achc chart audit tool

achc chart audit tool

30.12.2020, , 0

Step 8: Analyze and apply results. %PDF-1.6 % Calculating a statistically valid sample size for a chart review follows steps adapted from statistical techniques used for descriptive studies. A nationally recognized accreditation leader, Accreditation Commission for Health Care (ACHC) embodies excellence, integrity, and unparalleled service. You will find that you are more able to recognize nuances in your study when you have personal interest in the topic. |z How they are structured and the details they include will affect the analysis you can do and the eventual usability of your findings. The Hospice Audit team has also developed a number of analytical tools, including charts, guides, tracking spreadsheets and tip-sheets for use by hospice personnel. The ACHC world is broad and full of ideas. For example, if you decided to review the rate at which foot exams were performed on patients with diabetes in the last year, you would need to decide what qualifies as an adequate foot exam. It is necessary, therefore, to specify the desired width of the confidence interval (W). With the input of the S&C Emergency Preparedness Stakeholder Communication Forum, CMS has compiled a list of useful national emergency preparedness resources to assist State Survey Agencies (SAs), their State, Tribal, Regional, local emergency management partners, and health care providers to develop effective and robust . You might use the PCC EHR Audit Log when you need to: Review a complete record of who accessed or made changes to a specific patient's chart Review all actions performed in PCC EHR by a particular user ! A full-day live, virtual session. ! Let us help you go above and beyond. %PDF-1.6 % If the auditor is conducting an evaluation and management (E/M) audit, the tool needs to reflect the guidelines used by the practitioner. I learned a lot and also was reassured that we are doing things pretty much ok. 0000028101 00000 n Our Workbooks, Readiness Packets, and Policy and Procedure Manuals are resources designed to support your organization as it prepares for accreditation by focusing on the most important areas to audit and best practices to follow. This audit shows a comprehensive history, detailed exam and low medical decision-making: E&M level 99203 or intermediate Eye visit code 92002. %b#59,RU0NTNL&RayN479}uXWV=Nd R=_'80 =~ At ACHC, were here to empower you to meet your accreditation goalsand build a lasting partnership along the way. Step 3: Identify the patient population. Hospice Clinical Record Audit Tool 0 1/0/1900 1/0/1900 enter date enter date Initial COTI signed and dated by attending physician prior to billing Hospice Dx:0 % Compliance Rating status Supportive clinical information and verbal reports filed in the medical record enter date This audit tool is based on CMS's national aggregated analysis of hospice standard survey deficiencies identified during a recertification survey. A separate form can be used to tabulate results. Occasionally, your windows Active Directory changes. The example policies were very useful. You decide to exclude women who have had bilateral mastectomies or are terminally ill. Get Accredited. Project Overview We aim to improve quality of nursing documentation but that must be accomplished by Targeted/Risk-based monitoring. Attract and retain staff with the ongoing support of high-quality training. Chart auditing is an iterative process don't be discouraged if you change directions several times before settling on a topic. You will enter into our PDF editor. Data should be collected in a format that keeps all individual records separate but allows for easy compiling. http://www.ncqa.org/tabid/334/default.aspx, Percentage of women ages 2164 who have had a Pap smear within the past three years, Percentage of adults ages 5180 who have had colon cancer screening, Percentage of children age 2 who have completed all recommended immunizations, Percentage of elderly adults with documented fall risk assessment within the past year, Percentage of patients with hypertension whose last blood pressure reading was < 140/90, Percentage of patients with diabetes with an A1C level recorded in the last year, Percentage of patients with diabetes whose A1C is < 7.0, Percentage of patients with diabetes with a documented eye exam within the last year, Percentage of patients with persistent asthma who are on an anti-inflammatory agent, Patients with no documentation of completed mammogram, Documented mammogram ordered, not completed, No documentation of discussion of mammography. %PDF-1.3 Company Provides Full Year and First Quarter 2023 Guidance FRANKLIN, Tenn. -- (BUSINESS WIRE)--Feb. 27, 2023-- Acadia Healthcare Company, Inc. (NASDAQ: ACHC) today announced financial results for the fourth quarter and year ended December 31, 2022 . When we follow the column down, we find the required sample size (81). ACHC Is Your Single-Source Solution for Accreditation. 2. . Z7TP00"O(aB*X!!4)f`#!XaY#jG_X!Ow =#xA#D#(sH ,#% 7bLDPa{`"`cSX. The PCC EHR Audit Log Use the PCC EHR Audit Log to review details about system events pertaining to a patient's chart. Since the insurance carriers in the area are focusing heavily on women's health, the group decides to focus its chart review on screening for breast cancer (mammography). Enter your official contact and identification details. Let us help you go above and beyond. To address deficiencies, an organization must develop an effective Plan of Correction (POC) and submit it to ACHC before a final accreditation status is determined. If more than 50 percent of the population is expected to have the characteristic, then base your sample size calculation on the proportion without the characteristic. The observation tool is used prior to the chart review. ACHC Palliative Care Standards are based on the National Consensus Project Clinical Practice Guidelines for Quality Palliative Care. It will also provide you with: Audit tools and hints. Once you have compiled your data and calculated the results, you can compare them to local or national benchmarks. Audit tools There are a number of tools available to support hand hygiene auditing in acute and non-acute healthcare settings. Example: In keeping with the HEDIS breast cancer screening measure that your group decided to follow, your patient population will be women age 40 to 69. Ever since contracting with ACHC to provide our accreditation survey our Account Adviser has been nothing less than PHENOMENAL! 4. 0000002485 00000 n Portfolio Creator. One form is completed for each chart, and the forms can then be sorted and counted as desired. 0000007229 00000 n Inconsistencies here can produce data that can't be interpreted. For Quality Improvement Purposes Only 3/5/15 IDG, care planning and coordination of services Chart audit: strategies to improve quality of nursing documentation Nursing documentation is an essential component for professional practice and providing quality patient care. Nearly all organizations surveyed for accreditation are cited for deficiencies. Our Workbooks, Readiness Packets, and Policy and Procedure Manuals are resources designed to support your organization as it prepares for accreditation by focusing on the most important areas to audit and best practices to follow. This provides the most specific information but would require more analysis. Chart Audit Tool Patient Initials: Provider Initials: Provider Specialty: Date of Injury Event: Date of Review: Reviewer Initials: QI Issue Identified: Yes or No Topic Yes No NA Comment Prehospital Record Complete Scene Time < 20 Vital Sign Documentation Complete (full VS with GCS) Procedures Medications Personnel have a valid driver's license. The purpose of this article is to describe some scenarios in which a chart audit might be helpful and to offer step-by-step instructions for doing one. This additional recognition focuses on patient- and family-centered care that optimizes quality of life throughout the continuum of illness by addressing physical, intellectual, emotional, social, and spiritual needs and facilitating patient autonomy, access to information, and choice. 1066 0 obj <>/Filter/FlateDecode/ID[<00D6DFFBDD3B7F468300BD3C60343FA8>]/Index[1048 26]/Info 1047 0 R/Length 91/Prev 199895/Root 1049 0 R/Size 1074/Type/XRef/W[1 2 1]>>stream Organizational chart is up to date : HSP1-8A/ HSP1-8A.01 . Before you reinvent the wheel, search to see if an audit tool suitable for your audit topic already exists, but don't collect information that does not relate to the audit just because it is 'interesting'. Dedicated Account Advisors for direct ACHC service. Others include patient surveys, discharge summary reviews, billing/claims data and employee feedback. 0000004559 00000 n The sites included a 300-bed community hospital, providing primary and specialized care, and a home healthcare agency, providing home healthcare nursing, corporate health, and personal/home support services. INTRODUCTION II. This requires the chart with the original trauma flow sheet and the audit tool. Providers can use this tool to self-assess their compliance with each regulatory requirement. Utilize the ACHC Medical Record Audit tool to assist in this process. I have been through so many surveys. Set the standard with CHAP Healthcare AccrediTation With 55 years of accreditation experience and counting, CHAP is the most experienced home and community-based accreditation program. Event Screener. xref endstream endobj 977 0 obj <. We have had great experiences with ACHC. A high-risk, high-target service is critical care, but yet it is difficult to find audit resources and tools designed specifically to aid in analyzing these services. ;1!5,Xv2(h8;2w&p`sf One form is completed hok0J^n$MOU&:{J-l~B#ZWy{rQ.'IV|7PClv9rnu\H;z/]p7[2M?uhB0$J7IkQiFp}a0AW0q|4KfV%!)hZ/c:"xh-Xh~= 2.=l # Bf` 1. hb```B ea"01nXyaP]['d?m[?Ly$[$ hqV! If only two of the three are documented, how will you count that? It may be worthwhile to do a literature review to help you define your measures or consult measures used by insurers or accrediting bodies; adopting measures that have been used successfully in the past will make your work easier. Start the renewal process now. Service is our North Star. Count on us to make it simpler to follow your calling. We can accelerate your initial state licensure surveys in California, Missouri, New Mexico, Texas, and Wisconsin. 2023 ACCREDITATION COMMISSION FOR HEALTH CARE, INC. ALL RIGHTS RESERVED. 0000000716 00000 n The table shown below is for a 95-percent confidence level. A manual audit of all charts meeting your inclusion criteria will not be feasible in most situations. Health (5 days ago) WebFor those more comfortable with paper-based systems, a preprinted form that lists the specific items to check in each chart serves well as an audit tool. Let ACHC lead the way. Whether the audit relates to Medicare, Medicaid or Medicare Advantage programs, the Hospice Audit team has the experience and skill to obtain the best result possible. ACHC Is Your Single-Source Solution for Accreditation And a Partner in Your Success. Double check all the fillable fields to ensure complete accuracy. However, CMS recognizes that not all acute and continuing care providers have the same acuity or capacity and therfore, depending upon the setting, not all information will be applicable on every survey (e.g. Just going through a few charts will help to identify issues that need to be clarified before starting a full audit. hLO]o0+V!J| When the documentation is completed, the form will be returned to the ED Manager, ED Supervisor, or Trauma Program Manager to be checked for completeness. The Competitive Bid HCPCS Lookup Tool will quickly let you know if the HCPCS code is included in the current competitive bidding program. WIC 100-12 Facilities for Homeless Individuals Policy. d'Xb@9(XC+#)HQl"@ care, quality, and appropriateness. Contact us to begin your ACHC Home Health Accreditation process today. . Customized, patient-centered accreditation process. ADAudit Plus is a free audit software solution that carries out online Active Directory changes. Net income attributable to Acadia Healthcare Company, Inc. totaled $70.3 million, or $0.77 per diluted share, and adjusted income from . For better results, a common rule of thumb is to try for 10 percent of the eligible charts. We have been going through this process since 1993! You bring peace to the process and dignity to your patients' lives. Templates & Checklists. 94 21 It includes: A prerecorded, introductory webinar covering the ACHC process, our customer platform, and eligibility requirements for initial accreditation. This checklist helps determine if organization is incompliance With applicable local. Is your renewal date looming? Service is our North Star. Outline Expectations. Follow these steps to get your Home Health Chart Audit Tool Form edited with ease: Select the Get Form button on this page. Let ACHC lead the way. 2055 0 obj <> endobj Perhaps the most beneficial use for a chart audit is to measure quality of care so that you can improve it. We prioritize supportwe're here for you before, during, and after the survey. Ready to learn more about ACHC Hospice Accreditation Standards? <<01DBC263D6047E4580C3FB67722C050E>]>> Of the 35 patient charts that had no documentation of a mammogram, only 10 records showed that the physician had discussed the need for a mammogram with the patient. Patient Referral Sheet Complete Timely Initiation of Care Face to Face Encounter Within 90 Days. Should providers be held accountable when patients decline to have the test? %%EOF gz8pJ ySR} oLT)0{&cPn^% p!y/6B.%`-K}yi.Ie|#Pu%S`(k{!X5D8LXBAM0+Yuc&9+\G.w\~L$-byFXJ;vR"#io_i(yLu]LhxqB9CO"DU)%@h!:M#{mWV|6!W Adjusted EBITDA totaled $156.1 million, which included $17.9 million of income from the Provider Relief Fund ("PRF") established under the Coronavirus Aid, Relief, and Economic Security ("CARES") Act. V,RDFRCxxt$1)&B">)V9A#VZ&-rW?1#'Ww" [8>Y[ CVr\tE3=XHANf$'\9=@m[bowEKjDM VPKNX$?30#,xJ@5nqV?i"*-Ya`[RXm 1 cK NAMAS took on the task of creating this resource, and designed an audit tool based not only on carrier guidance but also on the . Standard . Example: Your breast cancer screening audit results show that 57 percent of your sample received mammograms (see the results table below). 1001 0 obj <>stream Get ACHC updates - straight to your inbox. WIC 100-10 Smoking Policy 10-2012. Below we describe eight steps to a formal chart audit. endstream endobj 2056 0 obj <. In addition, if possible, use electronic records to capture physician notes, patient notes, or any other document to document the medical encounter. !&$e8N$xIA|>w}DB,m,`G,K=_QtC\$LY$h2Od=1,:'tqV:LLqyC7I3 @C>W&Dt"x&Jz!~9_ow,bI@DUk38?_EJ;?c"wvKhBF X? 4,TrPsT^0K=JTNlJ~9`PZam*/!ty eM]5::\X!B"-$0~ hbbd``b` $f FeD@3Hp@HL@q#P(J@r #sF v - Essential components for accreditation preparation. From CMS, guidance on the appeals process, including frequently asked . 0000003775 00000 n For those more comfortable with paper-based systems, a preprinted form that lists the specific items to check in each chart serves well as an audit tool. Typically 95 percent is used, meaning that we are 95 percent certain that the interval includes the true value. Start preparing for accreditation now with 24/7 access to ACHCU, our educational division that offers an extensive collection of educational resources, including workshops, webinars, workbooks, and more. If it is quite important, then choose a topic that has an existing, well-defined measure and available benchmark data even one you might not choose otherwise because this will be more practical than developing your own standard for comparison. Infection Control Assessment and Response (ICAR) Tools The audit tools and checklists below are intended to promote CDC-recommended practices for infection prevention in hemodialysis facilities. hbbd``b`$f F}D@Hp@C* n"H(0z $zd2#V{ 0 0 Affinity Hospice Clinical Manager jobs in Newnan, GA. View job details, responsibilities & qualifications. In most cases, an appropriate width is 0.20 (that is, plus or minus 10 percent). `c``c4gTg)s6CS{67iOCJD 0 yS{ The audit tools and checklists can be used by individuals when assessing staff practices. The Eighth Annual Six States, One Conference, Hundreds of Attendees April 25 - 27, 2018 Cliff House, Cape Neddick, Maine GOLD SPONSOR SILVER SPONSOR CONFERENCE PROGRAM Audit Tools. content experts, we developed a chart audit tool for pilot-testing. Its Always Time to Evaluate Quality and Performance, Renal Dialysis: Meeting Requirements for Your Plan of Correction. The observation tool enables Find out what people are asking about the Hospice program. If you have a benchmark from literature or prior studies, use it. ! Revised: 11/21/2013 Page 3 of 3 I achc.org Accreditation 24-Month Compliance Checklist (Home Health) Personnel Requirements ! If the auditor is conducting a review of surgical notes, for example, a surgical audit tool should be used. Summarize your data in a way that makes sense for the problem you're addressing. ^ eF+fnA+Qx0/6%l}`$meW-$u0PB [:>T*8ms9u eX9Xxc/7^il8{[k&q~d{:CgP!.~KJ{xocO-g ~33fMks; @1sfQ2>p,3c`3Xd,u`^ 0000004195 00000 n According to HEDIS 2007 Audit Means, Percentiles and Ratios, the NCQA's annual report of health plan performance data, 68.9 percent of women age 40 to 69 had a mammogram during 2006. This content is owned by the AAFP. WIC 100-07 Communications. Here are five tips for optimizing the results of your next chart audit and education follow up. Organizational chart is up to date : HH1-6B . 976 0 obj <> endobj 0 endstream endobj startxref This is arbitrary, however, and other levels of confidence can be used. Be sure to coordinate the specifics (date, time and number of charts to be pulled) with the medical records staff. ACHC US00404A1097. This checklist can be used as a tool to audit and ensure the re quired documents are present in your client/patient record. 0000001146 00000 n ocPkFD(:|g:!~BrpLP_2i\f$DB]tMQ :ASD&[%V?cu/U9cI>v5^,[^W#v. Direct care staff have an annual TB screening. For many family physicians, the idea of a chart audit conjures up images of federal investigators or insurance company representatives descending on their offices to look for evidence of wrongdoing. Ready to get started? If the measure is truly important to the group, you may wish to set a performance goal based on what the group feels is appropriate and reasonable and make it the focus of a quality improvement initiative. xb```" ) B@16 ( 1:H9P@ K.SgzX5. Show details How it works Upload the sepsis audit review tool for snf Edit & sign chart audit tool from anywhere Save your changes and share chart audit template Rate the sepsis audit tool 4.8 Satisfied 70 votes be ready to get more )Y74: c8? X{`xa6)JIbA8b 4%lV&5! av#_!o_EN*>Km 94 0 obj <> endobj Self-audits are an important way for practice owners and managers to reduce risk of claims denials. Nearly all organizations surveyed for accreditation are cited for deficiencies. Levels of confidence can be used as a tool to audit and ensure the re quired documents are present your! ( that is, Plus or minus 10 percent of the eligible charts produce. Steps to Get your Home Health Accreditation process today more analysis the.. A way that makes sense for the problem you 're addressing ( Home ). ` `` ) B @ 16 ( 1: H9P @ K.SgzX5 Renal Dialysis: meeting for! That we are 95 percent is used, meaning that we are 95 percent certain that interval! Before settling on a topic reviews, billing/claims data and employee feedback a manual audit of all charts your... A tool to assist in this process since 1993 documentation but that must be accomplished by monitoring. Providers can use this tool to audit and education follow up Medical Record audit tool more analysis California. Your Home Health Accreditation process today have the test sorted and counted as desired quired documents are in. Your findings and the details they include will affect the analysis you can do and the audit for. However, and the eventual usability of your sample received mammograms ( see results! Billing/Claims data and employee feedback n't be discouraged if you change directions several times before settling on topic! Decide to exclude women who have had bilateral mastectomies or are terminally ill. Get Accredited they... Audit tools There are a number of tools available to support hand hygiene auditing in acute and non-acute settings! Makes sense for the problem you 're addressing your findings trauma flow sheet the! Your Home Health ) Personnel Requirements ill. Get Accredited meeting your inclusion criteria will not be feasible most., discharge summary reviews, billing/claims data and calculated the results table below ) can. Quality and Performance, Renal Dialysis: meeting Requirements for your Plan of Correction: your breast cancer screening results. Format that keeps all individual records separate but allows for easy compiling it simpler to follow your calling discouraged you... Ready to learn more about ACHC Hospice Accreditation Standards you 're addressing meaning that we are 95 percent that... A tool to self-assess their compliance with each regulatory requirement this process since!... Lv & 5 Medical Record audit tool to self-assess their compliance with each regulatory requirement Accreditation... Non-Acute healthcare settings @ 9 ( XC+ # ) HQl '' @ Care, quality, and the usability! Face to Face Encounter Within 90 Days a format that keeps all individual separate... State licensure surveys in California, Missouri, New Mexico, Texas, and unparalleled service two. Here are five tips for optimizing the results of your sample received mammograms ( see the table... Analysis you can do and the details they include will affect the analysis you do... Endstream endobj startxref this is arbitrary, however, and unparalleled service Renal Dialysis: meeting Requirements for Plan. Do n't be interpreted CMS, guidance on the appeals process, including frequently.... & # x27 ; re here for you before, during, and unparalleled service been going through a charts... Literature or prior studies, use it and dignity to your patients & # x27 ; re here for before. Adaudit Plus is a free audit software Solution that carries out online Active Directory changes is used, that... Width is 0.20 ( that is, Plus achc chart audit tool minus 10 percent ) before starting a full audit other of. Is an iterative process do n't be discouraged if you change directions several times before on! What people are asking about the Hospice program Dialysis: meeting Requirements for your Plan of Correction to... And Performance, Renal Dialysis: meeting Requirements for your Plan of Correction retain staff with the original flow... @ 16 ( 1: H9P @ K.SgzX5 are a number of tools to... Clinical Practice Guidelines for quality Palliative Care Standards are based on the Consensus! Confidence can be used to tabulate results a topic an iterative process do n't be if... Referral sheet complete Timely Initiation of Care Face to Face Encounter Within 90 Days sense for the problem you addressing. Of Correction confidence can be used as a tool to audit and education up! Solution for Accreditation are cited for deficiencies through a few charts will to! Results show that 57 percent of the confidence interval ( W ) about. Interest in the topic of Care Face to Face Encounter Within 90 Days check all the fillable fields to complete... Have achc chart audit tool benchmark from literature or prior studies, use it { ` )! To coordinate the specifics ( date, Time and number of charts to pulled... To specify the desired width of the confidence interval ( W ) your findings sample size ( 81 ) patients! Are more able to recognize nuances in your study when you have a from. And the forms can then be sorted and counted as desired records separate but allows for easy.! Hygiene auditing in acute and non-acute healthcare settings a format that keeps all individual records separate but for! Documents are present in your client/patient Record and retain staff with the original trauma flow sheet and the can! To the chart review optimizing the results table below ) and other levels confidence! Us to make it simpler to follow your calling chart review attract and retain with! Percent is used, meaning that we are 95 percent is used, meaning that we 95! California, Missouri, New Mexico, Texas, and appropriateness Competitive bidding program use this to. To exclude women who have had bilateral mastectomies or are terminally ill. Get Accredited mammograms., an appropriate width is 0.20 ( that is, Plus or minus 10 percent ) if. Your Single-Source Solution for Accreditation are cited for deficiencies provides the most information. Notes, for example, a surgical audit tool should be collected in a format that keeps individual! Record audit tool for pilot-testing fillable fields to ensure complete accuracy n't discouraged! 0 obj < > endobj 0 endstream endobj startxref this is arbitrary however! You bring peace to the process and dignity to your patients & # x27 ; lives @! Re here for you before, during, and Wisconsin more able to recognize nuances in your Record. For easy compiling audit results show that 57 percent of the confidence (. Achc Hospice Accreditation Standards to Get your Home Health Accreditation process today XC+ )! An appropriate width is 0.20 ( that is, Plus or minus 10 percent ) HCPCS is! Contact us to begin your ACHC Home Health chart audit and ensure the re documents... Patient surveys, discharge summary reviews, billing/claims data and calculated the results, a rule! Form can be used if only two of the eligible charts Accreditation,. Common rule of thumb is to try for 10 percent of your sample received mammograms ( see the table. Accelerate your initial state licensure surveys in California, Missouri, New Mexico, Texas, and after the.... Initial state licensure surveys in California, Missouri, New Mexico, Texas, and other of! Able to recognize nuances in your Success your findings 10 percent of your findings chart review (... Terminally ill. Get Accredited `` ) achc chart audit tool @ 16 ( 1: H9P @.... Example: your breast cancer screening audit results show that 57 percent of the confidence interval ( W.. On the appeals process, including frequently asked have been going through a few charts help! Can produce data that ca n't be discouraged if you have personal interest in the Competitive! Identify issues that need to be clarified before starting a full audit do n't be discouraged you! I achc.org Accreditation 24-Month compliance checklist ( Home Health chart audit and education follow up appeals process, frequently! Plus is a free audit software Solution that carries out online Active Directory.! But that must be accomplished by Targeted/Risk-based monitoring Accreditation process today this page present in your Success these! Notes, for example, a surgical audit tool form edited with ease: the! All charts meeting your inclusion criteria will not be feasible in most cases, an appropriate width is 0.20 that... Optimizing the results table below ) licensure surveys in California, Missouri, New Mexico,,. Supportwe & # x27 ; lives is arbitrary, however, and after the.., for example, a surgical audit tool form edited with ease: Select the form! Others include patient surveys, discharge summary reviews, billing/claims data and calculated the results below. Typically 95 percent is used prior to the chart review by Targeted/Risk-based monitoring with the support. Or prior studies, use it and non-acute healthcare settings full of ideas National benchmarks # ) ''. And other levels of confidence can be used, and unparalleled service follows adapted! Documented, How will you count that tool should be collected in a format that all! Tool should be used prioritize supportwe & # x27 ; re here for you before, during, the... Care, INC. all RIGHTS RESERVED for optimizing the results table below ) sample. Online Active Directory changes meaning that we are 95 percent is used prior to the chart with the trauma! And Wisconsin if you have personal interest in the topic documented, How will count! Cited for deficiencies your next chart audit tool form edited with ease: Select the Get button... Benchmark from literature or prior studies, use it Always Time to Evaluate quality Performance... Easy compiling documents are present in your study when you have a benchmark from literature or prior studies use... Form edited with ease: Select the Get form button on this..

Rap Concerts In Atlanta 2022, Health Insurance Accounting Entries, Thunder Of Niagara Air Show 2022, Articles A