quality management report for ccpc 2014-15 pamela casey-lewis, ms, rd june 24, 2015
Post on 18-Jan-2018
219 Views
Preview:
DESCRIPTION
TRANSCRIPT
Quality Management Reportfor CCPC2014-15
Pamela Casey-Lewis, MS, RD
June 24, 2015
HRSA National Monitoring Standards
Agency Expectations:• Participate in Quality Management activities• Compliance with HRSA service category
definitions and local standards of care• Collection and entering data for use in
measuring performance
Objectives
• To utilize the data from the chart review to track the performance of Ryan White core services
• To identify any areas for improvement
• To provide the CCPC with the information needed to make funding decisions during the priority setting and resource allocation
The process
• Chart tool revised• Access database updated• Abstractors hired• Scheduled during the last quarter• Data collected and analyzed• Data input and compilation
Review of CoreService Categories
Ambulatory careMedical case managementOral health servicesHome and community-based health servicesMental health servicesSubstance use servicesEarly Intervention Services (EIS)
Ambulatory Care4 agencies
Demographics
68%
30%
gender
malefemale
8%
24%
43%
22%
age
18-2526-4041-5051+
60%8%
16%
8%
race
African Amer-icanLatinoWhiteother
At least 2 HIV provider visits during the period
Series10
20
40
60
80
100
91%
99%90%
2014-152013-14National Standard
Documentation of Primary Care in the last 6 months
MCM SA MH Home 0
20
40
60
80
100
86%79%
96%
87%58%
41% 46%
100%
2014-152013-14
Elements of the Treatment Cascade
ARV Prescribed viral load suppression0
20
40
60
80
10097%
84%92%
74%
2014-152013-14
Hepatitis-C Status Documented
Series10
20
40
60
80
100
89%
50%
98%
2014-152013-14national standard
Other Measures
HIV risk counseling
flu vaccine dental care0
20
40
60
80
100
87%
60%48%
72%81%
55%67%
35%
2014-152013-14national standard
Highlights
• Looking good– Prescribed ARV– VL suppression– Documentation of Hep-C status
• Areas for improvement– Document the dental care
Case Management8 sites125 charts
Demographics
63.2%
33.6%
2.7%
Gender
malefemaletransgender
5.6% 13.6%
15.2%
57.6%
8%
Age
<1718-2526-4041-6061+
Demographics
60.8%
8%
22.4%
1.8% 1.6% 5.6%
Race
African AmericanLatinoWhiteAsianAI/AN/NH/PIunk/other
HRSA MCM performance measures
020406080
100
86.4% 80%76.6%63.7%
2014-152013-14
Visits per 12 month period
2014-15 2013-146.5%
26.3%
35.5%
44.1%13%
4.3%
10.3%
8%
less than 2 visits 2-4 visits 6 visits 12 or more visits
Measures
HIV med ad-herence
risk reduction counseling
partner disclosure 0
20
40
60
80
100
86.4%77.4%
53.6%
73.8%
55.4%44.4%
2014-15
2013-14
Screening for other needs
0
20
40
60
80
100 97.6% 99.2%
87.3% 94.2% 94.2%
78.4%
2014-15
2013-14
Budgeting, life skills and self-sufficiency
documentation included in file0
20
40
60
80
100
82.6%
50.6%
Re-scheduling appointments
(adjusted for clients who did not need a re-scheduled ...0
20
40
60
80
100
71.7% 72.8%
2014-152013-14
Highlights
• Looking good– Discussing self-sufficiency– Social service assessments– Risk reduction – Partner disclosure
• There is an increase in MCM clients being seen for 6 or more times per year.
Substance Use4 sites38 charts
Demographics
68%
32%
Gender
malefemale
13.2%
26.3%
26.3%
34.2%
Age
18-2526-4041-5051+
76.3%
10.5%
13.2%
Race
African Amer-ican
Latino
White
Care and Treatment
treatment plan
in treatment at 3 months
in treatment at 6 months
HIV medication adherence
0
20
40
60
80
100
76.3% 76.3%
60.5%
73.7%76% 76%
38%
54% 2014-15
2013-14
Retention in care
re-scheduled appointments0
20
40
60
80
100
81.6%
Highlights
• Drop in retention in care from 3 months to 6 months, but less of a
drop than in the previous year
• Improvement in discussion around medication adherence
Mental Health5 sites55 charts
Demographics
70.9%
21.8%
1.8%Gender
male
female
transgender
10.9%
30.9%
29.1%
29.1%
Age
18-2526-4041-5051+
32.7%
23.6%
36.4%
5.5%
RaceAfrican Amer-ican
Latino
White
Asian
Care and Treatment
0
20
40
60
80
100 98.2%96.4%
80%76.4%82%
90%
57.4%
91.8%
2014-15
2013-14
Other assessments
risk reduction re-scheduled appointments
0
20
40
60
80
100
72.7%
92.7%
23%
86.9%
2014-15
2013-14
Highlights
• Improvement in documentation of risk reduction, HIV medication adherence
• slight increase in retention at three months
• An increase in re-scheduled visits
Oral Health6 sites 87charts
Demographics
79.3%
17.2%
Gender
malefemale
1.1%
24.1%
28.7%
44.8%
Age
18-2526-4041-5051+
31%
24.1%
19.5%
9.2% RaceAfrican Amer-ican
Latino
White
Asian
HRSA Performance Measures for Oral health
0
20
40
60
80
100100%
93.1% 97.7%
58%
70%
92%
2014-15
2013-14
Assessment and Retention
substance use re-scheduling appts0
20
40
60
80
100
83.9% 83.7%
66%54.9% 2014-15
2013-14
Highlights
• Improvement in all HRSA performance measures
• Attempts to retain clients in care
Home Health1 site
15 charts
Demographics
66.7%
26.7%
Gender
malefemale
20%
80%
Age
41-5051+
73.3%
6.7%20%
Race
African Amer-ican
Latino
White
Performance measures
assessment every 30-60 days
medication adherence
doctors order0
20
40
60
80
100
93.3% 93.3%
60%
100% 100% 100%
2014-152013-14
Early InterventionServices
1 site15 charts
Demographics
60%
13.3%
13.3%
Gender
male
female
transgender 66.6%
20%
6.7%
6.7%
Race
African AmericanWhiteLatinoAI/AN
60%
33.3%
6.7%
Age
18-3031-5051+
Performance Measures
previously
linked to
care
linked/re
-linked w
ithin 90 days
risk re
duction
assesse
d for s
ubstance use
0
20
40
60
80
100
40% 53.3% 53.3% 46.7%50% 50%2014-15
2013-14
Assessment for client needs
Housing stability food/utilities/transportation0
20
40
60
80
100
46.6%
66.6%
30% 30%
2014-152013-14
Highlights
• Younger population
• Less than half were previously linked to care
• Comprehensive assessments
Evaluation of the Chart Review
Good:• Helpful staff• Separate private, space provided• Flexibility with arranging extra timeNeeds improvement:• Accessibility of data from EHRs• Client list pulled from ARIESLooking to the future:• Review data more often• Use different contractors
49
Patient Satisfaction
• Boxes placed at several different agencies
• Partial collection (77)
Happy Just okay
unhappy
50
Demographics
30%
25%
45%
Age
26-4041-5051+
51%
18%
16%
15%
Race
African AmericanLatinoWhiteOther
51
More demographics
75%18%
7%
gender
male
female
transgender
62%
35%
3%
sexual orientation
LGB
heterosexual
other
52
The amount of time it takes to get an appointment
2015 20140
20
40
60
80
100
68% 65%
26.3%35%
6%
happyjust okayunhappy
53
How does Staff treat youover the phone?
2015 20140
20
40
60
80
100
72.3%
48%
18.4%
52%
9%
happyjust okayunhappy
54
How does staff treat youwhile face-to-face?
2015 20140
20
40
60
80
100
82%70%
17%
30%
1%
happy just okayunhappy
55
The way your provider explains health-related information
2013 (N=176) 2014 (N=183)0
20
40
60
80
100
79% 80%
11%14%
3% 2%
happyjust okunhappy
56
The way your medical provider explains information to you
20150
20
40
60
80
100
83.8%
12% 4%
happyjust okayunhappy
57
How is your privacy is handled?
2015 20140
20
40
60
80
100
78.7%70%
17.3%
26%
4% 4%
happyjust okayunhappy
58
How happy are you with the way your concerns/complaints are addressed?
2015 20140
20
40
60
80
100
68%61%
23.6% 35%
8.3% 4%
happyjust okayunhappy
59
Do you have a complaint that you are afraid to discuss with the staff?
2015 20140
20
40
60
80
100
17%
5%
83%90%
yesno
60
The complaints
• No return phone call
• Incorrect medical information in file
61
How happy are you about the cleanliness at the site?
2015 20140
20
40
60
80
100
76.6% 74%
19.5%26%
3.9%
happyjust okayunhappy
62
What helps you stay in care?
(multiple responses, check all that appy) 2014
0
20
40
60
80
100
73%
23%
2%
39%
6%
I like my doctortransportationI just know I need to come to stay healthyreminder callsother
63
Others reasons listed…
• Talking to my mental health therapist• Prescriptions are delivered at no additional
charge• Everybody is professional and friendly• Getting fresh produce• My case manager helped lift my spirits
What helps you stay connected to care?
20150
20
40
60
80
100
74%
53%46%
25%14%
like my dr
I want to stay healthy
reminder calls
transportation
other
Other comments
• It’s my responsibility to make appointments• The staff is phenomenal• I have a very good doctor• Para transit vouchers
66
What are some reasons you’ve been out of care?
(multiple responses, check all that apply) 2014
0
20
40
60
80
100
57%
9%
25%
8% 7%
never miss apptswanted a breakneeded to re-scheduleother things more importantother
If you were out of care for 6 months, name the reason
20150
20
40
60
80
100
64%
5% 4% 4% 4% 3% 3%
does not apply
other things more im-portant
family issues
my regular dr left or retired
I wanted to take a break
I was in jail
too hard to make appt
Other reasons
• Didn’t have the money• Depression• Homeless• Personal issues• No transportation• Sick• Didn’t have insurance
69
How happy are you aboutrecommending this site to other HIV+ clients?
2015 20140
20
40
60
80
100
79% 74%
16%26%
6%
happy
just okay
unhappy
70
Future Client Survey Distribution
• Increase responses by cross-part collaboration– using peers to promote the survey and to help clients
complete it– Consider distributing the surveys at HIV support
groups– Make even shorter
• Make the survey category-specific• Make it available on-line
top related