Quality Management Report for CCPC Pamela Casey-Lewis, MS, RD June 24, 2015

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 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

The process Chart tool revised Access database updated Abstractors hired Scheduled during the last quarter Data collected and analyzed Data input and compilation

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 4 agencies

Demographics

At least 2 HIV provider visits during the period

Documentation of Primary Care in the last 6 months

Elements of the Treatment Cascade

Hepatitis-C Status Documented

Other Measures

Highlights Looking good – Prescribed ARV – VL suppression – Documentation of Hep-C status Areas for improvement – Document the dental care

Case Management 8 sites 125 charts

Demographics

HRSA MCM performance measures

Visits per 12 month period

Measures

Screening for other needs

Budgeting, life skills and self-sufficiency

Re-scheduling appointments

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.

Substance Use 4 sites 38 charts

Demographics

Care and Treatment

Retention in care

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

Mental Health 5 sites 55 charts

Demographics

Care and Treatment

Other assessments

Highlights Improvement in documentation of risk reduction, HIV medication adherence slight increase in retention at three months An increase in re-scheduled visits

Oral Health 6 sites 87charts

Demographics

HRSA Performance Measures for Oral health

Assessment and Retention

Highlights Improvement in all HRSA performance measures Attempts to retain clients in care

Home Health 1 site 15 charts

Demographics

Performance measures

Early Intervention Services 1 site 15 charts

Demographics

Performance Measures

Assessment for client needs

Highlights Younger population Less than half were previously linked to care Comprehensive assessments

Evaluation of the Chart Review Good: Helpful staff Separate private, space provided Flexibility with arranging extra time Needs improvement: Accessibility of data from EHRs Client list pulled from ARIES Looking to the future: Review data more often Use different contractors

Patient Satisfaction Boxes placed at several different agencies Partial collection (77) 49 Happy Just okay unhappy

Demographics 50

More demographics 51

The amount of time it takes to get an appointment 52

How does Staff treat you over the phone? 53

How does staff treat you while face-to-face? 54

The way your provider explains health-related information 55

The way your medical provider explains information to you 56

How is your privacy is handled? 57

How happy are you with the way your concerns/complaints are addressed? 58

Do you have a complaint that you are afraid to discuss with the staff? 59

The complaints No return phone call Incorrect medical information in file 60

How happy are you about the cleanliness at the site? 61

What helps you stay in care? 62

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 63

What helps you stay connected to care?

Other comments It’s my responsibility to make appointments The staff is phenomenal I have a very good doctor Para transit vouchers

What are some reasons you’ve been out of care? 66

If you were out of care for 6 months, name the reason

Other reasons Didn’t have the money Depression Homeless Personal issues No transportation Sick Didn’t have insurance

How happy are you about recommending this site to other HIV+ clients? 69

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 70