1. Establishing the H4C Viral Suppression Cohort
Michael

2. Overview
H4C participants at LS1 discussed overall collaborative impact assessments and the need for a more direct measurement of impact
Creation of cohort to show patient-level improvement in viral load suppression in H4C
Updated annually to see improvement in this cohort over a two-year period

3. Expectations for Participation
Submit baseline performance data and annual updates (2015 & 2016) to NQC
Note that this continues after the transition to the sustainability phase in July 2015
Roll up data similarly to performance measurement:
Grantees roll up subgrantee data
Grantee reports data to Response Team
Response Team submits data to NQC

4. Measure Definitions – Establish Cohort
Definition of the cohort
Patients, regardless of age, with a diagnosis of HIV with a HIV viral load greater than or equal to 200 copies/mL at last HIV viral load between July 1, 2013 – June 30, 2014
Numerator
Number of patients in the denominator with a HIV viral load greater or equal to than 200 copies/mL at last HIV viral load test during the measurement period between July 1, 2013 – June 30, 2014
Denominator
Number of patients, regardless of age, with a diagnosis of HIV with at least one medical visit between July 1, 2013 – June 30, 2014
Exclusions
1. Patients who are documented to be deceased during the measurement year
2. Patients who were incarcerated for the greater than 6 months of the measurement year
3. Patients who relocated out of the care site’s geographic catchment during the measurement year
4. Patients who transferred HIV medical care during the measurement year

5. Measure Definitions Update #1: 2015 Viral suppression among cohort
Patients, regardless of age, with a diagnosis of HIV with a HIV viral load less than 200 copies/mL at last HIV viral load between July 1, 2014 – June 30 , 2015
Numerator
Number of patients in the denominator with a HIV viral load less than 200 copies/mL at last HIV viral load test between July 1, 2014 and June 30, 2015
Denominator
Number of cohort patients (number of patients, regardless of age, with a diagnosis of HIV with at least one medical visit and not virally suppressed between July 1, 2013 – June 30, 2014)
Exclusions
1. Patients who are documented to be deceased during the measurement year
2. Patients who were incarcerated for the greater than 6 months of the measurement year
3. Patients who relocated out of the care site’s geographic catchment during the measurement year
4. Patients who transferred HIV medical care during the measurement year

6. Measure Definitions Update #2: 2016 Viral suppression among cohort
Patients, regardless of age, with a diagnosis of HIV with a HIV viral load less than 200 copies/mL at last HIV viral load between July 1, 2015 – June 30, 2016
Numerator
Number of patients in the denominator with a HIV viral load less than 200 copies/mL at last HIV viral load test between July 1, 2015 and June 30, 2016
Denominator
Number of cohort patients (number of patients, regardless of age, with a diagnosis of HIV with at least one medical visit and not virally suppressed between July 1, 2013 – June 30, 2014)
Exclusions
1. Patients who are documented to be deceased during the measurement year
2. Patients who were incarcerated for the greater than 6 months of the measurement year
3. Patients who relocated out of the care site’s geographic catchment during the measurement year
4. Patients who transferred HIV medical care during the measurement year

7. Eligible patients: Number of patients, regardless of age, with a diagnosis of HIV with at least one medical visit between July 1, 2013 and June 30, 2014
Virally suppressed: Patients with a HIV viral load less than 200 copies/mL at last HIV viral load test
Closed Cohort/Not virally suppressed: Patients with a HIV viral load greater than or equal to 200 copies/mL at last HIV viral load test (not virally suppressed) between July 1, 2013 – June 30, 2014
Censorship: Patients who have died, moved away, transferred their care, or were incarcerated more than 6 months
Update 1:
Of those in the closed cohort, patients in the with a HIV viral load less than 200 copies/mL at last HIV viral load test between July 1, 2014 and June 30, 2015
Censorship: Patients who have died, moved away, transferred their care, or were incarcerated more than 6 months
Update 2:
Of those in update 1, patients in the with a HIV viral load less than 200 copies/mL at last HIV viral load test between July 1, 2015 and June 30, 2016

8. Cohort Viral Load Suppression Rate for 2015 =
Those in denominator with suppressed viral load for last test in 2014/2015 reporting period
Cohort Viral Load Suppression Rate for 2015 =
Moved, transferred. incarcerated, died
as of June 30, 2015
Original Closed Cohort
Those in denominator with suppressed viral load for last test in 2015/2016 reporting period
Cohort Viral Load Suppression Rate for 2016 =
Denominator from 2015 update (green minus red boxes above)
Moved, transferred, incarcerated, died
as of June 30, 2016

9. Setting Goals * 20% improvement goal based on NHAS goals
 State
Cohort Denominator
Based on Apr 2014***
20%* Improvement Goal: Estimated Number of Patients achieving Viral Load Suppression by June 2016** AR
325 65 MO
631
126 MS
1328
266 NJ
3407
681 OH
2424
485
All States
8115
1625
* 20% improvement goal based on NHAS goals
** Will be updated to reflect new baseline date
*** Based on H4C Round 1 data submission

10. Timelines and Milestones
April 2014: cohort discussed by H4C participants
June 2014: cohort designed by HAB and NQC
July 2014: cohort finalized by NQC with H4C team input
August 2014: cohort study announced to all H4C teams
October 2014: H4C teams submit cohort baseline data (n.i.n)
December 2014: H4C teams submit complete cohort baseline data
October 2015: H4C teams submit cohort update 1
October 2016: H4C teams submit cohort update 2

11. Review of Data Collection Tool
Michael

12. Group Discussion