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Care Management - Admin Guide

Care Management - Admin Guide

Owned by Matthew Cavallo (Unlicensed)
Last updated: Jan 09, 2024 by Stephanie Smith
8 min read

Description: In this guide, the user will learn about the Care Management Module. The DCI Care Management Module is designed to track the Individual Support Plan (ISP) of a client. An Individual Support Plan (ISP) is defined as documentation of the activities, resources, and supports that an individual, Personal Agent or Service Coordinator, and other designated caregivers agree are important to or for achieving and maintaining personal outcomes. The Individual Support Plan is referred to as the Plan of Care in DCI and is specific to the individual receiving care. The Plan of Care is where individual goals are tracked.

*Please note: Care Management is an instance-level setting and must be enabled by a DCI Project Manager or account representative. If Care Management is enabled, the Care Management tab will be visible on the main menu in DCI.

Roles Required: Super User, Supervisor

Permissions Required: Plan of Care Admin, Client Admin

Setting Up Care Management for a Client

Description: In this topic, the user will learn how to set up Care Management for a client. Complete all steps in all sections below to finish the set-up which includes enabling care management for the client, creating the plan of care, adding goals, adding tasks, and linking goals to the funding account.

Enable Care Management for a Client

  1. Log in with the appropriate profile

  2. Click Home on the main menu

  3. Click Clients on the submenu

  4. Enter the client name into the search filter and click Search

  5. Click anywhere on the client’s row in the results table to open the Client Details page

  6. Click Actions 

  7. Select Edit Client from the drop-down menu

  8. Click the Client Information tab on the Edit Client Details page

  9. Click the Enable Care Management checkbox at the bottom of the page

  10. Click Save and Yes to confirm

Add a Plan of Care for a Client

  1. Log in with the appropriate profile

  2. Click Care Management on the main menu

  3. Click Plan of Care on the submenu

  4. Click Actions 

  5. Select New Plan of Care from the drop-down menu

  6. Complete the Add Plan of Care form wizard

    1. Client - Type the client's name and select it from the list generated

      1. Please note: If the client’s name does not appear in the list, Care Management is not enabled on the client profile.

    2. Assessment - Enter the assessment, a summary plan of care, progress, and status of goals.  

      1. Assessment field is free text, data-based, or narrative, and can be edited throughout the life of a Plan of Care.

    3. Effective Date – Enter the date the Plan of Care starts

    4. End Date – Enter the date the Plan of Care ends

    5. Status – Select Active or Inactive from the drop-down

  7. Click Save and Yes to confirm

Add Goals to the Plan of Care

  1. Log in with the appropriate profile

  2. Click Care Management on the main menu

  3. Click Plan of Care on the submenu

  4. Enter the client name into the search filter and click Search

  5. Click anywhere on the client’s Plan of Care in the results table to open the Plan of Care Details page

  6. Click Actions

  7. Select Add Goal from the drop-down menu

  8. Complete the Add Goal form wizard

    1. Goal Name - Enter a general name for the goal

    2. Summary - Enter information specific to the individual and goals

    3. Target Outcome - Represents the target percentage of met outcomes for all completed tasks under this goal

    4. Effective date - Select a start date. Goals can start on any date within the plan of care dates and will display for the caregiver.

    5. End date - Select an end date. After this date, the caregiver will no longer see the goal.

    6. Status - Select Active or Inactive from the drop-down

  9. Click Save and Yes to confirm

  10. Repeat steps 6-9 to add additional goals for the client

Add Tasks to Goals

  1. Log in with the appropriate profile

  2. Click Care Management on the main menu

  3. Click Plan of Care on the submenu

  4. Enter the client name into the search filter and click Search

  5. Click anywhere on the client’s Plan of Care in the results table to open the Plan of Care Details page

  6. Select the Goals tab on the Plan of Care details page

    1. The goal(s) for the client will be listed

    2. Optionally search for a specific goal or scroll down to view all goals for the client

  7. Click anywhere on the goal row in the results table to open the Goal Details page

  8. Click Actions 

  9. Click Add Task from the drop-down menu

  10. Complete the Add New Task form wizard

    1. Task Details tab:

      1. Task Name - Tasks are a component of the overall goal

      2. Summary - Enter the actions the caregiver must take for the task

      3. Met Condition - Enter the condition(s) acceptable for the task to be marked as Met

      4. Not Met Condition - Enter the condition(s) in which the caregiver should mark Not Met

      5. Additional information - Required field to ensure the task can be marked as met or not met

      6. Required - Click Yes or No

        1. If Yes, the task must be resulted before a care note can be published.

          1. Please Note: Employees using the mobile app cannot clock out until the task is resulted if the Require Care Note setting is set to Yes on the service code.

        2. If No, the task is not required for the care note to be published.

      7. Target Outcome - The target percentage of met outcomes of completed tasks

      8. Effective date - The date the task starts. Can be any date within the goal dates. The task will be visible to the caregiver.

      9. End date - After this date, the caregiver will no longer see the task.

      10. Status - Select Active or Inactive from the drop-down 

      11. Click Next

    2. Tracking Option tab:

      1. Allow Refusal - Select Yes to allow the caregiver to select that the client refused to participate

        1. If yes is selected, it will count towards the target outcome goal.

        2. If no is selected, it does not count towards the target outcome goal.

      2. Allow Barrier - Select Yes to allow the caregiver to select Barrier as a task outcome

        1. Examples of barriers might include Client was sleeping, client was having a medical issue, etc.

      3. Click Next

    3. Additional Questions tab:

      1. Additional Questions are questions the employee will document with their care note and can be either Canned or Custom question types

      2. Question type - Click Canned or Custom

        1. Canned – This question type applies to more than one client. To add canned task questions, see the step-by-step instructions below for Create a Canned Task Question.

          1. Select Question - Click the Select Question drop-down and make a selection

          2. Required - Click Yes or No

          3. Status - Select Active or Inactive from the drop-down

          4. Click the plus sign (+) button to add a canned question

          5. Repeat as necessary

          6. Click Save

        2. Custom – This question type is specific to a client and the documented task

          1. Question - Enter Question text

          2. Required - Click Yes or No

          3. Click Next

          4. Answer - Enter the answer text and click the plus sign (+) button

          5. Repeat to add up to seven additional answer criteria

          6. Click Save to return to the Additional Question screen

        3. Repeat either the Canned or Custom process to add additional questions as needed

    4. Click Save and Yes to confirm

Link Goals to Funding Account

  1. Log in with the appropriate profile

  2. Click Authorization on the main menu

  3. Click Funding Accounts on the submenu

  4. Enter the search criteria in the filter (i.e., client, cost center) and click Search

  5. Click anywhere on the Service Account row in the results table to open the Account Details page

  6. Click Actions 

  7. Select Add/Remove Goals from the drop-down menu

  8. The Add/Remove Goals wizard will open

  9. Select a goal(s) in the Available Goals column

    1. Click the right triangle button to add a goal to the Selected Goals column

    2. Click the double right triangle >> button to add all goals to the Selected Goals column

    3. Click the left triangle button to remove the goal from the Selected Goals column

    4. Click the double left triangle << button to remove all goals from the Selected Goals column

  10. Click Save and Yes to confirm

Create a Canned Task Question

  1. Log in with the appropriate profile

  2. Click Settings on the main menu

  3. Click Task Question on the submenu

  4. Click Actions

  5. Select Add New Task Question from the drop-down menu

  6. Complete the form wizard

    1. Question - Enter question text

    2. Status - Select Active or Inactive from the drop-down

    3. Click Next

    4. Answer - Enter the answer. Click the plus sign (+) to add additional answers to be available for the question.

    5. Click Save underneath the answers to add more questions to this task if applicable

  7. Click Save and Yes to confirm

  8. The task question is now available for use when adding tasks to goals in the Add New Task form under the Additional Questions tab, Question Type Canned.

Care Management Overview

Description:  In this topic, the user will learn about the Care Management Overview page, how to search for and select a client who has a Plan of Care and view their progress toward goals and care notes.

  1. Log in with the appropriate profile

  2. Click Care Management on the main menu

  3. Click Overview on the submenu

  4. Enter the search criteria in the filter (i.e., client, employee, cost center) and click Search

  5. Click anywhere on the row to select and open the Care Management Overview Detail page

  6. On the Care Management Overview Detail page:

    1. View the Trends widget by selecting a tab

      1. Task Outcomes Over Time tab

      2. Task Submissions By Task tab

      3. Use the radio buttons to change the days displayed in the Trends widget

    2. The Plan of Care widget provides Goal details including goal name, number of tasks, outcome, target outcome, last tracked, effective date, end date, status, and added by.

      1. Select the goal by clicking anywhere in the row to open the Goals Details page

    3. Select a tab i.e., Care Notes, Task Results, Notes, Attachments, or Events to view. Select an entry in the results table to view the details page.

Reports

Description:  In this topic, you will learn about care management reports. The Care Management Reports are accessible in the Reports Module.

  1. Log in to personal profile

  2. Click Reports on the main menu

  3. Click Care Management Reports on the submenu

  4. The available reports are listed on the flyout menu:

    1. Pending Care Notes Report

    2. Task Result Details Report

    3. Raw Data Dump Report

    4. Client Diagnosis Report

    5. Diagnosis Code Usage Report

  5. Select the Report to run

  6. Enter desired criteria into the filters and click Search

  7. The records will display in the table below the filters

  8. Organize the results as needed by dragging and dropping the column headers

  9. Optionally, click the Download button and select the columns and the format in which to download the report.

For more information on how to download reports, please see the Reports - Run and Download article.

ICD-10 Codes

The user has access to advanced functionality for storing client diagnosis codes, including:

  • A library of all current ICD-10 Codes

  • The ability to add multiple diagnosis codes to a single client profile

Access and Search the ICD-10 Code Library

  1. Log in with the appropriate profile

  2. Click Settings on the main menu

  3. Click Diagnosis Code on the submenu

  4. Use the filters to view available codes

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