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Comprehensive Clinic Assessment Software Application (CoCASA)
logo of VFC/AFIX evaluation software

CoCASA Frequently Asked Questions
questions and answers
February 15, 2006

On this page:


General Questions

Q: Is CDC eliminating CASA and ACASA once CoCASA is completed? We have providers that utilize both software programs for evaluative purposes at this time. If they have to shift to CoCASA, we need to gauge training needs.

A: CASA and ACASA will no longer be supported once CoCASA has been made available. Obviously there will be a transition period between the release of the new software and the lack of any support for the existing software, but once CoCASA is made available, all existing CASA and ACASA users are encouraged to begin using the new software. (As for training needs, there will be a training module within CoCASA that will help new users learn the software.)

 

Q: When we initially set up CoCASA we entered multiple user names and they are all still listed in the log-on screen. We understand what we did and why the names are there, but is there a way to delete the names from the log-on screen?

A: Unfortunately, there is no way to delete names from the log-on screen once they have been created.

 

Q: If we didn't use your evaluation software for 2004 how will we populate the 2005 version?

A: We are working on the ability to import information from a registry or from VACMAN for the next release of CoCASA. For the time being, you will need to manually enter the data into the 2005 software.

 

Q: We have our own inventory system that we use as our PIN number, and don’t readily have access to VACMAN numbers. Can we use our inventory 11-digit PIN number?

A: We told people to use the VACMAN number as their PIN because during one of the quarterly conference calls the majority of people said the VACMAN number and the VFC PIN number are the same. Also, in the next release, users will have the ability to import provider information from VACMAN to populate the database. If you don’t plan on importing from VACMAN, then don’t worry. You can use whatever VFC numbering system you currently have in place. Just remember, each provider you enter into the database must have a unique VFC number. So if you have several providers with the same PIN, you will have to come up with a system for altering the PIN to make it unique (e.g. adding a letter at the end of the number).

 

Q: We like to sort our providers by specialty (Pediatrician, Family Practice, etc). Should we just select ‘Other’ in the Provider Type variable and enter the specialty there?

A: It is important to first understand how the Provider Type variable functions in the database before selecting ‘other’. Provider type’ is an important variable for the summary reports that you need to produce for the annual VFC Management Survey. Currently, the report reviews the Provider Type’ field and classifies the provider as Public or Private. For example, the options public health dept clinic and FQHC are classified as Public in the report and the option private practice and hospital based - private are classified as Private in the report. So, if you select other for your pediatricians who are private physicians, these visits cannot be incorporated into the report summary of your activities as they cannot be included with either public or private visits. We are considering adding a variable for ‘Provider Specialty’ to a future version of the software.

 

Q: How is the variable ‘The number of children eligible in the practice’, located on the Visit Information screen, best determined? We find that most of our providers do not know how many children they have in the 24- to 35-month-old age group.

A: The number of eligible children in practice variable is not a required field. To get this information, most assessors ask the provider for an estimate, or take it from a computerized list of age-eligible patients. If you don't think the provider can give a good estimate (or a computerized list is not available) then leave the field blank.

 

Q: Is there a limit on how long a Custom Question can be?

A: Yes. The limit is currently set at 255 characters (for the multiple choice question option this includes both the question and the answers). However, if you exceed 150 characters, you will not be able to see the entire text of the question.

 

Q: Is it possible to create an open-ended question in the Custom Question section?

A: At this time you cannot create an open-ended question. A solution to work around this problem would be to create a multiple choice question with broad categories. For example, if you wanted learn the hours of service, you could create a multiple choice question with the options of: normal business hours (8-9 hours with appointments available between 8 a.m. and 6 p.m.), extended early business hours (appointments available before 8 a.m.), extended late business hours (appointments available after 6 p.m.), Saturday a.m. hours (morning), etc. We are considering the possibility of including an open-ended option in the Custom Questions setup for future software versions.

 

Installation, Setup, and Compatibility

Q: Can I install CoCASA on a network so that my staff can enter data at their computer but the data is saved in one central database?

A: Yes. There is a way to install CoCASA on your network (or a shared drive) so that your staff can enter data in one, central database. There are a few steps required to have this option set up. We recommend that you contact us at nipCoCASA@cdc.gov to assist with setting up your centralized database.

It is important to note, however, that difficulties with using CoCASA from a shared drive have been documented. In some cases (particularly where users are accessing it remotely rather than from one central site) the software has been very slow to respond (slower than it is normally). Others have had the application unexpectedly close. If these problems are experienced, we recommend that you go back to using the database on your individual hard drives and exporting data to one, central database on a periodic basis.
 

Q: Once the setup is imported, will it do any damage to import it again (for a demonstration or by mistake)?

A: You will not do any damage by importing it again for demonstration or by mistake. It will update your setup based on the latest import, so just be sure you are importing the correct setup.

 

Q: Is the software compatible with any type of hand-held computer to use for direct on-site data entry during the actual site visit?

A: At this time we have not yet tested the application on any hand-held device, so we are not sure if the software is compatible. There is a page on the Microsoft website (exit site) that lists the minimum system requirements and which machines you should be able to deploy a .NET application.

 

Q: Is the software compatible with Windows 98?

A: At this time, we do not have a solution for running CoCASA under Windows 98. The software programmers are looking into the issue and will provide updates, when available.

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Importing

Q: If we retain all of the provider data and questionnaire data, will duplicates be created when the import becomes functional? Should the files be deleted before that? What do you suggest?

A: There should not be duplicate entries when you merge the data. The software will be set to merge using the VFC PIN# for the providers. As long as all users in a program use the same PIN for a provider, then the visit data will all be merged into one record for that provider. If different PIN numbers are used for the same clinic, then you will have duplicate entries that will need to be weeded out. This is why we are so adamant about unique PIN numbers for each provider site and that everyone use them consistently. If possible, populate all databases with the provider names/address and PIN numbers from the start so that differences are less likely to occur.

 

Q: As we have several field staff that conduct VFC-AFIX visits around the state, do you have any suggestion as to how we can compile the information in CoCASA that we need to submit with our Annual Report without having to do double entry? Or are you expecting that the import function will be available before the end of the year so we can import all the visits and generate the reports we need for the Annual Report?

A: The import/export functions will be made available in the September ’05 patch release. You will be able to import data from all end users in time to submit your annual reports to CDC and elsewhere.

 

Q: Can the field ‘Number of age-eligible children in provider practice’ be imported along with the PINs prior to completing visit information?

A: Since the number of age-eligible children is not a field in the provider setup screen it cannot be imported.

 

Q: How can our local import template be incorporated into CoCASA so that it is available when the software is downloaded from the web?

A: Specific instructions for this process have been added to the website at the following location:
http://www.cdc.gov/nip/cocasa/cocasa_documentation.htm#importing

Q: How can I import my WinCASA sites to my providers that are already in CoCASA?

A: First import your legacy WinCASA data into CoCASA. Then for each assessment use the “Move” button on the Assessment Setup tab to move each assessment from the provider that was created from the import to the provider that was already in CoCASA.

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VFC/AFIX Evaluation Module

Q: If I conduct a follow-up site visit to see if a provider has addressed issues of noncompliance from an earlier VFC Site Visit, how do I document that visit? What type of visit would this be?

A: If you do a follow-up visit, you should enter it as a new visit and select VFC Follow-Up Visit as the purpose of visit. Although there is not currently anywhere for you to enter notes summarizing the contents of that follow up visit, the assumption is that you are following up on the corrective actions you recommended at the previous VFC site visit.

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VFC Site Visit Questionnaire

Q: Regarding the storage section of the questionnaire, it has fields for up to five different refrigerators. Our concern is that our representatives won't remember which refrigerator is which (when doing future site visits). This would be an example where the person conducting the VFC site visit should enter side notes for clarification.

A: Since there is not currently a separate notes field you may have to keep track of information like this in a separate, electronic file. If, however, one of the provider’s refrigerator (or freezers) is outside the acceptable range, you can document the exact location of this refrigerator in question #35 (where you enter corrective actions). For example, Refrigerator #1 (next to sink in exam room #12) was out of the acceptable temp. range. Vaccine needs to be moved to alternative unit until temp can be controlled and monitored appropriately.

 

Q: If the provider's thermometer and our field representative's thermometer have both been calibrated and certified, and if there is a temperature difference (between thermometers, with one outside the allowable range of proper storage), are there any guidelines as to what is acceptable?

A: If the reviewer has brought their own thermometer to the practice, then this is the temperature that should be entered into the Site Visit Questionnaire. If this temperature is outside the allowable range then the provider is not in compliance for this aspect of vaccine storage.

 

Q: Is there a way to lock the custom questions to ensure they are always entered the same way?

A: When a questionnaire setup is exported or imported the custom questions become locked and the end users cannot edit or deselect a custom question. This way all exported/imported Custom Question setups will be identical.

 

Q: In the VFC Site Visit Questionnaire, why can’t I enter data for question 22?

A: Question 22 is auto-calculated by the computer. When you enter a temperature in question 21, the computer will automatically determine if the temperature was within the specified range and enter the appropriate answer into question 22. After you enter data into question 21 and then move your cursor to question 23, the computer will fill in question 22.

 

Q: When filling in information for the documentation section of the survey, how should you answer question number 32 in reference to VFC eligibility screening in the clinic/practice if they are unable to provide you with records to review during your site visit?

A: Provider offices should be contacted in advance of the VFC site visit and informed of the purpose and expectations of the site visit; including the specific number of records that should be made available for review/inspection or available for the reviewer to select from, depending on the protocol of the state VFC Program.

If a reviewer finds that the provider records are not available for inspection, the provider is noncompliant for this element of the visit. Address the specific issue or reason with the provider and schedule a follow-up visit within the next thirty days. If records are located at an alternate location, schedule a visit to that facility. If the records are not available during the rescheduled visit, a letter should be sent from the state program giving the provider a specific timeframe to come into compliance. If compliance is not achieved, the program should consider disciplinary actions such as suspension from the program. Medical records maintenance is not only a requirement for the VFC program, but a state requirement and a Medicare and Medicaid requirement.


 

Q: How can I move the information listed in the box titled Issues Requiring Corrective Actions to the text box to the left (Question 35)?

A: You are not able to move information from the list on the right to the text box on the left. The purpose of the list on the right is to let you know in which high priority areas the provider was noncompliant. The purpose of the text box on the left is for you to document what actions you took with the provider to correct the problems. For example, if the list on the right said the provider was not recording temperatures at least 2 times per day, you might enter Reviewed guidelines for recording temperatures with provider; instructed provider to record temps at least 2x a day in the text box on the left.

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Reports

Q: When I try to run the VFC Site Visit Questionnaire Results or VFC Site Visit Questionnaire Optional Questions reports, I get the following error message: “Index was outside the boundaries of the array.” What does this mean?

A: This error is due to a bug in that report. This problem has been reported by a few users and is being fixed in the patch.

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Error Messages

Q: I’m getting an error message that says “Failed to load resources from resource file” when I start CoCASA. What can I do to fix this?

A: A. Download and install Service Pack 1 for the .NET Framework 1.1 at http://www.microsoft.com/downloads/details.aspx?FamilyID=a8f5654f-088e-40b2-bbdb-a83353618b38&displaylang=en.

 

Q: I’m getting an error message that says “Foxpro driver does not support this function” when I try to import legacy WinCASA data. What can I do to fix this?

A: If you have Windows XP, download and install an updated Foxpro driver at http://msdn.microsoft.com/vfoxpro/downloads/updates/odbc/default.aspx.

The file you need to download and install is the VFPODBC.MSI file (not the VFPODBC.MSM file). You should click on the link that says “English” under the heading “VFPODBC.MSI” towards the bottom of the web page.

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Differences between CASA and CoCASA

Q: The missed opportunity* rate for most assessments is significantly higher (twice as big in many cases) in CoCASA than in CASA…we used the "at last visit" (vs "at any visit") setting. Do you know anything that might help explain why the missed opp rates are so different in CoCASA vs CASA even when the assessments are seemly set up to run similarly?

A: One important difference between CASA and CoCASA is in the definition of a “missed opportunity.” CoCASA considers the patient’s entire immunization history, while CASA considers only the doses that were given in the series specified by the user.

For example, suppose a user runs the CASA Summary report for the 43133 series and the child received a dose of DTaP, Polio, MMR, HIB and HepB on his/her last visit to the office (the last visit date for all vaccines is the same date), but the child is still missing a DTaP4. The child also received an influenza vaccine 9 months after this last visit. CASA would consider the child as “not-up-to-date” but not as a “Missed Opportunity” because it does not consider the influenza dose…it’s not part of the 43133 series that the user specified. CoCASA on the other hand, would classify the child in the “Missed Opportunity” category because it does consider the entire history and the child could have received a 4th dose of DTaP on the date that he/she received the flu shot. Therefore, the Missed Opps would be greater in CoCASA than in CASA.

It’s important to remember (as in CASA) that the Not Up-to-Date categories in CoCASA are hierarchical and mutually exclusive. Once a patient is identified as Not Up-to-Date, the record is reviewed to determine if a missed opportunity occurred. If not, then the record is reviewed to determine if the child is eligible for any doses (meaning minimum ages or intervals have been met on the day of the assessment). If the child is eligible, then the record is reviewed to see if the last visit was within the past 12 months or over 12 months ago.

*NOTE: The answer above assumes that Missed Opportunities are defined as “On the last Immunization visit”.

 

Q:When comparing single vaccine rates using the "ACIP Rec." box vs not using ACIP recs., there are times when the single vaccine rates actually are higher when the "ACIP rec." box is checked (that was a very poorly written sentence). I can't think of any reason why single vaccine rates would be higher when the "ACIP Rec." box is checked but that appears to be the case in some assessments.

A: Most likely you are looking at a report like the Diagnostic Report which requires the user to select a series and then provides the coverage for that series and each individual component of that series. If this is the case, most likely HIB is the issue. When the ACIP Recs are applied, the software is programmed to accept 1 dose of HIB after 15 months as “up-to-date” for HIB even if the series that was selected was the “43133” (3 doses of HIB) series. If a user deselects “Apply ACIP Recs”, then up-to-date for 3 doses of HIB would count only situations where 3 dates were recorded for HIB.

 

Q: What is the biggest difference between CASA and CoCASA?

A: The most important difference between reports results from CASA and CoCASA is the option to Apply ACIP Recommendations. This option is applied by default in CoCASA and means that only valid doses are considered in the calculation of report results. If a dose is determined as “invalid” by CoCASA, then it is as if that dose never occurred. This can result in a very different categorization of a patient included in the Summary Report. For example, if a child received all doses in the 43133 series before 24 months of age with the first MMR after the first birthday, the child would be considered “Up-to-Date” in CASA. However, if the 4th DTaP was not given 6 months after the 3rd dose of DTaP, then this child would be considered “Not Up-to-Date” in CoCASA.

Deselecting the ACIP Recs.

The “Apply ACIP Recs” option is only available in CoCASA and is selected by default to apply all ACIP recommendations. If it is deselected, all recommendations for minimum age and minimum intervals between doses are not considered. The software only counts the dates recorded for each vaccine type. In CASA, the software does not consider minimum intervals for any report that produces a coverage level, or rate. The CASA Summary Report only verifies that the first dose of MMR and/or Varicella was given after 12 months of age and that the specified series was completed prior to 24 months of age

When the “Apply ACIP Recs” option is deselected, the results for CoCASA and CASA should be similar for the Up-to-Date, Late Up-to-Date and Not Up-to-Date. They may not match exactly because in this situation, CoCASA is not applying any ACIP recommendations (minimum age, minimum interval, etc), but CASA does look for a minimum age of 12 months for MMR and Varicella. Therefore, the up-to-date rates in CoCASA may be slightly higher. The biggest difference between CoCASA and CASA when the “Apply ACIP Recs” is deselected will be found in the 4 categories for “Not Up-to-Date”. These four categories include: Missed Opportunities*, Not Eligible for Vaccine, Last Visit <12 months and Last Visit >= 12 months.

Without applying the ACIP Recs, CoCASA will look for a missed opportunity on the last visit date for any immunization regardless if the minimum age or interval has been met (remember ACIP recs are NOT applied). So, if a child received an immunization but did not receive an immunization in all other vaccine groups included in the series (i.e. 43133 series is selected in the criteria and child did not get a MMR on the last immunization date recorded), CoCASA will categorize that child as having had a “Missed Opp” regardless if he/she has met the minimum age of 12 months. CASA on the other hand, will not consider this a Missed Opp, because the minimum age has not been met. Therefore, the category results will drastically differ.


*NOTE: The answer above assumes that Missed Opportunities are defined as “On the last Immunization visit”.

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This page last modified on February 15, 2006

   

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