1. The Role of the CPCDMS in QM Activities Elizabeth Love, MPH Harris County Public Health and Environmental Services Department HIV Services Section

2. QM in the Houston EMA QM in the Houston EMA consists of the following activities: –Outcomes evaluation for all direct service categories –Clinical chart review for all medical services –Client satisfaction measurement for all direct service categories

3. I. Outcomes Evaluation

4. FY 2000 The RWPC requested that HIV Services develop and implement a comprehensive evaluation plan Goals included: –Developing appropriate outcomes for each service –Keeping data collection and reporting methodologies standard across services –Providing useful information for RWPC processes –Involving all stakeholders –Keeping data collection tools succinct

5. FY 2000 The CPCDMS was considered to be the foundation upon which the evaluation plan would be built –With comprehensive client-level data collected on demographics, biological markers, co-morbidities, mortality and service utilization, the system has unlimited evaluation potential

6. FY 2000 Using United Way methodology, HIV Services facilitated work groups that selected outcomes and indicators to be measured for each service category –Participants included providers, consumers and RWPC members –Reference materials included outcomes from other EMAs, HRSA guidances and accepted industry outcomes

7. Data Collection Work groups selected data collection methods for each outcome and indicator HIV Services developed and piloted each tool Each data collection method depends on the CPCDMS All outcomes data is stored in the CPCDMS

8. Data Collection Through registrations, encounters and medical updates, the CPCDMS collects the following unduplicated data used in outcomes analysis: Demographics CD4 counts and viral load results Stage of illness diagnoses Co-morbidities Opportunistic infections Health and support service utilization

9. Data Collection Through special screens created for certain service categories, the CPCDMS collects the following data used in outcomes analysis: Provider assessment of client progress – GAF, severity of pain, symptom control Health data not collected in primary care – BIA, ocular diagnoses, oral pathologies Number of days in care, number of hospitalizations and number of ER visits Further information about type and result of intervention

14. Data Collection Client surveys collect information that gauges client perception Quality of life Knowledge, attitudes and practices (KAP) The CPCDMS supports survey administration and automated data entry

15. Survey Administration CPCDMS Versions 1 and 2 –Providers handed out photocopied survey forms –Clients wrote their 11-character code on the survey form and circled their responses –Providers entered survey data into Excel –HIV Services stored data in an Access database which could be linked to SQL data in CPCDMS

16. Survey Administration CPCDMS Versions 3 and 4 1.Clients may take their survey online at their provider’s CPCDMS workstation OR 2.Providers can print survey forms from the CPCDMS with the 11-character code bar-coded; clients bubble in their responses The bar-coded surveys are scanned at HIV Services and stored in a SQL database

23. Data Analysis All data used for outcomes evaluation is stored in SQL format in the CPCDMS database –Demographic information collected at registration –CD4, VL, SOI, OI data collected at medical updates –Service utilization data collected at encounter updates –Provider assessment data collected through special CPCDMS screens –Client self-administered survey data

24. Data Analysis The 11-character client code allows cross- analysis of each dataset –Examples - Change over time in viral load by race Oral pathology results by stage of illness Change over time in CD4 count by service utilization Survey results by gender Seagate Info/Crystal Reports is used to generate analysis reports

25. Implementation Data collection for 25 Title I service categories began March 1, 2001 –Providers and RWPC members receive analyses of outcomes data from HIV Services on a quarterly basis –The outcome measures are revised annually

26. Data Analysis – Example One of the outcome measures for Adult Primary Care is “Slowing/Prevention of Disease Progression” The indicator for this outcome is –75% of clients will show improved or maintained CD4 and viral load results over time

30. Data Analysis - Example This report shows that 79% of 3,627 FY02 primary care clients with >1 viral load recorded in the CPCDMS decreased or maintained their viral load from the earliest to most recent test –This is reported by gender, race, Hispanic status and stage of illness –This is reported for each primary care provider and for all primary care providers (unduplicated)

31. Data Analysis - Example One of the outcome measures for Outreach is “Entrance into the system of care” The indicator for this outcome is “By the end of the fiscal year, a minimum of 50% of clients will enter Ryan White primary care and a minimum of 50% of clients will enter case management” – Or other primary care and case management for which there is encounter data in the CPCDMS

34. Data Analysis - Example This report shows that 32% of 456 newly diagnosed or not-in-care FY02 outreach clients accessed HIV case management after their first outreach encounter –This includes Title I, Title II, TCADA and TDH case management –This can be reported by gender, race, Hispanic status, age and stage of illness

35. II. Clinical Chart Review

36. Clinical Chart Review In FY 2002 the Houston EMA initiated ongoing clinical chart review at health service provider sites to ensure that PHS guidelines and other accepted standards are followed –Primary Care –Dental Care –Vision Care –Professional Counseling –Substance Abuse Treatment –Hospice Care –Home Health Care –Rehabilitation –Case Management –Drug Reimbursement

37. Clinical Chart Review Desired sample characteristics –10% of the caseload for each service –Reflective of the population served Stage of illness, age, gender, race and Hispanic status –Randomly selected

38. Clinical Chart Review To determine the demographic make-up of clients at each provider site, HIV Services runs a CPCDMS report that provides the number and percent of clients meeting each criteria A second CPCDMS report randomly selects a sample of 10% of the provider’s clients, mirroring the demographic make-up –HIV Services furnishes the client codes to providers immediately prior to the review so charts can be pulled

42. III. Client Satisfaction

43. Client Satisfaction In FY 2002 the Houston EMA initiated standardized measurement of client satisfaction across all funded services The same methodology used to generate outcomes surveys through the CPCDMS is used to generate client satisfaction surveys –For confidentiality purposes, there is no option to complete the survey on-line

44. Client Satisfaction Survey forms are scanned at HIV Services and the data is stored in a SQL database that is linked to other CPCDMS data –Demographics –Service utilization As with outcomes analysis, Seagate Info/Crystal Reports is used to generate analysis reports

45. Conclusion The CPCDMS is vital to all QM activities in the Houston EMA –Data collection –Survey administration –Data analysis –Sample generation

46. For more information… Elizabeth G. Love, MPH Project Coordinator – Evaluation and QM Harris County Public Health Department HIV Services Section (713) 439-6041 elove@harriscountyhealth.com www.harriscountyhealth.com/hivservices