1. Quality Management Chart Review 2013-14 Pamela Casey, MS, RD June 24, 2014

2. 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

3. Objectives To utilize the data from the chart review to track the performance of the core services selected by the CCPC – Only a portion of the measures provided 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

4. The process Chart tool developed Nurses hired Schedule created for January and February Data collected Cleaned Data input Compiled in a report

5. 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)

6. Ambulatory Care 117 charts 7 agencies

7. Demographics

8. At least 2 HIV provider visits during the period

9. Primary Care in last 6 months

10. CD4

11. ARV

12. Viral Load Suppression

13. Cervical cancer/PAP screen

14. Hepatitis-C Status Documented

15. Tobacco

16. Other Measures

17. Highlights Looking good – ARV – Pap smears – Documentation of dental care Areas for improvement – Identify both viral load suppression and undetectable – Documentation of Hep-C status – Tobacco cessation counseling or referral – Document the connection with primary care to help identify those out of care

18. Case Management 13 sites 170 charts

19. Demographics

20. Measures

21. Assessment of needs

22. Highlights Looking good – Plan updates – Assessments Areas for improvement – Risk reduction – Partner disclosure – Life skills/self-sufficiency

23. Substance Use 4 sites 37 charts

24. Demographics

25. Care and Treatment

26. Highlights Looking good – In treatment at 3 months Areas for improvement – In treatment at 6 months – medication adherence discussed: 54% in 2013-14, but 52% in 2011-12 chart review

27. Mental Health 7 sites 61 charts

28. Demographics

29. Care and Treatment

30. Highlights Looking good – In care for 3 months – Assessed for substance use at the rate of 92% in 2013-14; 67% in 2011-12 Areas for improvement – HIV Medication adherence (100% in 2012-13 to 57% in 2013-14)

31. Oral Health 6 sites 59 charts

32. Demographics

33. HRSA Performance Measures for Oral health

34. Assessment

35. Highlights Looking good – Assessed for ARV – Periodontal screens Areas for improvement – Oral health education – Medical history

36. Home Health 1 site 10 charts

37. Demographics

38. Performance measures

39. Early Intervention Services 1 site 10 charts

40. Performance Measures

41. Assessment for client needs

42. Highlights Looking good – Risk reduction – Assessment of substance abuse Areas for improvement – Need for follow-up with connection to primary care – Assessed for basic needs

43. Retention in Care

44. Attempts made to reschedule appointments

45. Eligibility Information

46. Eligibility Requirements

47. Evaluation of the Chart Review Good: HIV specialist on staff Helpful staff Separate private, space provided Flexibility with arranging extra time Chart lay out was provided, data elements highlighted Not so good: Accessibility of EHRs Inconsistencies with client list pulled from ARIES Signatures of clients not found on care plans Documents located in several places Looking to the future: Track the same data element year-to-year for trends Collaborative effort on chart review