the time of discharge they follow-up in the same hospital system, but not burn clinic - would this be lost to follow up or follow-up complete?

Answer: If the patient is discharged from the Burn Service and does not follow up in the Burn Service clinic but still need burn follow up, then they are Lost to Follow Up. If the patient is discharged and it is determined by the burn service that they no longer require any burn follow up, then their Follow up is Complete. You may need to ask you burn team which selection is appropriate.

Question: What if patient died during their hospital stay and won't have LTO? Ok to leave screens blank?

Answer: Yes, you should not enter LTOs on any patient that died as an inpatient.

Question: If a patient has an appointment in the burn clinic but "no shows," should they put that in as an LTO encounter and just put ND in all the fields?

Answer: No, if they don’t show up, don’t put in as an encounter. Only enter encounters when they show up to appointments.

Date of 95% Wound Closure

Question: Is the Variable "Date of 95% wound closure" required for non-burn patients as well?

Answer: No, this field is only required for burn patients. The next update of the Data Dictionary will reflect this but for the time being, only record this information for burn patients and click "Not applicable" for patient with inhalation injury or non-burn patients.

Question: On data dictionary page for 95% wound closure (page 147), it gives us the field value of "Not known/Not recorded" but that option is not available in BCQP. I only see a date field or Not applicable. What do we use in BCQP for Not known/Not recorded?

Answer: For now, just leave it blank. We will discuss this with BData.

Question: If you have a patient that was discharged and will follow up at another burn center closer to their home, what should you document for the LTO - Closure and Procedures tab for: Date of 95% wound closure? - Not applicable since they aren't following in your burn center? and Follow-status? - Lost to follow up?

Answer: You should leave the 95% wound closure field blank, if the wound was not 95% closed at your facility, either before they were discharged or after if you are seeing them in your clinic. You would select "Lost to Follow Up" for follow up status.

Outpatient Follow Up Status

Question: If patient is from out of state and follow-up care after inpatient stay does not occur at the burn center clinic/outpatient department, what should be entered for follow up status?

Answer: If the patient will not be returning for follow up care, and that care is still needed, they should be recorded as lost to follow up. This is true even if they were referred to another care center for follow up.

Question: Are long term outcomes collected for a specified period of time?

Answer: Long Term Outcomes are collected for 12 months from the time of the patient's initial discharge.

Question: What should be entered when a patient that has an inhalation injury is discharged and does not require any follow up in the burn clinic? Would it be "follow up complete" even though they did not have any follow up? What about when their follow up is with their PCP?

Answer: Yes, it would be Follow Up Complete because, from the Burn Center's point of view, the patient does not require any further follow up for their burn. If they do require follow up for their burn, but this is referred to their PCP, enter Lost to Follow Up.

Question: A burn patient followed up at our outpatient clinic for 2 months after discharge, then moved to another state for continued follow-up. What should be selected for the follow-up status: "continue," "complete," or "lost to follow-up"?

Answer: Lost to Follow-up if the patient still requires follow-up care for the burn injury but is being sent to a different facility for continued care. This is not a negative statement as many burn centers send their patient to other facilities for follow-up care if they live a distance away.

Operative or Outpatient Procedure Date

Question: Procedure types- Are pinch grafting, kenalog injections included under Procedure types? Are irrigation and debridement’s excluded under the current definition?

Answer: Include all incisional procedures and laser procedures. Kenalog injections are not incisional and not included.

Question: Question: Is ABA defining the onset of PTSD after ASD - our facility refers to ASD as converting to PTSD after 30 days.

Answer: If the patient has ASD within the 1st 30 days and then continues to have PTSD after 30 days, you will select both of these.  Some patients may have one or the other or both.

Question: Question: For patients who might be repeatedly coming to clinic, is it required that they be reevaluated for symptoms at every clinic visit? If a screening tool at the first clinic visit is used, would questions about mood, or self-disclosure be enough to document presence of ASD/PTSD/Depression?

Answer: ASD and PTSD must be diagnosed by a medical professional, depression may be either by patient/parent report or medical professional.  A screening tool may be used to document depression, but not ASD/PTSD. No, you do not have to do this every visit and if you don’t for a selected visit, select “Not Documented in Outpatient Record”.

Date of Outpatient Visit

Question: Is every LTO visit being recorded for a defined period of time or based on a triggering event?

Answer: Record every outpatient visit for the first 12 months post-discharge.

Question: What should be entered for clinic evaluations on patients that come into the clinic daily for dressing changes?

Answer: The decision about which clinic visits to enter is up to the burn center. If the patient is coming in daily for dressing changes, you may decide to only enter a weekly clinic visit to capture how the patient is doing. The intent here is to obtain long term follow up data on those variables in the clinic evaluation section, and if the data is not changing from daily visit to daily visit, you may decide not to enter each daily visit.

Scar Appearance Evaluated

Question: For the LTO scar appearance evaluated field, there are only two options - yes or not documented. What if the patient's burn is still acute and there's no scar formation yet? I feel like "not documented" doesn't necessarily reflect what's happening, since there's no scar to evaluate yet.

Answer: This is currently being reviewed by the Data Definitions Workgroup. For now, if there are no scar to evaluate, leave this blank.

Patient has Return to Pre-Burn Injury Activities

Question: When answering if patient has returned to pre-burn injury activities would you select “yes fully” for a situation in which a patient returns to work even if they are in a different vocation? Also, for patients that may not be employed are we correct in assuming that this includes activities, such as school, past times, and general life responsibilities?

Answer: Yes, that’s correct. Yes, it’s whatever the patient/parent considers fully returned to pre-burn activities.

Presence of Post-traumatic Stress Disorder (PTSD)

Question: Can a social worker document PTSD or ASD?

Answer: A medical professional can document the presence of PTSD or ASD - a psychologist or psychiatrist should be involved in the diagnosis of these conditions.

Question: For the data points PTSD and ASD - what is the different between "yes-screening tool" and "yes-documented"?

Answer: If the clinic is using a screening tool to evaluate these data points, then check “yes – based on screening during clinic” field value. If the clinic note references health professional documentation of PTSD or ASD, but no specific screening tool is mentioned in the chart, then check “yes- based on documentation in chart”.

Question: Can you add N/A on the LTO - Evaluation section for PTSD follow up? Our pediatric patients don’t get screened for PTSD.

Answer: No, if you don't screen, then click "Not documented in Outpatient Record".

Question: In LTOs, does the mental health diagnoses for PTSD and ASD need to be documented in the clinic notes or can we take the diagnosis from an inpatient note?

Answer: For the Data Points on PTSD and ASD, the initial documentation can be in the inpatient note but should also be documented in the outpatient note if the condition is still present.

Presence of Acute Stress Disorder

Question: Are we specifically coding for ASD/PTSD/ Depression with onset at or near time of event? Would pre-existing diagnosis be included in this definition?

Answer: ASD/PTSD/Depression should be recorded regardless of time of onset, so yes, include pre-existing diagnosis.

Presence of Pain

Question: Which LTO presence of pain option would we choose for the presence of pain for a patient who says they have pain, but are not taking either prescription or over the counter pain medication? They are choosing to just live with what they have, they don't like taking medications, or it doesn't bother them enough to take something.

Answer: Please select "Yes, requiring over the counter pain medication" for those patients who say they have pain but are not taking any pain medication.