Missouri WISEWOMAN Program Manual

The goal of the Quality Assurance (QA) program component is to assure that appropriate services are provided to each participant and that program funds are utilized as required by program protocol. QA activities ensure high-quality medical standards of care are provided to women receiving SMHW and WISEWOMAN screenings, diagnostic and education services, as well as referrals for treatment, when appropriate.

Performance Measures

Funding received from the CDC’s WISEWOMAN Program is contingent upon the Missouri WISEWOMAN Program meeting or exceeding several quality assurance parameters and performance measures. WISEWOMAN performance measures have been created based on the required measures from the CDC and other essential program requirements.

WISEWOMAN grantees are expected to meet or exceed the following performance measures:

• Program submits MDE files on schedule and with no more than a 5% error rate
• Program has actively engaged with a minimum of two public or private partner organizations to promote and support environmental changes for increased physical activity, access to healthy food choices, smoking cessation and elimination of exposure to secondhand smoke
• Program delivers Risk Reduction Counseling, including appropriate referral to Health Coaching, community resources or lifestyle programs, to 100% of women screened
• Program follows up with 100% of women with abnormal BP values with follow-up parameters determined by WISEWOMAN guidelines and facility medical protocol
• Program ensures that 80% of women referred to a lifestyle program or Health Coaching participate in the program, with participation defined as attendance at a minimum of one lifestyle program or coaching session
• Program ensures that 60% of women who participate in a lifestyle program or Health Coaching complete the program, with completion defined as the number of sessions that the evidence base for the program has determined to be required for behavior change

Provider Progress Reports

The goal of the progress reports is to increase provider ability to make changes throughout the fiscal year that enable them to maximize volume and quality of screenings completed and streamline reporting expectations across WISEWOMAN contracts, where possible. Providers will be sent a quarterly provider progress report (PPR).

Program Site Visits

WISEWOMAN staff members conduct annual site visits with providers throughout the course of the five-year grant cycle. Site visits serve as an opportunity to highlight program successes, challenges encountered, lessons learned, useful tools and technical assistance needs.

Program Monitoring and Audits

MDHSS/WISEWOMAN monitors and evaluates the quality and appropriateness of participant care using the following QA activities: 

• Incorporating data edits in the MOHSAIC electronic reporting system that limit the reporting of inappropriate and inaccurate participant service records
• Reviewing electronically submitted participant service reports for compliance to standards of care prior to approval for reimbursement
• Tracking ALERT values and abnormal testing results to assure participants receive appropriate diagnostic services and access to treatment, if needed
• Performing initial on-site QA audits at each new SMHW and WISEWOMAN provider six months after the first participant is served and every two years thereafter
• Scheduled QA audits occur at any time deemed necessary by MDHSS staff because of questionable reports
• Providing training and technical assistance to providers to improve quality of care based on results of QA audits
• Evaluating participant and provider expectations