Download Incorporating HAB Measures into Your Quality Portfolio

Incorporating HIV/AIDS
Bureau Measures into Your
Quality Portfolio
Tracy Matthews
Chief Clinical Advisor
Department of Health and Human Services
Health Resources and Services Administration
HIV/AIDS Bureau
Lori DeLorenzo
Quality Consultant, HIV/AIDS Bureau
Organizational Ideas
Part D Quality Conference
August 29-30-2011
1
Learning Objectives
• Discuss the HAB quality expectations for Part
D grantees
• Review the HAB performance measures and
explore how they are defined
• Explore how to apply and utilize the measures
to meet your regional/local needs
• Share examples of how HAB measures have
been applied locally
2
Why Measure the Quality of HIV Care?
• Communicates priorities
• Identify areas for improvement
• Track the effectiveness of different quality
improvement strategies
• Provide information to others about the
quality of care and services they receive
3
Why Measure the Quality of HIV Care?
• Builds a community of providers focusing
on the same aspects of care
• Provides a way to compare performance
across programs and over time
• The National HIV/AIDS Strategy sets
clear goals for improvement in HIV care
• Quality management is a legislative
requirement of the Ryan White
HIV/AIDS Treatment Extension Act of
2009
4
Ryan White HIV/AIDS Treatment Extension Act
All RWTMA grantees are required to establish
clinical quality management programs to:
– Assess the extent to which HIV health
services are consistent with the most recent
Public Health Service guidelines for the
treatment of HIV disease and related
opportunistic infections; and
– Develop strategies for ensuring that such
services are consistent with the guidelines
for improvement in the access to and
quality of HIV services
5
HAB Expectations for Quality Management
A Quality Management Program should consist
of a systematic process with identified
leadership, accountability and dedicated
resources and uses data and measureable
outcomes to determine progress toward
relevant, evidence-based benchmarks.
– Infrastructure
– Performance Measurement
– Quality Improvement
6
The HAB Performance Measures
• Each group of measures represents
different aspects of care and treatment
• Combined, the measures offer an agency
the opportunity to examine system level
performance
7
Creating a Balanced Set of Measures
Clinical
Systems Level
Quality
AIDS Drug
Assistance Program
Management
Pediatric
Program
Oral Health
Medical Case
Management
8
The Clinical Performance Measures
Address Three Aspects of Care
Laboratory
Screening
Counseling,
mental health
and substance
use assessment
Medical and
Dental Care
and Treatment
Clinical
Care
9
Medical Care and Treatment Includes:
•
•
•
•
•
•
•
•
•
•
ARV therapy for pregnant women
Hepatitis B vaccination
Influenza vaccination
Medical visits
Oral exam
PCP prophylaxis
ARV therapy
Pneumococcal vaccination
Viral load monitoring
Viral load suppression
10
Laboratory Screening Measures Look at
Appropriate Screening for:
•
•
•
•
•
•
•
Cervical cancer
Chlamydia & gonorrhea
Hepatitis B
Hepatitis C
Lipids
Syphilis
Tuberculosis
11
Counseling, Mental Health and Substance
Use Assessment Include:
•
•
•
•
HIV transmission risk screening
Hepatitis/HIV alcohol counseling
Mental health screen
Substance use screen
12
Medical Case Management
• Care Plans
• Medical Visits
13
Oral Health
•
•
•
•
•
Dental and Medical History
Dental Treatment Plan
Oral Health Education
Periodontal Screening or Examination
Phase I Treatment Plan Completion
Note: These measures are used by dental
providers who are providing the actual services
14
System Level Measures
• Waiting Time for Initial Access to
Outpatient / Ambulatory Medical
Care
• HIV Test Results for PLWHA
• Disease Status at Time of Entry Into
Care
• Quality Management Program
• System-Level Performance
15
Pediatric Performance Measures:
Overview
• Age of eligible population varies by
measure
– Refer to detail sheet for exact age range
– Utilize table of PMs for quick reference
• Addresses clinical, social and system
issues
Pediatric Measures
• Adherence Assessment and
Counseling
• ARV Therapy
• CD4 Value
• Developmental Surveillance
• Diagnostic Testing to Exclude
HIV Infection in Exposed
Infants
• Health Care Transition
Planning for HIV-infected
Youth
• HIV Drug Resistance Testing
Before Initiation of Therapy
•
•
•
•
•
•
•
•
Lipid Screening
Medical Visit
MMR Vaccination
Neonatal Zidovudine
Prophylaxis
PCP Prophylaxis for HIVExposed Infants
PCP Prophylaxis for HIVInfected Children
Planning for Disclosure of
HIV Status to Child
TB Screening
17
Elements of HAB PMs
• Performance Measure
• Numerator and Denominator Definitions
• Patient Exclusions
• Data Element
• Data Sources
• National Goals, Targets & Benchmarks
• US Public Health Service Guidelines
• References/notes
• Examples (Systems-level)
18
Eligibility, Numerator and Denominator:
Each is Different
• Who is eligible to be evaluated? (Who
constitutes the overall population?)
• What part of this population should have
received the care being measured? (Who
should be counted in the denominator?)
• What part of those who should have received
the care did receive the care? (Who should
be counted in the numerator?)
19
Pediatric HIV Drug Resistance Testing
Eligibility
Denominator
Numerator
Percentage of pediatric patients
with HIV infection who had an
HIV drug resistance test
performed before initiation of
ARV therapy if therapy started
during the measurement year
Number of HIV-infected pediatric
patients who:
• were prescribed ARV therapy
during the measurement year
for the first time; and
• had a medical visit with a
provider with prescribing
privileges at least once in the
measurement year
Number of HIV-infected
pediatric patients who had an
HIV drug resistance test
performed at any time before
initiation of ARV therapy
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Eligible Patients
Pediatric HIV
Drug Resistance
Testing
Performance
Measure
Percentage of pediatric patients with
HIV infection who had an HIV drug
resistance test performed before
initiation of ARV therapy if therapy
started during the measurement year
Denominator
Number of HIV-infected pediatric patients who:
•
were prescribed ARV therapy during the
measurement year for the first time; and
•
had a medical visit with a provider with prescribing
privileges at least once in the measurement year
Numerator
Number of HIV-infected
pediatric patients who had an
HIV drug resistance test
performed at any time before
initiation of ARV therapy
21
How to Calculate the Performance Rate on the
Pediatric HIV Drug Resistance Testing
Eligible
Patients:
Percentage of pediatric patients with HIV infection who had
an HIV drug resistance test performed before initiation of
100
ARV therapy if therapy started during the measurement year
Number of HIV-infected pediatric patients who had
Numerator: an HIV drug resistance test performed at any time
90
before initiation of ARV therapy
= 90%
Number of HIV-infected pediatric patients who:
Denominator: • were prescribed ARV therapy during the
measurement year for the first time; and
• had a medical visit with a provider with
prescribing privileges at least once in the
measurement year
100
22
Selecting and Prioritizing
Measures
23
HAB Does Not Require Grantees to Use
These Measures
But it strongly urges you to use the
measures to:
• Track and trend performance over time
• Identify areas for improvement
• Integrate them into your written quality
management plans
• Modify the measures to meet the needs
of your patients and community
24
Role of HAB Performance Measures:
A la Carte Dining
Selecting & Prioritizing Measures
• Consider the following:
– Epidemic
• Primary modes of transmission
• Change in trends
• Subpopulations affected
– Population served
• Race/ethnicity
• Gender
• Age
• Risk factors
• Culture
26
Selecting & Prioritizing Measures (cont.)
• Services provided
• Sophistication & maturity of quality program
• Influencing factors
– Priority areas of funding agencies
– Other measures being monitored by other
RW programs in the region
• Presents an opportunities to coordinate
or compliment activities and compare
results
27
Balanced Measures
• 1 or 2 measures are not sufficient
• Consider the purpose of the measures
– Primary focus of your program will
impact the set of measures selected
• Family centered care network vs.
primary care clinic
• State or region-focus vs. stand alone
clinic
• Support services program vs. clinical
program
28
TB Screens
HAB Measure: Percentage of clients with HIV infection who received testing with
results documented for latent tuberculosis infection (LTBI) since HIV
diagnosis…….2010 = 99%
NJ RWPD Measure: Percentage of clients with HIV infection who received
testing with results documented for latent tuberculosis infection (LTBI) within
the measurement year…….2010 = 81%
Annual screening “read” rates rise in children and adolescents over 6 years
from low 40th percentile to low 80th percentile: Linkage with schools which
allow school nurses to read the plant and fax/call results to RW clinic. No
need for a return visit.
Annual screening “read” rates in women also rise to 80th percentile partly
due to use of the more expensive QuantiFERON screen when applicable
and affordable….3 strikes and you’re out – QuantiFERON is in!
CD4 Monitoring
HAB Measure: Percentage of clients with HIV infection who had 2
or more CD4 T-cell counts performed in the measurement year at least
3 months apart. Denominator includes patients with ONE medical visit.
NJ RWPD Network
• averaged a steady 76% over the past 2 years…..quite mediocre,
certainly not stellar! Is this a measure that the Network should focus
on for improvement?
• Nicely ask Careware to rerun the HAB measure using TWO medical
visits in the denominator. Results rise to 88%
• Is this still a measure worthy of focused improvement efforts? To
improve CD4 screens, should we focus first on improving visit rates?
Looking at root cause helps drive QI activity.
Examples from the Field
• Agency name
• Identify the HAB measures used for your Part D
program
– Identify any modifications that have been made to
the measure to better reflect your population
• If you’ve run the data in various ways to look at subpopulations, what did you look at and how was it
used?
• Discuss how the measures have been used to make
improvements to the Part D care delivery system
– Include info about how the measures have been
used across your network sites
31
What Are You Using?
• What measures are being used?
• Are gaps noted in the type of measures
used or element of care?
• If set up as a network, how are
measures used for satellite sites?
• What changes will you make?
32
Contact Information
Tracy Matthews
Chief Clinical Advisor
HIV/AIDS Bureau
301-443-7804
[email protected]
Marlene Matosky
Quality Specialist
HIV/AIDS Bureau
301-443-0798
[email protected]
Lori DeLorenzo
Quality Consultant
HIV/AIDS Bureau
Organizational Ideas
[email protected]
33
Contact Information
National Quality Center (NQC)
212-417-4730
NationalQualityCenter.org
[email protected]
HIVQUAL-US
212-417-4620
HIVQUAL.org
[email protected]
How do you rate the overall
effectiveness of this workshop?
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providing you practical solutions and
strategies for your program?
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This workshop have the right blend of
lecture and group discussion?
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NQC offer additional webinars on this
topic in the future?
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