1. Developing Performance Measures
Portland Oregon TGA

2. Objectives: Share Portland TGA performance measures
Describe the process of developing one measure and refining it
Share challenges and lessons learned

3. Portland TGA Performance Measures

4. Measuring Client Access to Primary HIV Medical Care Original Measure (2001): Does client have an HIV medical provider? -
Non-specific (Y/N)
Does not measure actual activity
Client self report
Duplicated +
Easily reported by all service providers
Valuable for providers - coordination of care
Prior to having a client level database

5. Measuring Client Access to Primary HIV Medical Care Next Measure (2006): Did you see your medical provider in the last 4 months, 5-6 months, > 6 months? +
More activity specific, client getting care
Flexibility in collection methodology depending upon provider
Began collecting at client level within database
1st step in a process -
Different levels of confidence in the data
Check box annual survey
Collecting date of last visit
Client self report for some providers
Medical chart abstraction for others
Not all providers submitting data at client level
Date of last medical visit collected Upon discharge, Every visit, Quarterly
Date of last medical visit internally available for 60% of clients. Goal is information on all clients to accurately analyze system and provider specific impact .
Remainder reported in aggregate – the two cannot be combined therefore no reliable system-wide outcome

7. Measuring Client Access to Primary HIV Medical Care Current Measure: Was your last medical visit 4 months ago , 5-6 months ago , > 6 months ago?
Shifted from range to specific visit dates
All core service providers submitting client level data and required to use best or good data collection criteria
Best - data sources that pull directly from client medical record accepted first, followed by provider pulling from medical record
Good – client self report of last medical visit date collected regularly from all clients
Support Services – may use best or good criteria, acceptable is minimum requirement
Acceptable – client self report from a sample, reported in aggregate
First year – core services “should” cover 93% of clients therefore would be applicable across the system and hopefully to all service providers. We will analyze the data once it is in to confirm. If this is successful, we will not require support services to collect this data any longer.

8. Challenges Maintaining reasonable expectation of service providers
Using medical outcomes is reasonable as an outcome measure for the system. Is it equally applicable across providers?
Data sharing – inability to share data increases data collection and reporting burden HIV
Oregon HIV, substance abuse and mental health confidentiality laws
Strict county interpretation of HIPAA

9. Lessons Learned Programmatic lessons
Keep clients at the center – performance measures are aimed at improving the quality of the care and evaluation programs, not at proving a thesis
Don’t let measurement guide the program - the results should guide the program but not the measurability
Work with providers to establish measures - provide technical assistance and make compromises
Technical lessons
Be realistic about time involved in collecting data for certain measures
Critical to have a client level data base
Providers are experts at providing care – we need to provide expertise in analysis

10. Contact Information
Marisa McLaughlin, Research Analyst
x25705
Margy Robinson, HIV Care Services Mgr.
x25681