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Quality ManagementChart Review 2013-14
Pamela Casey, MS, RDJune 24, 2014
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 the core services selected by the CCPC – Only a portion of the measures provided
• 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 developed• Nurses hired• Schedule created for January and February• Data collected• Cleaned• Data input• Compiled in a report
Review of CoreService Categories
Ambulatory careMedical case managementOral health servicesHome and community-based health servicesMental health servicesSubstance use servicesEarly Intervention Services (EIS)
Ambulatory Care
117 charts7 agencies
Demographics
78%
20%
2%
gender
malefemaleTransgender
2%
26%
33%
39%
age
18-2526-4041-5051+
At least 2 HIV provider visits during the period
ambulatory care0
20
40
60
80
100
95%
99%90%
2012-132013-14National Standard
Primary Care in last 6 months
Case mgmt Oral health Substance Abuse
Mental Health
Home Health
0
20
40
60
80
100
98%
67%
88%93%
77%
58%
41% 46%
100%
2012-132013-14
CD4
done at least twice0
20
40
60
80
100100%
86%
2012-132013-14
ARV
Prescribed adherence counseling0
20
40
60
80
10093%
86%92%
88%
2012-132013-14
Viral Load Suppression
viral load less than 2000
20
40
60
80
100
89%
(<200 or Undetectable)
74% (<200 only)
85% (<200 only)
2012-132013-14national benchmark
Cervical cancer/PAP screen
Series10
20
40
60
80
100
71%
87%
63%
2012-13 (n=38)2013-14 (n=23)national standard
Hepatitis-C Status Documented
Series10
20
40
60
80
100
46%50%
98%
2012-132013-14national standard
Tobacco
assessment cessation counseling0
20
40
60
80
10090%
70%
No national standard
95%
2012-132013-14national standard
Other Measures
HIV risk counseling
flu vaccine dental care0
20
40
60
80
100
76%
63%
48%
72%81%
55%
No national standard
67%
35%2012-132013-14national standard
Highlights
• Looking good– ARV– Pap smears– Documentation of dental care
• Areas for improvement– Identify both viral load suppression and undetectable– Documentation of Hep-C status– Tobacco cessation counseling or referral– Document the connection with primary care to help
identify those out of care
Case Management13 sites170 charts
Demographics
63%
31%
3%
Gender
malefemaletransgender
4%children 5%
26%
34%
31%
Age
<1718-2526-4041-5051+
Measures
0
20
40
60
80
100
61%
75% 74%64% 73%
54%47% 2012-13
2013-14
Assessment of needs
0
20
40
60
80
100Up to 92%
(low as65%)
No info2012-13
83%
49%
2012-132013-14
Highlights
• Looking good– Plan updates– Assessments
• Areas for improvement– Risk reduction – Partner disclosure– Life skills/self-sufficiency
Substance Use4 sites37 charts
Demographics
68%
32%
Gender
malefemale
27%
32%
41%
Age
18-2526-4041-5051+
Care and Treatment
treatment plan in treatment at 3 months
in treatment at 6 months
HIV medication adherence
0
20
40
60
80
100 100%
63%
25%
No info
76% 76%
38%
54%
2012-132013-14
Highlights
• Looking good– In treatment at 3 months
• Areas for improvement– In treatment at 6 months– medication adherence discussed: 54% in 2013-14,
but 52% in 2011-12 chart review
Mental Health7 sites61 charts
Demographics
74%
23%
2%
Gender
malefemaletransgender
13%
8%
21%
31%
27%
Age
<1718-2526-4041-5051+
Care and Treatment
0
20
40
60
80
100 100% 100% 100%
No info
82% 90%
57%
92%
2012-132013-14
Highlights
• Looking good– In care for 3 months– Assessed for substance use at the rate of 92% in
2013-14; 67% in 2011-12
• Areas for improvement– HIV Medication adherence (100% in 2012-13 to
57% in 2013-14)
Oral Health6 sites 59 charts
Demographics
73%
25%
Gender
malefemale
2%
17%
36%
46%
Age
18-2526-4041-5051+
HRSA Performance Measures for Oral health
0
20
40
60
80
100 91%84%
95%
58%70%
92%
2012-132013-14
Assessment
ARV substances and/or tobacco
0
20
40
60
80
100
52%
62%
88%
66%
2012-132013-14
Highlights
• Looking good– Assessed for ARV– Periodontal screens
• Areas for improvement– Oral health education– Medical history
Home Health1 site
10 charts
Demographics
50%
50%
Gender
malefemale
30%
70%
Age
41-5051+
Performance measures
0
20
40
60
80
100 100% 100%
90%
100%
2012-132013-14
Early InterventionServices
1 site10 charts
Performance Measures
1 HIV appt risk reduction assessed for substance use
referred for substance use
0
20
40
60
80
100
20%
50% 50%
11%
2012-132013-14
Assessment for client needs
support system housing stability food/utilities transportation0
20
40
60
80
100
30% 30%
40% 40%2012-132013-14
Highlights
• Looking good– Risk reduction – Assessment of substance abuse
• Areas for improvement– Need for follow-up with connection to primary
care– Assessed for basic needs
Retention in Care
Attempts made to reschedule appointments
MCM oral health substance use mental health0
20
40
60
80
100
53%
36%44%
64%
78%
54%
86%
96%
2012-132013-14
Eligibility Information
Eligibility Requirements
amb care/ income
amb care/ Medi-cal
MCM/income MCM/Medi-cal0
20
40
60
80
100 89%99%
90%100%
68%
97%
80%88%
2012-132103-14
Evaluation of the Chart ReviewGood:• HIV specialist on staff • Helpful staff• Separate private, space provided• Flexibility with arranging extra time• Chart lay out was provided, data elements highlighted
Not so good:• Accessibility of EHRs• Inconsistencies with client list pulled from ARIES• Signatures of clients not found on care plans• Documents located in several places
Looking to the future:• Track the same data element year-to-year for trends• Collaborative effort on chart review