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TRANSCRIPT
Ryan White A Clinical Quality Management Summary of FY12 Review
Presenta@on for the Greater Bal@more HIV Health Services Planning Council
July 16, 2013
FY2012 Data Collec@on & Scope
2
Service Category Charts Reviewed
Consumers Interviewed
OAHS Primary Care 573 (Adult) 14 (Pediatric)
168
Medical Transporta?on 775 124
Housing 83 102
Housing Emergency Financial Assistance 311
Health Insurance 247 33
OAHS Emergency Financial Assistance 361 96
Child care 18 7
TOTAL 2,387 530
NOTE • Where possible, data is compared to previous years. Data variance can be
a\ributed to
– Different reviewers – Different agencies being reviewed – Different records being reviewed – Varia@ons in the abstrac@on tool – Movement from paper to electronic records
– Actual differences in performance
• Variance in N
– Measure not applicable or indicated
– Client new to care (<12 months of data) – Missing data
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Adult PMC Demographics, N=573
GENDER
58%
41%
1%
Male Female Transgender
Adult PMC Demographics, N=573
HIV RISK BEHAVIOR
40%
27%
13%
5% 2% 1% 2%
5% 5%
Heterosexual MSM IDU
Perinatal Hetero & IDU MSM & IDU
Other Missing Not documented
Adult PMC Demographics, N=573 AGE
4%
19%
14%
23%
27%
9%
2% 2%
0%
5%
10%
15%
20%
25%
30%
<20 20's 30's 40's 50's 60's >70 Missing
Laboratory Values
CD4, N=558 Median, 452 cells/mm3
8
3% 4%
17%
39% 36%
4% 4% 2%
12%
39% 37%
6%
0%
10%
20%
30%
40%
50%
<50 50-‐100 101-‐249 250-‐500 501-‐1,000 >1,000
2011
2012
Laboratory Values
Viral Load, N=554 Median, 20 copies/mL
9
54%
11% 9% 6% 5%
10% 4%
51%
11% 9% 10% 8% 8% 4%
0%
20%
40%
60%
<50
<200
200-‐1,000
1,001-‐5,000
5,001-‐20,00
0
20,001-‐100,
000
>100,000
2011
2012
VL by HAART All PMC N=554 On HAART N=449
10
51%
11% 9% 10% 8% 8% 4%
59%
12% 8% 8% 5% 5% 3%
0%
20%
40%
60%
80%
100% <50
<200
200-‐1,000
1,001-‐5,000
5,001-‐20,00
0
20,001-‐100,
000
>100,000
All PMC
On HAART
Medical Visits
% of clients with HIV infec@on who had 2 or more medical visits at least 3 months apart in an HIV care sehng in measurement year
90% 93% 92%
0%
20%
40%
60%
80%
100%
2010 2011 2012
Medical Visits, N=497
11 HRSA/HAB Performance Measures
CD4 T-‐Cell Count
% of clients with HIV infec@on who had 2 or more CD4 T-‐cell counts performed at least 3 months apart during measurement year
86% 88% 81%
0%
20%
40%
60%
80%
100%
2010 2011 2012
CD4, N=492
12 HRSA/HAB Performance Measures
Viral Load Monitoring, N=492
• % of clients with HIV infec@on who had 2 or more Viral Load tests performed at least 3 months apart during measurement year – New measure
– 81% of charts documented VL monitoring
13 HRSA/HAB Performance Measures
HAART
% of clients with AIDS who were prescribed a HAART regimen within measurement year
92% 95% 90%
0%
20%
40%
60%
80%
100%
2010 2011 2012
HAART, N=270
14 HRSA/HAB Performance Measures
PCP Prophylaxis
% of clients with HIV infec@on and a CD4 count below 200 cells/mm3 prescribed PCP prophylaxis
89% 89% 84%
0%
20%
40%
60%
80%
100%
2010 2011 2012
PCP Prophylaxis, N=90
15 HRSA/HAB Performance Measures
MAC Prophylaxis
% of clients with HIV infec@on with CD4 count <50 cells/mm3
prescribed MAC prophylaxis within measurement year
65%
86%
68%
0%
20%
40%
60%
80%
100%
2010 2011 2012
MAC Prophylaxis, N=37
16 HRSA/HAB Performance Measures
Hepa??s B Screening
% of clients for whom Hepa@@s B screening was performed at least once since the diagnosis of HIV infec@on
Of the 506 screened, 38% were posi@ve
96% 95%
0%
20%
40%
60%
80%
100%
2010 2011 2012
Hepa??s B, N=534
17 HRSA/HAB Performance Measures
Hepa??s C Screening
% of clients for whom Hepa@@s C screening was performed at least once since the diagnosis of HIV infec@on
Of the 503 screened, 27% were posi@ve
90% 94% 95%
0%
20%
40%
60%
80%
100%
2010 2011 2012
Hepa??s C, N=533
18 HRSA/HAB Performance Measures
Lipid Screening
% of clients with HIV infec@on on HAART who had a fas@ng lipid panel during measurement year
78% 71%
76%
0%
20%
40%
60%
80%
100%
2010 2011 2012
Lipids, N=484
19 HRSA/HAB Performance Measures
Syphilis Screening
% of adult clients with HIV infec@on who had a test for syphilis performed within measurement year Of the 396, 13% were posi@ve. Of the posi@ve, 70% documented treatment
84% 84%
75%
0%
20%
40%
60%
80%
100%
2010 2011 2012
Syphilis, N=526
20 HRSA/HAB Performance Measures
Toxoplasma Screening
% of clients with HIV infec@on for whom Toxoplasma screening was performed at least once since the diagnosis of HIV infec@on
77% 81%
77%
0%
20%
40%
60%
80%
100%
2010 2011 2012
Toxoplasma, N=509
21 HRSA/HAB Performance Measures
Chlamydia Screening
% of clients with HIV infec@on at risk for sexually transmi\ed infec@on who had a test for Chlamydia within measurement year
33%
55%
68% 66%
0%
20%
40%
60%
80%
100%
2009 2010 2011 2012
Chlamydia, N=501
22 HRSA/HAB Performance Measures
Gonorrhea Screening
% of clients with HIV infec@on at risk for sexually transmi\ed infec@on who had a test for gonorrhea within measurement year
35%
56%
68% 66%
0%
20%
40%
60%
80%
100%
2009 2010 2011 2012
Gonorrhea, N=500
23 HRSA/HAB Performance Measures
TB Screening
% of clients with HIV infec@on who received tes@ng with results for latent tuberculosis infec@on since HIV diagnosis Of the 319 screened, 10% were posi@ve. Of the posi@ve, 51% documented treatment
63%
77%
65%
0%
20%
40%
60%
80%
100%
2010 2011 2012
TB Screening, N=488
24 HRSA/HAB Performance Measures
Oral Exam
% of clients with HIV infec@on who received an oral exam by a den@st at least once during measurement year
24%
13% 17%
0%
20%
40%
60%
80%
100%
2010 2011 2012
Oral Exam, N=477
25 HRSA/HAB Performance Measures
Substance Use Screening (New Clients Only)
% of new clients with HIV infec@on who have been screened for substance use (alcohol & drugs)
26
77%
23%
Substance Use Screening, N=91
Yes
No
HRSA/HAB Performance Measures
Mental Health Screening (New Clients Only)
% of new clients with HIV infec@on who have had a mental health screening
27
71%
29%
Mental Health Screening, N=91
Yes
No
HRSA/HAB Performance Measures
Influenza Vaccina?on
% of clients with HIV infec@on who have received an influenza vaccina@on within measurement year
60% 64%
70%
0%
20%
40%
60%
80%
100%
2010 2011 2012
Influenza Vaccina?on, N=499
28 HRSA/HAB Performance Measures
Pneumococcal Vaccina?on
% of clients with HIV infec@on who ever received pneumococcal vaccine
83% 81% 87%
0%
20%
40%
60%
80%
100%
2010 2011 2012
Pneumococcal Vaccina?on, N=500
29 HRSA/HAB Performance Measures
Hepa??s B Vaccina?on
% of clients with HIV infec@on who completed the vaccina@on series for Hepa@@s B
36%
62%
54%
66%
0%
20%
40%
60%
80%
100%
2009 2010 2011 2012
Hepa??s B Vaccina?on, N=354
30 HRSA/HAB Performance Measures
Adherence Assessment & Counseling
% of clients with HIV infec@on on ARVs who were assessed and counseled for adherence at least 2 @mes in measurement year
69% 76%
83%
0%
20%
40%
60%
80%
100%
2010 2011 2012
Adherence & Counseling, N=441
31 HRSA/HAB Performance Measures
HIV Risk Counseling
% of clients with HIV infec@on who received HIV Risk Counseling within measurement year
64%
72% 72%
0%
20%
40%
60%
80%
100%
2010 2011 2012
HIV Risk Counseling, N=507
32 HRSA/HAB Performance Measures
Hepa??s/Alcohol Counseling
% of clients with HIV and Hepa@@s B or C infec@on who received alcohol counseling within measurement year
45% 51% 43%
0%
20%
40%
60%
80%
100%
2010 2011 2012
Hepa??s/Alcohol Counseling, N=226
33 HRSA/HAB Performance Measures
Tobacco Cessa?on Counseling
% of clients with HIV infec@on who received tobacco cessa@on counseling within measurement year
57% 57% 55%
0%
20%
40%
60%
80%
100%
2010 2011 2012
Tobacco Cessa?on Counseling, N=293
34 HRSA/HAB Performance Measures
Cervical Cancer Screening
% of women with HIV infec@on who have a PAP screening in measurement year
61% 65%
68%
0%
20%
40%
60%
80%
100%
2010 2011 2012
Cervical Cancer Screen, N=212
35 HRSA/HAB Performance Measures
ARV Therapy for Pregnant Women
% of pregnant women with HIV infec@on who are prescribed an@retroviral therapy
50%
100% 100%
0%
20%
40%
60%
80%
100%
2010 2011 2012
ARV & Pregnancy, N=5
36 HRSA/HAB Performance Measures
FY12 PMC Summary
Excellent
• Medical Visits, 92%
• ARV prescrip@on for AIDS, 90% • Hepa@@s B screen, 95% • Hepa@@s C screen, 95% • ARV in Pregnancy, 100%
Has Improved FY11
• Hepa@@s C screen (1%)
KEY
Excellent Performance 90% and above
Moderate Performance Performance 70% and above
Needs Improvement Below 70%
Has Improved (Improved from previous review by X%)
FY12 PMC Summary, cont.
Moderate • CD4 Tests, 81% • Viral Load Monitoring, 81% • PCP Prophylaxis, 84% • Lipids Panel, 76% • Syphilis screen, 75% • Toxoplasma screen, 77% • Pneumococcal vaccina@on, 87% • Flu vaccina@on, 70% • Adherence Counseling, 83% • HIV Risk Counseling, 72%
Has Improved FY11
• Lipids Panel (5%) • Pneumococcal Vaccina@on
(6%)
• Influenza Vaccina@on (6%) • Adherence Counseling (7%)
KEY
Excellent Performance 90% and above
Moderate Performance Performance 70% and above
Needs Improvement Below 70%
Has Improved (Improved from previous review by X%)
FY12 PMC Summary, cont.
S?ll Needs Improvement • MAC prophylaxis, 68% • Chlamydia screen, 66% • Gonorrhea screen, 66% • TB screen, 65% • Oral Exam, 17% • Substance Use screen, 65% • Mental Health screen, 61% • Hepa@@s B vaccina@on, 66% • Hepa@@s/Alcohol counseling, 43% • Tobacco Cessa@on counseling, 55% • Pap screen, 68%
Has Improved • Oral Exam (4%)
• Hepa@@s B vaccina@on (12%) • Pap Screening (3%)
KEY
Excellent Performance 90% and above
Moderate Performance Performance 70% and above
Needs Improvement Below 70%
Has Improved (Improved from previous review by X%)
Medical Transporta@on
Doing well…
• Service not excessive
• Majority of transports to core services
• Lowest-‐cost modes of transporta@on are used
What’s Improved
• Ini@al documenta@on of Ryan White Eligibility
• Documenta@on of transporta@on des@na@on
Housing & Housing EFA
Doing well…
• Clients more stably housed
• Transi@onal housing not excessive
• Comple@on of required documenta@on
What’s Improved
• Contacts with client
• Documenta@on of u@lity bills or evic@on no@ce
Summary
• HRSA leaders and HIV experts have developed clinical performance measures that provide detailed guidelines on the delivery of quality HIV Care
• The Bal@more-‐Towson EMA has improved the quality of HIV care and con@nues to excel in management of HIV
Summary (2)
• Housing and Medical Transporta@on were priori@zed by the COCC in light of 2014
• Bal@more-‐Towson EMA con@nues to do well in providing these key services
Thank You
Bal@more City Health Department Ryan White A Office Christy Skipper
Deputy Director of Quality Management Christy.skipper@[email protected]; 410.396.1408