1. NYSDOH AIDS Institute Quality of Care Program eHIVQUAL
Institute for Implementation Science in population health at cuNY
CUNY Graduate School of Public Health and Health Policy
June 2016
Disclaimer: The information in this slide set was assembled by the The Institute for Implementation Science in Population Health at CUNY to inform the work of the NYC DSRIP HIV projects. The content of these slides is based on publicly available information as of June 2016.
For detailed eHIVQUAL inquiries, see the resources and contact information slides.

2. OUTLINE
Background
Content
How to use the data
Limitations
Resources

3. BACKGROUND What is eHIVQUAL?
HIV performance measurement tool for HIV ambulatory care providers in NYS
Primary purpose is to review an organization’s performance of quality of clinical care processes and outcomes
Since 2009, data submitted by providers using web-based eHIVQUAL application
“eHIVQUAL” refers both to a quality of care review for HIV ambulatory care and the web application used to conduct that review, which can be accessed at

4. BACKGROUND (2) Population and geography
In 2013, 187 participating clinics across NYS submitted data
Clinic staff used standardized statistical sampling to determine the number of records abstracted from the total primary care case list of eligible patients (at least one HIV medical visit in review period, ≥18 yrs. of age)
Core review represents a sample population (11,697 patients in 2013) of the total primary caseload from all clinics
Newly diagnosed patient review includes all newly diagnosed patients from participating facilities (1,984 in 2013)
Previous years:
2009: 200 clinics, 10,361 patients
2011: 186 clinics, 9,943 patients

5. BACKGROUND (3) Timeframe of available data Accessibility of data
Odd year collection review periods (2009, 2011, 2013)
*2014: Abbreviated ‘short’ review of core measures focused on ETE
Accessibility of data
Programs have immediate access to reports and real‐time benchmarks within the application
Annual reports publicly available for 2011 and 2013 data, found on ehivqual.org
2011 dataset publicly released on Health Data NY website (health.data.ny.gov)

6. CONTENT What’s in the eHIVQUAL data set?
Clinical and laboratory data obtained from patient medical records include:
Demographic variables (sex, race/ethnicity, age group, transmission risk group, housing)
Clinical care indicators (mental health screenings, cognitive function screenings, tobacco use, anal pap test, etc.)

7. CONTENT (2) HIV-related indicators Viral load suppression
Retention in care
ART usage
CD4 count
Etc.

8. HOW TO USE THE DATA Examples of how data has been used in the past
Statewide benchmark reports summarize clinic-level scores and offer comprehensive data to facilitate comparison between providers.

9. HOW TO USE THE DATA (2)
- Longitudinal data when available and entire sample benchmarks

10. HOW TO USE THE DATA (3)
- Evaluate care outcomes among high risk populations

11. HOW TO USE THE DATA (4)
Potential use of eHIVQUAL to further DSRIP PPS work
Clinic and region level quality improvement work
Identify gaps in clinical care, target resources to address specific outcomes (e.g. linkage to care, retention in care, viral load suppression)
Regional collaboration – eHIVQUAL reports can inform benchmark setting at the regional level
Targeted follow-up with low-performing HIV programs

12. LIMITATIONS What to keep in mind:
Annual review periods every other year
Indicator definitions change, limiting ability to do trend analyses
Patients were not eligible if they were in care at a Veteran’s Administration clinic, a residential or skilled nursing facility, were incarcerated throughout the review period, or received care exclusively in the private sector.
Changing criteria definitions, making longitudinal data challenging to assess trends
*In 2013, had to have at least one visit during the 12 month review period to be considered in the caseload
*Note that in 2011 only patients with at least one HIV primary care visit in each six-month period of the year were eligible for the review.
**New patients were defined as patients who are 1) newly diagnosed during the 2013 review period; 2) previously diagnosed, new to clinic; and 3) returning to clinic after at least a two-year lapse in care. All providers submitted retention, viral load, ARV, and CD4 data for all new patients.

13. STRENGTHS
HIV programs have immediate access to reports and real-time benchmarks within the application which drives quality improvement activities 
Track progress over time on multiple HIV care outcomes and ability to compare to regional and statewide benchmarks
Application filters allow for running reports specific to newly diagnosed patients and untreated/unscreened patients

14. RESOURCES Publications and reports
eHIVQUAL 2013 annual report
eHIVQUAL 2011 annual report
Feller DJ, Agins BD. The dissociation between viral load suppression and retention in care. AIDS Patient Care and STDs. 2016;30(3):
Guides/guidelines and general information
User’s guide
Indicator guide
2014 eHIVQUAL overview slides
For additional documents and webinars, visit ehivqual.org

15. CONTACT INFORMATION
New York State Department of Health AIDS Institute
212‐417‐4620

16. CUNY Institute for Implementation Science IN population health
Thank you!
CUNY Institute for Implementation Science IN population health
cunyisph.org