ipp measures of effectiveness utilization of data to evaluate and inform project activities december...

IPP Measures of IPP Measures of EffectivenessEffectivenessUtilization of Data to Utilization of Data to Evaluate and Inform Evaluate and Inform

Project ActivitiesProject Activities

December 12, 2007December 12, 2007Kelly Morrison Opdyke, MPHKelly Morrison Opdyke, MPH

Region II Infertility Prevention Region II Infertility Prevention ProjectProject

Project Area DataProject Area Data

Laboratory Test Turnaround Time Laboratory Test Turnaround Time (TAT)(TAT)

IPP Measures of EffectivenessIPP Measures of Effectiveness Screening CoverageScreening Coverage Test UtilizationTest Utilization

Gonorrhea trendsGonorrhea trends Key QuestionsKey Questions

Lab Test Turnaround Time Lab Test Turnaround Time (TAT)(TAT)

IPP Priority 3IPP Priority 3: Improve Appropriate : Improve Appropriate and Timely Treatment for Persons and Timely Treatment for Persons Diagnosed with Chlamydial Infection Diagnosed with Chlamydial Infection and Their Partners.and Their Partners.

Regional Plan Objective 3ARegional Plan Objective 3A: At least every : At least every two years, assess turnaround time within two years, assess turnaround time within lab to assure compliance with 3 business lab to assure compliance with 3 business days (develop tracking system clinic to days (develop tracking system clinic to clinic).clinic).

TAT Analysis - ObjectivesTAT Analysis - Objectives

Assess lab performance in meeting Region II IPP Assess lab performance in meeting Region II IPP Benchmarks for processing a CT/GC lab test within 3 Benchmarks for processing a CT/GC lab test within 3 business days.business days.

Assess impact that time elapsed from when a provider Assess impact that time elapsed from when a provider takes a specimen to when specimen reaches lab for takes a specimen to when specimen reaches lab for processing has on length of time it takes to have an processing has on length of time it takes to have an actionable test result available to the provider.actionable test result available to the provider.

Utilize TAT assessment results to enhance Utilize TAT assessment results to enhance understanding of project area performance related to understanding of project area performance related to the National IPP Performance Measure “Time to the National IPP Performance Measure “Time to Treatment for CT/GC”Treatment for CT/GC”

TAT Analysis - ApproachTAT Analysis - Approach Follow-up to March 2007 TAT regional pilot Follow-up to March 2007 TAT regional pilot

analysisanalysis

Study Participants:Study Participants: Labs providing diagnostic support to project area IPPLabs providing diagnostic support to project area IPP

How is TAT Defined:How is TAT Defined: Part I. Time to Lab – Number of days* from date of Part I. Time to Lab – Number of days* from date of

specimen collection to date specimen is received in specimen collection to date specimen is received in lablab

Part II. Time in Lab – Number of days* from date Part II. Time in Lab – Number of days* from date specimen is received in lab and date lab reports the specimen is received in lab and date lab reports the test resulttest result

*Including weekends and holidays*Including weekends and holidays

TAT Analysis - MethodsTAT Analysis - Methods Data collected for specimens received in lab Data collected for specimens received in lab

from September 1 through 30, 2007from September 1 through 30, 2007 Requested data elements: Requested data elements:

CLIA Laboratory IDCLIA Laboratory ID Clinic/facility ID number (used to identify facility Clinic/facility ID number (used to identify facility

type)type) Date of specimen collectionDate of specimen collection Date the specimen is received in the labDate the specimen is received in the lab Date the lab is able to report test resultDate the lab is able to report test result

Data was forwarded to Region II IPP Data was forwarded to Region II IPP Infrastructure and collated.Infrastructure and collated.

Electronic Data SubmissionElectronic Data Submission Line-listed data or aggregated data tables Line-listed data or aggregated data tables

acceptedaccepted

TAT Analysis – Mar ’07 TAT Analysis – Mar ’07 RecapRecap

Laboratory Laboratory Reporting Reporting

teststests

# of # of TestsTests

Time to Time to Lab Lab

(Days)(Days)

Avg.Avg.

Time in Time in Lab Lab

(Days)(Days)

Avg.Avg.

Total Total TAT TAT

(Days)(Days)

Avg.Avg.

NYS (CDD)NYS (CDD) 1,051,0511

2.82.8 00 2.82.8

NYS (EC NYS (EC PHL)*PHL)*

213213 1.61.6 2.22.2 3.93.9

PR DOH PHLPR DOH PHL 2,012,0166

2.52.5 5.15.1 7.57.5

*Data reported for non-IPP facilitiesNOTE: CDD currently not able to separate out time in lab from total TAT

TAT Analysis – Sep ’07 TAT Analysis – Sep ’07 ResultsResults

Laboratory Laboratory Reporting Reporting

teststests



(Days)(Days)

Avg.Avg.


(Days)(Days)

Avg.Avg.

Total Total TAT TAT

(Days)(Days)

Avg.Avg.

NYS (CDD)NYS (CDD) 1,031,0300

3.33.3 00 3.33.3

NYS (EC NYS (EC PHL)*PHL)*

692692 1.41.4 1.71.7 3.23.2

PR DOH PHLPR DOH PHL 2,422,4255

4.74.7 4.24.2 8.98.9

NJ (NJ PHL)NJ (NJ PHL) 6,546,5444

3.33.3 4.34.3 7.67.6

USVI (NJ USVI (NJ PHL)PHL)

1,961,9611

9.49.4 4.34.3 13.713.7

*Data reported for non-IPP facilitiesNOTE: CDD currently not able to separate out time in lab from total TAT


NYS (CDD) NYS (CDD) Facility Facility

typetype


Avg.Avg.

Total Total TAT TAT

(Days)(Days)

Proportion of all Proportion of all tests with Total tests with Total

TATTAT

≤≤3 Days3 DaysSTD ClinicSTD Clinic 647647 2.92.9 .66.66Juvenile Juvenile DetentionDetention

9393 3.63.6 .57.57

Adolescent Adolescent ClinicClinic

3030 3.43.4 .43.43

Alternate/Alternate/OutreachOutreach

5555 3.43.4 .67.67

Community HCCommunity HC 4141 6.86.8 .39.39University HCUniversity HC 165165 3.53.5 .51.51NOTE: CDD currently not able to separate out time in lab from total TAT


NJ (NJ NJ (NJ PHL) PHL)

Facility Facility typetype


Avg.Avg.


(Days)(Days)

Avg.Avg.


(Days)*(Days)*

Avg.Avg.

Total Total TAT TAT

(Days)(Days)

STD ClinicSTD Clinic 1,581,5877

1.71.7 4.34.3 6.06.0

Family PlanningFamily Planning 3,853,8566

3.63.6 4.34.3 7.97.9

Juvenile Juvenile DetentionDetention

213213 3.43.4 4.34.3 7.77.7

Adolescent Adolescent ClinicClinic

3939 4.94.9 4.34.3 9.29.2

Community HCCommunity HC 701701 3.83.8 4.34.3 8.18.1University HCUniversity HC 117117 8.88.8 4.34.3 13.113.1OtherOther 3131 4.34.3 4.34.3 8.68.6

*Assumes same average Time in Lab for all NJ PHL specimens regardless of source.

TAT Analysis – Next TAT Analysis – Next StepsSteps

Refine methods and repeat analysis Refine methods and repeat analysis regionally with additional IPP labsregionally with additional IPP labs

Share successful project area Share successful project area strategies for using TAT data to strategies for using TAT data to inform program objectives and inform program objectives and improve timely treatmentimprove timely treatment

IPP Measures of IPP Measures of EffectivenessEffectiveness

Measure 1: Screening Coverage in FPMeasure 1: Screening Coverage in FPProportion of female Family Planning Proportion of female Family Planning

users screened for chlamydia, by age users screened for chlamydia, by age groupgroup Data Source: FPAR Tables 1 & 11Data Source: FPAR Tables 1 & 11

Measure 2: Test Utilization Measure 2: Test Utilization Proportion of chlamydia tests conducted Proportion of chlamydia tests conducted

on females, stratified by age groupon females, stratified by age group Data Source: IPP Prevalence Monitoring Data Source: IPP Prevalence Monitoring

DataData

Measure 1: Screening Measure 1: Screening Coverage in FPCoverage in FP

Region IIRegion II Age Age Group Group

(Years)(Years)

# # Females Females ScreenedScreened

# # Females Females EligibleEligible

Estimated Estimated Screening Screening Coverage Coverage

(%)(%)

CY 2005CY 2005 15-1915-19 51,028 51,028 112,134 112,134 45.5%45.5%

20-2420-24 67,541 67,541 140,010 140,010 48.2%48.2%

>24>24 75,895 75,895 190,106 190,106 39.9%39.9%

TOTALTOTAL 194,464 194,464 442,250 442,250 44.0%44.0%

CY 2006CY 2006 15-1915-19 50,614 50,614 110,734 110,734 45.7%45.7%

20-2420-24 69,288 69,288 140,198 140,198 49.4%49.4%

>24>24 79,355 79,355 191,509 191,509 41.4%41.4%

TOTALTOTAL 199,257 199,257 442,441 442,441 45.0%45.0%Data Source: FPAR Tables 1 & 11Data Source: FPAR Tables 1 & 11

Measure 1: Screening Measure 1: Screening Coverage in FPCoverage in FP

FY2008 Performance GoalFY2008 Performance Goal

Increase estimated screening coverage Increase estimated screening coverage among females 15-19 years old and 20-24 among females 15-19 years old and 20-24 years old by 5% within each Title X years old by 5% within each Title X Grantee.Grantee.

Est. Screening Est. Screening Coverage (%)Coverage (%)

Age 15-19 yrAge 15-19 yr

Est. Screening Est. Screening Coverage (%)Coverage (%)


CY2006 CY2006 FPARFPAR

CY2007 CY2007 GoalGoal

CY2006 CY2006 FPARFPAR

CY2007 CY2007 GoalGoal

45.7%45.7% 48.0%48.0% 49.4%49.4% 51.9%51.9%

Measure 2: Test UtilizationMeasure 2: Test Utilization

Region IIRegion II

Age Age (Years)(Years)

CY 2005CY 2005 CY 2006CY 2006# Females # Females

TestedTested% of % of

Females Females Tested by Tested by

AgeAge

# Females # Females TestedTested

% of % of Females Females

Tested by Tested by AgeAge

15-1915-19 58,660 58,660 23.7%23.7% 64,071 64,071 24.9%24.9%

20-2420-24 88,131 88,131 35.7%35.7% 91,209 91,209 35.4%35.4%

25-2925-29 45,986 45,986 18.6%18.6% 47,087 47,087 18.3%18.3%

>29>29 54,362 54,362 22.0%22.0% 55,096 55,096 21.4%21.4%

TOTALTOTAL 247,139 247,139 100.0%100.0% 257,463 257,463 100.0%100.0%

Data Source: Region II IPP Prevalence Monitoring DataData Source: Region II IPP Prevalence Monitoring Data

Measure 2: Test UtilizationMeasure 2: Test Utilization

FY2008 Performance GoalFY2008 Performance GoalDecrease the proportion of tests conducted among Decrease the proportion of tests conducted among

females >29 years of age by 5%, and increase females >29 years of age by 5%, and increase the proportion of tests conducted among the proportion of tests conducted among females 15-19 and 20-24 years of age by 5% females 15-19 and 20-24 years of age by 5% within each Project Area. within each Project Area.

% Females % Females TestedTested





Age >29 yrsAge >29 yrs

CY200CY2006 FPAR6 FPAR

CY200CY2007 Goal7 Goal





24.9%24.9% 26.1%26.1% 35.4%35.4% 37.2%37.2% 21.4%21.4% 20.3%20.3%

Region II IPP TrendsRegion II IPP TrendsFemale CT Testing and Female CT Testing and

PositivityPositivityAmong females tested for chlamydia each yearAmong females tested for chlamydia each year Overall positivity is high (~6%)Overall positivity is high (~6%) Females aged 15-24 yrs account for:Females aged 15-24 yrs account for:

~60% of tests~60% of tests ~80% of positives~80% of positives

Positivity is higher in STD and Detention settings Positivity is higher in STD and Detention settings although more cases are reported from FP clinicsalthough more cases are reported from FP clinics

Health disparities by race/ethnicity are evidentHealth disparities by race/ethnicity are evident Black/African American females account forBlack/African American females account for


Need more data for American Indian/Alaska Native, Need more data for American Indian/Alaska Native, Native Hawaiian, and Asian populations to inform Native Hawaiian, and Asian populations to inform trendstrends

Region II IPP TrendsRegion II IPP Trends

Female Chlamydia Positivity by Age

0.0%

2.0%

4.0%

6.0%

8.0%

10.0%

12.0%

CY2004 CY2005 CY2006 CY2007*

15-19 yrs20-24 yrs25-29 yrs30-44 yrs45+ yrs

N=172,465 N=244,293 N=257,069 N=127,577

*Data available through 2007 Q2


Female Chlamydia Positivity by Facility Type

0.0%2.0%4.0%6.0%8.0%

10.0%12.0%14.0%16.0%18.0%

CY2004 CY2005 CY2006 CY2007*

DetentionSTDPrenatalOtherFP

N=172,465 N=244,293 N=257,069 N=127,577



Female Chlamydia Positivity by Race/ Ethnicity

0.0%

2.0%

4.0%

6.0%

8.0%

10.0%

12.0%

CY2004 CY2005 CY2006 CY2007*

Black N-HNH/ PIHispanicAI/ ANAsianWhite N-H

N=172,465 N=244,293 N=257,069 N=127,577


Region II IPP Trends:Region II IPP Trends:Female GC Testing and Female GC Testing and

PositivityPositivityAmong females tested for gonorrhea each yearAmong females tested for gonorrhea each year Overall prevalence is very low (<1%) – Need targeted Overall prevalence is very low (<1%) – Need targeted

testingtesting Females aged 15-24 yrs account for:Females aged 15-24 yrs account for:


STD clinics account for:STD clinics account for: ~19% of tests~19% of tests ~49% of positives~49% of positives

Health disparities by race/ethnicity are even more pronouncedHealth disparities by race/ethnicity are even more pronounced Black/African American females account forBlack/African American females account for


Need more data for American Indian/Alaska Native, Native Need more data for American Indian/Alaska Native, Native Hawaiian, and Asian populations to inform trendsHawaiian, and Asian populations to inform trends


Female Gonorrhea Positivity by Age

0.0%

0.5%

1.0%

1.5%

2.0%

2.5%

3.0%

CY2004 CY2005 CY2006 CY2007*

15-19 yrs20-24 yrs25-29 yrs30-44 yrs45+ yrs

N = 119,207 N = 173,440 N = 179,753 N = 87,915



Female Gonorrhea Positivity by Facility Type

0.0%

1.0%

2.0%

3.0%

4.0%

5.0%

6.0%

7.0%

8.0%

CY2004 CY2005 CY2006 CY2007*

DetentionSTDFPPrenatalOther


N = 119,207 N = 173,440 N = 179,753 N = 87,915


Female Gonorrhea Positivity by Race/ Ethnicity †

0.0%

0.5%

1.0%

1.5%

2.0%

2.5%

3.0%

CY2004 CY2005 CY2006 CY2007*

Black N-HHispanicWhite N-H


N = 119,207 N = 173,440 N = 179,753 N = 87,915

† Insufficient volume of data for American Indian/Alaska Native, Asian, and Native Hawaiian

Use of NAAT TechnologyUse of NAAT Technology IPP Priority 4IPP Priority 4: Promote Use of High : Promote Use of High

Quality, Cost Effective Diagnostic Tests for Quality, Cost Effective Diagnostic Tests for Chlamydia.Chlamydia.

GOALGOAL: All clinical providers will utilize : All clinical providers will utilize NAATS by 2008.NAATS by 2008.

Regional Plan Objective 4ARegional Plan Objective 4A: Increase use of : Increase use of FDA approved NAAT alternate specimen types FDA approved NAAT alternate specimen types (urine, vaginal swab) in females among (urine, vaginal swab) in females among participating IPP Clinics to identify chlamydial participating IPP Clinics to identify chlamydial infection when a pelvic exam is not being infection when a pelvic exam is not being conducted.conducted.

Use of NAAT forUse of NAAT forCT Testing Among FemalesCT Testing Among Females

Region II IPP, CY2007*Region II IPP, CY2007*

Project Area

FP STD All Other# Tests %

NAAT#

Tests%

NAAT#

Tests% NAAT

NJ 25,7525,7588

77%77% 3,123,1255

68%68% 5,085,0800

100%100%

NYC 6,6986,698 0%0% 14,314,37070

100%100% 5,145,1422

55%55%

NYS 48,2248,2200

53%53% 4,984,9811

100%100% 1,341,3444

100%100%

PR 4,7974,797 100%100% 2,242,2400

100%100% 5,715,7122

100%100%

USVI 611611 100%100% 138138 100%100% 344344 100%100%

Total 86,0886,0844

59%59% 24,824,85454

96%96% 17,617,62222

87%87%


NAAT Specimen Types forNAAT Specimen Types forCT Testing Among FemalesCT Testing Among Females

Region II IPP, CY2007*Region II IPP, CY2007*

Project Area

FP STD All Other

# Tests

% of total

# Tests

% of total

# Tests

% of total

EndocerEndocervixvix

4225422500

83%83% 1677167711

70%70% 1043104388

68%68%

UrineUrine 85148514 17%17% 70247024 29%29% 48864886 32%32%

Other†Other† 1919 0.0%0.0% 6767 0.3%0.3% 66 0.0%0.0%

Total 5080508077

100%100% 2386238688

100%100% 1533153300

100%100%


††Other specimen types include urethra, rectum, and “other” not specifiedOther specimen types include urethra, rectum, and “other” not specified

Project Area Data:Project Area Data:MaterialsMaterials

Facility Reference ListFacility Reference List By county, facility type and granteeBy county, facility type and grantee Includes active and inactive IPP sitesIncludes active and inactive IPP sites

Female Chlamydia & Gonorrhea TrendsFemale Chlamydia & Gonorrhea Trends By age group By age group By race/ethnicityBy race/ethnicity By facility typeBy facility type By lab test typeBy lab test type By specimen typeBy specimen type

Female Chlamydia Site-Level TrendsFemale Chlamydia Site-Level Trends By age group and countyBy age group and county

Project Area Data:Project Area Data:Key QuestionsKey Questions

What What facilitiesfacilities are represented in your IPP data? are represented in your IPP data? Which Which clientsclients are represented in your IPP data? are represented in your IPP data? Where/among what populations are the greatest Where/among what populations are the greatest

proportion of infections detected based on IPP data?proportion of infections detected based on IPP data? ChlamydiaChlamydia GonorrheaGonorrhea

What other epidemiologic data sources are available What other epidemiologic data sources are available to you?to you?

Where/at which facilities is there an opportunity to:Where/at which facilities is there an opportunity to: Increase screening coverage among females ≤25 years of Increase screening coverage among females ≤25 years of

age?age? Decrease screening among females >29 years of age?Decrease screening among females >29 years of age?

What other steps could be taken to increase the What other steps could be taken to increase the number of infections detected at each site?number of infections detected at each site? Consider test technology and specimen typeConsider test technology and specimen type

ipp measures of effectiveness utilization of data to evaluate and inform project activities december...

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