![Page 1: Quality Management Report for CCPC 2014-15 Pamela Casey-Lewis, MS, RD June 24, 2015](https://reader033.vdocument.in/reader033/viewer/2022051202/5a4d1b757f8b9ab0599b6e66/html5/thumbnails/1.jpg)
Quality Management Reportfor CCPC2014-15
Pamela Casey-Lewis, MS, RD
June 24, 2015
![Page 2: Quality Management Report for CCPC 2014-15 Pamela Casey-Lewis, MS, RD June 24, 2015](https://reader033.vdocument.in/reader033/viewer/2022051202/5a4d1b757f8b9ab0599b6e66/html5/thumbnails/2.jpg)
![Page 3: Quality Management Report for CCPC 2014-15 Pamela Casey-Lewis, MS, RD June 24, 2015](https://reader033.vdocument.in/reader033/viewer/2022051202/5a4d1b757f8b9ab0599b6e66/html5/thumbnails/3.jpg)
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
![Page 4: Quality Management Report for CCPC 2014-15 Pamela Casey-Lewis, MS, RD June 24, 2015](https://reader033.vdocument.in/reader033/viewer/2022051202/5a4d1b757f8b9ab0599b6e66/html5/thumbnails/4.jpg)
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
![Page 5: Quality Management Report for CCPC 2014-15 Pamela Casey-Lewis, MS, RD June 24, 2015](https://reader033.vdocument.in/reader033/viewer/2022051202/5a4d1b757f8b9ab0599b6e66/html5/thumbnails/5.jpg)
The process
• Chart tool revised• Access database updated• Abstractors hired• Scheduled during the last quarter• Data collected and analyzed• Data input and compilation
![Page 6: Quality Management Report for CCPC 2014-15 Pamela Casey-Lewis, MS, RD June 24, 2015](https://reader033.vdocument.in/reader033/viewer/2022051202/5a4d1b757f8b9ab0599b6e66/html5/thumbnails/6.jpg)
Review of CoreService Categories
Ambulatory careMedical case managementOral health servicesHome and community-based health servicesMental health servicesSubstance use servicesEarly Intervention Services (EIS)
![Page 7: Quality Management Report for CCPC 2014-15 Pamela Casey-Lewis, MS, RD June 24, 2015](https://reader033.vdocument.in/reader033/viewer/2022051202/5a4d1b757f8b9ab0599b6e66/html5/thumbnails/7.jpg)
Ambulatory Care4 agencies
![Page 8: Quality Management Report for CCPC 2014-15 Pamela Casey-Lewis, MS, RD June 24, 2015](https://reader033.vdocument.in/reader033/viewer/2022051202/5a4d1b757f8b9ab0599b6e66/html5/thumbnails/8.jpg)
Demographics
68%
30%
gender
malefemale
8%
24%
43%
22%
age
18-2526-4041-5051+
60%8%
16%
8%
race
African Amer-icanLatinoWhiteother
![Page 9: Quality Management Report for CCPC 2014-15 Pamela Casey-Lewis, MS, RD June 24, 2015](https://reader033.vdocument.in/reader033/viewer/2022051202/5a4d1b757f8b9ab0599b6e66/html5/thumbnails/9.jpg)
At least 2 HIV provider visits during the period
Series10
20
40
60
80
100
91%
99%90%
2014-152013-14National Standard
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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
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Elements of the Treatment Cascade
ARV Prescribed viral load suppression0
20
40
60
80
10097%
84%92%
74%
2014-152013-14
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Hepatitis-C Status Documented
Series10
20
40
60
80
100
89%
50%
98%
2014-152013-14national standard
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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
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Highlights
• Looking good– Prescribed ARV– VL suppression– Documentation of Hep-C status
• Areas for improvement– Document the dental care
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Case Management8 sites125 charts
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Demographics
63.2%
33.6%
2.7%
Gender
malefemaletransgender
5.6% 13.6%
15.2%
57.6%
8%
Age
<1718-2526-4041-6061+
![Page 17: Quality Management Report for CCPC 2014-15 Pamela Casey-Lewis, MS, RD June 24, 2015](https://reader033.vdocument.in/reader033/viewer/2022051202/5a4d1b757f8b9ab0599b6e66/html5/thumbnails/17.jpg)
Demographics
60.8%
8%
22.4%
1.8% 1.6% 5.6%
Race
African AmericanLatinoWhiteAsianAI/AN/NH/PIunk/other
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HRSA MCM performance measures
020406080
100
86.4% 80%76.6%63.7%
2014-152013-14
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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
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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
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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
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Budgeting, life skills and self-sufficiency
documentation included in file0
20
40
60
80
100
82.6%
50.6%
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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
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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.
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Substance Use4 sites38 charts
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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
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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
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Retention in care
re-scheduled appointments0
20
40
60
80
100
81.6%
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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
![Page 30: Quality Management Report for CCPC 2014-15 Pamela Casey-Lewis, MS, RD June 24, 2015](https://reader033.vdocument.in/reader033/viewer/2022051202/5a4d1b757f8b9ab0599b6e66/html5/thumbnails/30.jpg)
Mental Health5 sites55 charts
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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
![Page 32: Quality Management Report for CCPC 2014-15 Pamela Casey-Lewis, MS, RD June 24, 2015](https://reader033.vdocument.in/reader033/viewer/2022051202/5a4d1b757f8b9ab0599b6e66/html5/thumbnails/32.jpg)
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
![Page 33: Quality Management Report for CCPC 2014-15 Pamela Casey-Lewis, MS, RD June 24, 2015](https://reader033.vdocument.in/reader033/viewer/2022051202/5a4d1b757f8b9ab0599b6e66/html5/thumbnails/33.jpg)
Other assessments
risk reduction re-scheduled appointments
0
20
40
60
80
100
72.7%
92.7%
23%
86.9%
2014-15
2013-14
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Highlights
• Improvement in documentation of risk reduction, HIV medication adherence
• slight increase in retention at three months
• An increase in re-scheduled visits
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Oral Health6 sites 87charts
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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
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HRSA Performance Measures for Oral health
0
20
40
60
80
100100%
93.1% 97.7%
58%
70%
92%
2014-15
2013-14
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Assessment and Retention
substance use re-scheduling appts0
20
40
60
80
100
83.9% 83.7%
66%54.9% 2014-15
2013-14
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Highlights
• Improvement in all HRSA performance measures
• Attempts to retain clients in care
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Home Health1 site
15 charts
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Demographics
66.7%
26.7%
Gender
malefemale
20%
80%
Age
41-5051+
73.3%
6.7%20%
Race
African Amer-ican
Latino
White
![Page 42: Quality Management Report for CCPC 2014-15 Pamela Casey-Lewis, MS, RD June 24, 2015](https://reader033.vdocument.in/reader033/viewer/2022051202/5a4d1b757f8b9ab0599b6e66/html5/thumbnails/42.jpg)
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
![Page 43: Quality Management Report for CCPC 2014-15 Pamela Casey-Lewis, MS, RD June 24, 2015](https://reader033.vdocument.in/reader033/viewer/2022051202/5a4d1b757f8b9ab0599b6e66/html5/thumbnails/43.jpg)
Early InterventionServices
1 site15 charts
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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+
![Page 45: Quality Management Report for CCPC 2014-15 Pamela Casey-Lewis, MS, RD June 24, 2015](https://reader033.vdocument.in/reader033/viewer/2022051202/5a4d1b757f8b9ab0599b6e66/html5/thumbnails/45.jpg)
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
![Page 46: Quality Management Report for CCPC 2014-15 Pamela Casey-Lewis, MS, RD June 24, 2015](https://reader033.vdocument.in/reader033/viewer/2022051202/5a4d1b757f8b9ab0599b6e66/html5/thumbnails/46.jpg)
Assessment for client needs
Housing stability food/utilities/transportation0
20
40
60
80
100
46.6%
66.6%
30% 30%
2014-152013-14
![Page 47: Quality Management Report for CCPC 2014-15 Pamela Casey-Lewis, MS, RD June 24, 2015](https://reader033.vdocument.in/reader033/viewer/2022051202/5a4d1b757f8b9ab0599b6e66/html5/thumbnails/47.jpg)
Highlights
• Younger population
• Less than half were previously linked to care
• Comprehensive assessments
![Page 48: Quality Management Report for CCPC 2014-15 Pamela Casey-Lewis, MS, RD June 24, 2015](https://reader033.vdocument.in/reader033/viewer/2022051202/5a4d1b757f8b9ab0599b6e66/html5/thumbnails/48.jpg)
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
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49
Patient Satisfaction
• Boxes placed at several different agencies
• Partial collection (77)
Happy Just okay
unhappy
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50
Demographics
30%
25%
45%
Age
26-4041-5051+
51%
18%
16%
15%
Race
African AmericanLatinoWhiteOther
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51
More demographics
75%18%
7%
gender
male
female
transgender
62%
35%
3%
sexual orientation
LGB
heterosexual
other
![Page 52: Quality Management Report for CCPC 2014-15 Pamela Casey-Lewis, MS, RD June 24, 2015](https://reader033.vdocument.in/reader033/viewer/2022051202/5a4d1b757f8b9ab0599b6e66/html5/thumbnails/52.jpg)
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
![Page 53: Quality Management Report for CCPC 2014-15 Pamela Casey-Lewis, MS, RD June 24, 2015](https://reader033.vdocument.in/reader033/viewer/2022051202/5a4d1b757f8b9ab0599b6e66/html5/thumbnails/53.jpg)
53
How does Staff treat youover the phone?
2015 20140
20
40
60
80
100
72.3%
48%
18.4%
52%
9%
happyjust okayunhappy
![Page 54: Quality Management Report for CCPC 2014-15 Pamela Casey-Lewis, MS, RD June 24, 2015](https://reader033.vdocument.in/reader033/viewer/2022051202/5a4d1b757f8b9ab0599b6e66/html5/thumbnails/54.jpg)
54
How does staff treat youwhile face-to-face?
2015 20140
20
40
60
80
100
82%70%
17%
30%
1%
happy just okayunhappy
![Page 55: Quality Management Report for CCPC 2014-15 Pamela Casey-Lewis, MS, RD June 24, 2015](https://reader033.vdocument.in/reader033/viewer/2022051202/5a4d1b757f8b9ab0599b6e66/html5/thumbnails/55.jpg)
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
![Page 56: Quality Management Report for CCPC 2014-15 Pamela Casey-Lewis, MS, RD June 24, 2015](https://reader033.vdocument.in/reader033/viewer/2022051202/5a4d1b757f8b9ab0599b6e66/html5/thumbnails/56.jpg)
56
The way your medical provider explains information to you
20150
20
40
60
80
100
83.8%
12% 4%
happyjust okayunhappy
![Page 57: Quality Management Report for CCPC 2014-15 Pamela Casey-Lewis, MS, RD June 24, 2015](https://reader033.vdocument.in/reader033/viewer/2022051202/5a4d1b757f8b9ab0599b6e66/html5/thumbnails/57.jpg)
57
How is your privacy is handled?
2015 20140
20
40
60
80
100
78.7%70%
17.3%
26%
4% 4%
happyjust okayunhappy
![Page 58: Quality Management Report for CCPC 2014-15 Pamela Casey-Lewis, MS, RD June 24, 2015](https://reader033.vdocument.in/reader033/viewer/2022051202/5a4d1b757f8b9ab0599b6e66/html5/thumbnails/58.jpg)
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
![Page 59: Quality Management Report for CCPC 2014-15 Pamela Casey-Lewis, MS, RD June 24, 2015](https://reader033.vdocument.in/reader033/viewer/2022051202/5a4d1b757f8b9ab0599b6e66/html5/thumbnails/59.jpg)
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
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60
The complaints
• No return phone call
• Incorrect medical information in file
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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
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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
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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
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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
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Other comments
• It’s my responsibility to make appointments• The staff is phenomenal• I have a very good doctor• Para transit vouchers
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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
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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
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Other reasons
• Didn’t have the money• Depression• Homeless• Personal issues• No transportation• Sick• Didn’t have insurance
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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
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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