Quality Management Chart Review Pamela Casey, MS, RD June 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 Core Service Categories Ambulatory care Medical case management Oral health services Home and community-based health services Mental health services Substance use services Early Intervention Services (EIS)

Ambulatory Care 117 charts 7 agencies

Demographics

At least 2 HIV provider visits during the period

Primary Care in last 6 months

CD4

ARV

Viral Load Suppression

Cervical cancer/PAP screen

Hepatitis-C Status Documented

Tobacco

Other Measures

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 Management 13 sites 170 charts

Demographics

Measures

Assessment of needs

Highlights Looking good – Plan updates – Assessments Areas for improvement – Risk reduction – Partner disclosure – Life skills/self-sufficiency

Substance Use 4 sites 37 charts

Demographics

Care and Treatment

Highlights Looking good – In treatment at 3 months Areas for improvement – In treatment at 6 months – medication adherence discussed: 54% in , but 52% in chart review

Mental Health 7 sites 61 charts

Demographics

Care and Treatment

Highlights Looking good – In care for 3 months – Assessed for substance use at the rate of 92% in ; 67% in Areas for improvement – HIV Medication adherence (100% in to 57% in )

Oral Health 6 sites 59 charts

Demographics

HRSA Performance Measures for Oral health

Assessment

Highlights Looking good – Assessed for ARV – Periodontal screens Areas for improvement – Oral health education – Medical history

Home Health 1 site 10 charts

Demographics

Performance measures

Early Intervention Services 1 site 10 charts

Performance Measures

Assessment for client needs

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

Eligibility Information

Eligibility Requirements

Evaluation of the Chart Review Good: 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