Improving Client Health Outcomes using...

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Improving Client Health Outcomes using ARIES

David E. Ranck ARIES Informatics Specialist

What is Quality Management?

• The evaluation of services provided, and the results achieved, as compared with accepted standards in a two-part process: *

* thefreedictionary.com

• The evaluation of services provided, and the results achieved, as compared with accepted standards in a two-part process:

–First, the actual results are compared with

standard results. *

standard results.

–Then, any deficiencies noted or identified serve to prompt recommendations for improvement. *

standard results.

QM Measure

standard results.

QM Measure

QM Follow-Up We’ll come back to this…

What is a QM Measure?

• Selecting a set of items that have something in common

• Identifying a subset of those items that meet specific criteria

• Expressing the two numbers as a fraction, or as a percent

How is QM expressed?

There’s a fine line between…

Numerator and

Denominator

There’s a fine line between…

Numerator and

Denominator

Numerator

Set of items with something in common

Subset of items that meet specific criteria

Set of items with something in common

Subset of items = % Set of items

My New Year’s Party QM

My New Year’s Party QM = = ??? % Guests Invited 40

My New Year’s Party QM Guests Attending 23 = = 57.5 % Guests Invited 40

Is it reasonable to expect all invited guests to attend?

= = ??? % Local Guests Invited 35

Denominator Filter

Local Guests Attending 22 = = 62.9 % Local Guests Invited 35

Denominator Filter always applies to Numerator as well, because Numerator is a subset of the Denominator

One guest was excluded from the QM measure

My New Year’s Party QM Local Guests Attending 22 = = 62.9 % Local Guests Invited 35

Local Guests Attending staying until Midnight 16 = = 45.7 % Local Guests Invited 35

My New Year’s Party QM Local Guests Attending 22 = = 62.9 % Local Guests Invited 35

Local Guests Attending staying until Midnight 16 = = 45.7 % Local Guests Invited 35

Numerator filter applies only to the Numerator

Guests Invited

Guests Invited Local Guests Invited

Guests Invited Local Guests Invited Local Guests Attending

Guests Invited Local Guests Invited Local Guests Attending Local Guests Attending and staying until Midnight

standard results.

Guests Invited Local Guests Invited Local Guests Attending Local Guests Attending and staying until Midnight

Guests Invited Local Guests Invited Local Guests Attending Local Guests Attending and staying until Midnight Local Guests Attending not staying until Midnight

I want to follow up with this group. Could I intervene to improve outcome?

My Agency’s QM

All of my Clients

My Agency’s QM

All of my Clients Clients Served

My Agency’s QM

All of my Clients Clients Served Clients Served + Criteria - Exclusions = Denominator

My Agency’s QM

Example: HIV positive clients with a medical visit in the first 6 months of the year, excluding clients inactive at the end of the year.

My Agency’s QM

All of my Clients Clients Served Clients Served + Criteria - Exclusions = Denominator Subset of Denominator = Numerator

My Agency’s QM

Example: HIV positive clients with a medical visit in the first 6 months of the year, excluding clients inactive at the end of the year, who also had a medical visit in the last 6 months of the year.

My Agency’s QM

Example: HIV positive clients with a medical visit in the first 6 months of the year, excluding clients inactive at the end of the year, who also had a medical visit in the last 6 months of the year.

My Agency’s QM

All of my Clients Clients Served Clients Served + Criteria - Exclusions = Denominator Subset of Denominator = Numerator Clients Needing Follow-Up

My Agency’s QM

Example: HIV positive clients with a medical visit in the first 6 months of the year, excluding clients inactive at the end of the year, who did not have a medical visit in the last 6 months of the year.

My Agency’s QM

Gap in Medical Visits National Quality Forum #2079

My Agency’s QM

ARIES does the math…

My Agency’s QM

ARIES will identify…

My Agency’s QM

ARIES will identify…

YOU do the follow-up!

On-Screen Demo N

• Press <F1> from any QM screen – General help for using the QM interface – Specific help for Follow-Up and All Client Export – Overview of Calculations

QM Documentation

• Press <F1> from any QM screen – General help for using the QM interface – Specific help for Follow-Up and All Client Export – Overview of Calculations

• Detailed ARIES Calculations: www.projectaries.org Training page: “Calculations for the HAB QM Indicators” • HAB Calculations:

http://hab/hrsa.gov/deliverhivaidscare/habperformmeasures.html – link available in the ARIES Calculations above

QM Documentation

QM Measure: HIV positive clients with a medical visit in the first 6 months of the year, excluding clients inactive at the end of the year, who also had a medical visit in the last 6 months of the year.

• Medical tab > Basic Medical subtab > CDC Disease Stage = any of the following: – CDC-Defined AIDS – Disabling AIDS – HIV positive, asymptomatic – HIV positive, disabling – HIV positive, disease stage unknown – HIV positive, symptomatic, not AIDS – Pediatric, confirmed HIV positive

OR • Medical tab > Basic Medical subtab > Date First HIV Positive OR Year First HIV+ OR

AIDS Diagnosis Date has a date that occurs before the end of the reporting period OR • Medical tab > Basic Medical subtab > HIV Test Result is Positive AND test date is before

the end of the reporting period OR • Medical tab > Basic Medical subtab > AIDS Defining Condition is not blank AND is not

Other Diagnosis AND date occurs before end of reporting period OR • Medical tab > Medical History subtab > T Cell Count is under 200 AND CD4 Date is

before the end of the reporting period

QM Documentation ARIES Calculations

• Services tab > Primary Service = Outpatient/Ambulatory Medical Care (or Outpatient/Ambulatory Health Services) AND Secondary Service = any of the following:

– CD-4 T-Cell Count – Follow-Up Visit – Infectious Diseases – Laboratory Service – Medical History – Medication – Neurology – New Patient Intake – Ob/Gyn – Oncology – Other Specialty – Outpatient/Ambulatory Medical Care (or Outpatient/Ambulatory Health Services) – Pediatric Development Assessment – Physician Visit – Urgent Care Visit – Viral Load Test

OR • Medical tab > Medical History subtab > T Cell Count is not blank AND CD4 Date is within

reporting period OR • Medical tab > Medical History subtab > Value is not blank AND Viral Load Date is

within reporting period

• Demographics tab > Agency Specifics subtab > Agency Status = any of the following: – Reported Deceased as of the end of the reporting period – Confirmed Deceased as of the end of the reporting period – Disenrolled as of the end of the reporting period – Discharged as of the end of the reporting period

HAB’s Definition: • To read the HAB definition of this measure, go to

http://hab.hrsa.gov/deliverhivaidscare/habperformmeasures.html. ARIES operationalizes this measure in three ways that diverge from HAB’s definition: – Contrary to HAB’s original measure which measures clients who did not have

a medical visit in the last 6 months of the measurement year, ARIES measures clients who not have gaps in medical visits. This decision was made so that all percentage “moved in the same way” – the closer to 100%, the more positive the outcome.

– ARIES includes CD4 and Viral Load tests as evidence that a client was in medical care.

– ARIES applies client exclusions where HAB does not.

• Bug Fixes • • Shared data should not be included in the Denominator. Include only data within the

agency scope:

– Services in the Denominator must have been entered by the agency running the report, or if run by an Administrative Agency (AA) as an aggregate report, entered by an agency managed by the AA.

– CD4 and Viral Load test, if included, must have been entered by the agency running the report, or

if run by an AA as an aggregate report, entered by an agency managed by the AA. – Applies only to the Denominator. Shared data should continue to be included in calculations for

the Numerator.

• When filtering the Denominator on service-related criteria, exclude CD4 and Viral Load tests should be:

– If any one of the service-related filters is used (Funding Source, Contract, Program, Primary

Service), CD4 and Viral Load tests should be ignored.

– If the only filter is Staff Assignment, CD4 and Viral Load tests within agency scope should continue to be included. N

• Enhancements • • Add a criteria checkbox for "Consider CD4 and Viral Load tests as Medical Services" to

the QM screen:

– The box should be checked by default.

– If checked, CD4 and Viral Load tests, when included, should be considered to be "Medical Services" subject to the agency scope rule.

– This rule applies to CD4 and Viral Load tests in both Denominator calculations and Numerator

calculations.

• Add a criteria checkbox for "Include Shared data in the Numerator" to the QM screen:

– The box should be checked by default.

– If unchecked, only data within agency scope would be used for Numerator calculations.

ETA: Spring 2018

Custom Data for Custom QM

See ARIES Policy Notice G5

ARIES Support

• View this training at www.projectaries.org

• Press the <F1> key in ARIES to get on-line help “<F1> is Friend #1”

• The ARIES Help Desk

866-411-ARIES (2743) aries@cdph.ca.gov New Email! N

Questions??

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