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