1. 1 An Introduction to Performance Measurement for Quality Improvement Presenters: Lori DeLorenzo, Marlene Matosky & Benjamin Harris Wednesday, November 28, 3:30-5:00 pm Virginia C RWA-0239 Quality Institute #1: Performance Measurement for Quality—How to Get Started to Measure Quality at My HIV Program Session 2

2. 2 NQC and Quality Workshops at 2012 AGM

3. 3 NQC at 2012 AGM Networking Opportunities - Interact with your peers… Tue, Nov 27 12pm: HIVQUAL Regional Group– Thurgood Marshall Ballroom West Wed, Nov 28 12pm: in+care Campaign - Thurgood Marshall Ballroom South NQC Exhibit Booth - Stop by our booth… NQC Office Hours - Meet one of our NQC coaches...

4. 4 Who’s in the Audience? Part Role Experience with Performance Measurement

5. 5 Most Pressing Performance Measurement Question? What are you struggling with the most as it relates to performance measurement?

6. 6 Learning Objectives Understand the balance of performance measurement and quality improvement activities Identify and implement key performance measurement steps Understand the purpose, definitions, and expectations of the quality measures released by the HIV/AIDS Bureau Learn how to access existing resources on performance measurement

7. 7 Key Question Why is measurement so important to quality, and how does measurement support quality improvement?

8. 8 Pop Quiz How many people were estimated to be living with HIV in the United States in the year 2010? 18,000 929,000 43,000 1,200,000

9. 9 Answer: About 1,200,000 This is a measure. What can we do with this measure? Estimate resources Make predictions Epidemic getting better?

10. 10 Why Measure? It’s very simple: “You can’t improve what you can’t measure!”

11. 11 Measurement and Quality Improvement are Interlinked

12. 12 What is a Quality Measure? A quality measure is a tool to assess specific aspects of care and services that are linked to better health outcomes while being consistent with current professional knowledge and meeting client needs.

13. 13 Measures Can Be Both… Outcomes The end result The effect on the individual or the population Processes The actions taken to produce the outcome The procedures for achieving the best outcomes

14. 14 Examples of Outcomes Include: Patient Health Status Viral load suppression Intermediate outcomes like immune & virological status Disability The patient’s own sense of his/her quality of life Hospital and ER visits Patient Satisfaction Public Health Outcomes Retention in Care Access to Care

15. 15 Range of Performance Measures Available HRSA HIV/AIDS Bureau (HAB) HHS HIV Measures National Quality Forum (NQF) National Quality Center (NQC) In+care Campaign HIVQUAL

16. 16 HAB Performance Measures www.hab.hrsa.gov/deliverhivaidscare/habperformmeasures.html Clinical (Groups 1-3) Medical Case Management Pediatrics Oral Health ADAP Systems-level

17. 17 http://blog.aids.gov/2012/08/secretary-sebelius-approves- indicators-for-monitoring-hhs-funded-hiv-services.html

18. 18 MeasureNumeratorDenominator HIV Positivity Number of HIV positive tests in the 12-month measurement period Number of HIV tests conducted in the 12-month measurement period Late HIV Diagnosis Number of persons with a diagnosis of Stage 3 HIV infection (AIDS) within 3 months of diagnosis of HIV infection in the 12-month measurement period Number of persons with an HIV diagnosis in the 12-month measurement period Linkage to HIV Medical Care Number of persons who attended a routine HIV medical care visit within 3 months of HIV diagnosis Number of persons with an HIV diagnosis in 12-month measurement period Retention in HIV Medical Care Number of persons with an HIV diagnosis who had at least one HIV medical care visit in each 6 month period of the 24 month measurement period, with a minimum of 60 days between the first medical visit in the prior 6 month period and the last medical visit in the subsequent 6 month period Number of persons with an HIV diagnosis with at least one HIV medical care visit in the first 6 months of the 24 ‐ month measurement period

19. 19 MeasureNumeratorDenominator Antiretroviral Therapy (ART) Among Persons in HIV Medical Care Number of persons with an HIV diagnosis who are prescribed ART in the 12-month measurement period Number of persons with an HIV diagnosis and who had at least one HIV medical care visit in the 12-month measurement period Viral Load Suppression Among Persons in HIV Medical Care Number of persons with an HIV diagnosis with a viral load <200 copies/mL at last test in the 12–month measurement period Number of persons with an HIV diagnosis and who had at least one HIV medical care visit in the 12-month measurement period Housing Status Number of persons with an HIV diagnosis who were homeless or unstably housed in the 12-month measurement period Number of persons with an HIV diagnosis receiving HIV services in the last 12 months

20. 20 HRSA/CDC Found Suitable for NQF Endorsement Medical visit frequency Gap in medical care Prescribed HIV antiretroviral therapy Viral load suppression

21. 21 Useful at Many Levels of HIV Care To align the work on the different Ryan White Program Parts At the system level At the provider level Within a program’s quality management plan

22. 22 HAB Does Not Require Grantees to Use These Measures But it strongly urges you to use the measures to: Track and trend performance Identify areas for improvement Strengthen quality management plans

23. 23 Key Question What should we be measuring to assess and improve the quality of our HIV care and services?

24. 24 Selecting & Prioritizing Measures Consider the following: Epidemic Primary modes of transmission Change in trends Subpopulations affected Population served Race/ethnicity Gender Age Risk factors Culture Influencing Factors

25. 25 Balanced Measures 1 or 2 measures are not sufficient Consider the purpose of the measures Primary focus of your program will impact the set of measures selected State or region-focus vs. stand alone clinic Support services program vs. clinical program Consider different types of indicators Process vs. outcome Access, coordination, screening, prophylaxis, etc.

26. 26 Erie Family Health Center: Lending Hands for Life Humboldt Park, Chicago, IL

27. 27 Considerations for Data Collection Create a performance measurement plan Who, what, where, when & why Sampling—use only when absolutely necessary

28. 28 Establish Accountability for Data Collection & Ensure Data Integrity

29. 29 DATA COLLECTION: Process Erie Family Health Center Notify providers Select and confirm measures Define timeframe Run custom Crystal Reports Export to Excel for translation and interpretation

30. 30 DATA COLLECTION: Challenges Erie Family Health Center Open charts Variation in documentation New EMR forms Updating and troubleshooting Crystal Reports

31. 31 You’ve Got the Data—Now What?

32. 32 Translation & Interpretation

33. 33 Erie Family Health Center Lending Hands for Life

34. 34 Erie Family Health Center Lending Hands for Life

35. 35 Breaking Down the Data What stands out to you? Any immediate red flags? What trends do you see? What are the areas of priority? What would teams do with the data? What additional questions do we need to ask?

36. 36 Erie Family Health Center Lending Hands for Life

37. 37 Use the Data to Guide your Improvement Work Doing well, or not? Performance stable, or a trend? Compared to other grantees? Look at the data Which areas need improvement? What are our priorities for improvement? Decide how to act on the data Identify project team Define improvement goa l Begin improvement work

38. 38

39. 39 NQC Website Quality Academy NQC Offerings HIVQUAL Regional Groups On-Site TA in+care Campaign NQC Trainings

40. 40 NQC Resources

41. 41 Performance Measurement Resources

42. 42 Performance Measurement Resources

43. 43 Quality Academy

44. Marlene Matosky, MPH, RN Nurse Consultant/Quality Advisor HRSA HIV/AIDS Bureau mmatosky@hrsa.gov 301-443-0798 Lori DeLorenzo, RN, MSN NQC Consultant National Quality Center (NQC) mmatosky@hrsa.gov Benjamin Harris Quality Improvement Analyst Erie Family Health Center

45. National Quality Center 212-417-4730 NationalQualityCenter.org Info@NationalQualityCenter.org Info@NationalQualityCenter.org