Assessing & Improving Quality of Care

Newly Developed Quality of Care Tools

President’s Emergency Plan for AIDS ReliefTrack 1.0 ART Program Meeting

Seema Meloni, PhD, MPHAssistant Country Director, Harvard PEPFAR Nigeria

25 September 2007

Harvard PEPFAR Nigeria

Two Tools for Improving Care Quality Improvement

Treatment Response Utility: “Snapshot” of patient

Quality Assessment Site Assessment Database

Quality Improvement

Harvard PEPFAR Nigeria

Overview: Database System Electronic capture

of patient data from program inception

Data captured for Adult, Pediatric, and PMTCT program areas

Pre-

assessment

Entry

ARV naïve

ARV experienced

ART eligible

ART ineligible Palliative

Care

Visit

Lab

Pharmacy

ART eligible

Discontinue ToxicityFailure

VCT

Harvard PEPFAR Nigeria

Paper

records

Daily entry at program sites;

Merged & cleaned weekly

Uploaded to Server

Paper record placed in

patient chart

Best clinical management of

patients

Reports

Reports

Projections

Program Evaluations (QA)

Downloaded in Boston; merged

and reviewed

Treatment Response

Utility

Harvard PEPFAR Nigeria

Treatment Response UtilityGoal: Improve treatment process by providing clinicians quick and easy access to patients’ treatment-related data

Patient ID #

Quality Assessment

Harvard PEPFAR Nigeria

Evolution of Internal QA Program JSI Quality Assessments at 3 sites

Informal quality improvement efforts through ongoing monitoring of site progress and visits from clinical officers

Internal development of a quality assessment protocol Technical assistance on indicator selection provided by JSI Full assessment: 3 sites (different from JSI QA) Follow-up assessment on 1 site previously assessed by JSI

Harvard PEPFAR Nigeria

Site Assessment Goals Assess quality of care provided to HIV/AIDS

patients

Identify strengths and weaknesses in clinical processes/systems

Evaluate health outcomes of patients as related to clinical processes

Promote accountability for patient care

Facilitate the process of joint problem identification and solving

Harvard PEPFAR Nigeria

Site Assessment Indicators Informed consent

coverage CTX coverage TB screening coverage Lab data

% Charts missing values Toxicity

% patients with panic values

% patients with appropriate clinical response(s)

CD4 and Viral Load % patients with values at

baseline, 3, 6, and 12 months

% patients with CD4>200 and/or suppressing viral load at 6 and 12 months

Treatment failure % patients in failure at 6

and 12 months % patients with appropriate

clinical response(s)

Harvard PEPFAR Nigeria

Site Assessment DatabaseBasic procedure:• Random sample of patient

IDs selected from master databases. SA database preloaded with data from master Entry, Lab, Pharmacy, and Visit databases

• Database taken to site; data in charts compared to data loaded into SA database

• In addition, evaluate a few additional indicators to further evaluate quality of patient care

Harvard PEPFAR Nigeria

Chart Review & Data EntryClick through tabs to access data for various indicators

Data in unshaded fields are pulled from master files in Boston

Fields shaded in yellow are meant for SA team to enter notes

Pulled from Tx Response

Utility

Harvard PEPFAR Nigeria

Chart Review & Data Entry

•Electronic tool makes it easy for on-site analyses

•Jump to analysis screen and “find” all records that address given indicator

Harvard PEPFAR Nigeria

Innovative AdditionsRed flags indicating possible virologic failure Calculator for 6- and 12-month CD4 & VL

Layout that provides data summary

Harvard PEPFAR Nigeria

Tools Have Improved Quality & Efficiency Treatment Response Utility

Minimizes time clinician must spend reviewing patient charts Provides evaluation of adherence and treatment failures Will be adapted and used for transfer patients - allows for

continuity of care

Site Assessment Database Has sped up process of site assessments and allows us to

evaluate our program more in-depth Allows for detailed debriefing the day after chart review is

complete Can be used by sites for their own QA/QI initiatives

Thank you