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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


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


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


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


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


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


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


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


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


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


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


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


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


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


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


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


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


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


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


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


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


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


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


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





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





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

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