Developing Performance Measures Portland Oregon TGA

Objectives: Share Portland TGA performance measures Describe the process of developing one measure and refining it Share challenges and lessons learned

Portland TGA Performance Measures

Measuring Client Access to Primary HIV Medical Care Original Measure (2001): Does client have an HIV medical provider? - Non-specific (Y/N) Does not measure actual activity Client self report Duplicated + Easily reported by all service providers Valuable for providers - coordination of care Prior to having a client level database

Measuring Client Access to Primary HIV Medical Care Next Measure (2006): Did you see your medical provider in the last 4 months, 5-6 months, > 6 months? + More activity specific, client getting care Flexibility in collection methodology depending upon provider Began collecting at client level within database 1st step in a process - Different levels of confidence in the data Check box annual survey Collecting date of last visit Client self report for some providers Medical chart abstraction for others Not all providers submitting data at client level Date of last medical visit collected Upon discharge, Every visit, Quarterly Date of last medical visit internally available for 60% of clients. Goal is information on all clients to accurately analyze system and provider specific impact . Remainder reported in aggregate – the two cannot be combined therefore no reliable system-wide outcome

Measuring Client Access to Primary HIV Medical Care Current Measure: Was your last medical visit 4 months ago , 5-6 months ago , > 6 months ago? Shifted from range to specific visit dates All core service providers submitting client level data and required to use best or good data collection criteria Best - data sources that pull directly from client medical record accepted first, followed by provider pulling from medical record Good – client self report of last medical visit date collected regularly from all clients Support Services – may use best or good criteria, acceptable is minimum requirement Acceptable – client self report from a sample, reported in aggregate First year – core services “should” cover 93% of clients therefore would be applicable across the system and hopefully to all service providers. We will analyze the data once it is in to confirm. If this is successful, we will not require support services to collect this data any longer.

Challenges Maintaining reasonable expectation of service providers Using medical outcomes is reasonable as an outcome measure for the system. Is it equally applicable across providers? Data sharing – inability to share data increases data collection and reporting burden HIV Oregon HIV, substance abuse and mental health confidentiality laws Strict county interpretation of HIPAA

Lessons Learned Programmatic lessons Keep clients at the center – performance measures are aimed at improving the quality of the care and evaluation programs, not at proving a thesis Don’t let measurement guide the program - the results should guide the program but not the measurability Work with providers to establish measures - provide technical assistance and make compromises Technical lessons Be realistic about time involved in collecting data for certain measures Critical to have a client level data base Providers are experts at providing care – we need to provide expertise in analysis

Contact Information Marisa McLaughlin, Research Analyst marisa.a.mclaughlin@co.multnomah.or.us 503-988-3030 x25705 Margy Robinson, HIV Care Services Mgr. margaret.l.robinson@co.multnomah.or.us 503-988-3030 x25681