Quality ManagementChart Review 2013-14

Pamela Casey, MS, RDJune 24, 2014

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

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

The process

• Chart tool developed• Nurses hired• Schedule created for January and February• Data collected• Cleaned• Data input• Compiled in a report

Review of CoreService Categories

Ambulatory careMedical case managementOral health servicesHome and community-based health servicesMental health servicesSubstance use servicesEarly Intervention Services (EIS)

Ambulatory Care

117 charts7 agencies

Demographics

78%

20%

2%

gender

malefemaleTransgender

2%

26%

33%

39%

age

18-2526-4041-5051+

At least 2 HIV provider visits during the period

ambulatory care0

20

40

60

80

100

95%

99%90%

2012-132013-14National Standard

Primary Care in last 6 months

Case mgmt Oral health Substance Abuse

Mental Health

Home Health

0

20

40

60

80

100

98%

67%

88%93%

77%

58%

41% 46%

100%

2012-132013-14

CD4

done at least twice0

20

40

60

80

100100%

86%

2012-132013-14

ARV

Prescribed adherence counseling0

20

40

60

80

10093%

86%92%

88%

2012-132013-14

Viral Load Suppression

viral load less than 2000

20

40

60

80

100

89%

(<200 or Undetectable)

74% (<200 only)

85% (<200 only)

2012-132013-14national benchmark

Cervical cancer/PAP screen

Series10

20

40

60

80

100

71%

87%

63%

2012-13 (n=38)2013-14 (n=23)national standard

Hepatitis-C Status Documented

Series10

20

40

60

80

100

46%50%

98%

2012-132013-14national standard

Tobacco

assessment cessation counseling0

20

40

60

80

10090%

70%

No national standard

95%

2012-132013-14national standard

Other Measures

HIV risk counseling

flu vaccine dental care0

20

40

60

80

100

76%

63%

48%

72%81%

55%

No national standard

67%

35%2012-132013-14national standard

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

Case Management13 sites170 charts

Demographics

63%

31%

3%

Gender

malefemaletransgender

4%children 5%

26%

34%

31%

Age

<1718-2526-4041-5051+

Measures

0

20

40

60

80

100

61%

75% 74%64% 73%

54%47% 2012-13

2013-14

Assessment of needs

0

20

40

60

80

100Up to 92%

(low as65%)

No info2012-13

83%

49%

2012-132013-14

Highlights

• Looking good– Plan updates– Assessments

• Areas for improvement– Risk reduction – Partner disclosure– Life skills/self-sufficiency

Substance Use4 sites37 charts

Demographics

68%

32%

Gender

malefemale

27%

32%

41%

Age

18-2526-4041-5051+

Care and Treatment

treatment plan in treatment at 3 months

in treatment at 6 months

HIV medication adherence

0

20

40

60

80

100 100%

63%

25%

No info

76% 76%

38%

54%

2012-132013-14

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

Mental Health7 sites61 charts

Demographics

74%

23%

2%

Gender

malefemaletransgender

13%

8%

21%

31%

27%

Age

<1718-2526-4041-5051+

Care and Treatment

0

20

40

60

80

100 100% 100% 100%

No info

82% 90%

57%

92%

2012-132013-14

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)

Oral Health6 sites 59 charts

Demographics

73%

25%

Gender

malefemale

2%

17%

36%

46%

Age

18-2526-4041-5051+

HRSA Performance Measures for Oral health

0

20

40

60

80

100 91%84%

95%

58%70%

92%

2012-132013-14

Assessment

ARV substances and/or tobacco

0

20

40

60

80

100

52%

62%

88%

66%

2012-132013-14

Highlights

• Looking good– Assessed for ARV– Periodontal screens

• Areas for improvement– Oral health education– Medical history

Home Health1 site

10 charts

Demographics

50%

50%

Gender

malefemale

30%

70%

Age

41-5051+

Performance measures

0

20

40

60

80

100 100% 100%

90%

100%

2012-132013-14

Early InterventionServices

1 site10 charts

Performance Measures

1 HIV appt risk reduction assessed for substance use

referred for substance use

0

20

40

60

80

100

20%

50% 50%

11%

2012-132013-14

Assessment for client needs

support system housing stability food/utilities transportation0

20

40

60

80

100

30% 30%

40% 40%2012-132013-14

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

Retention in Care

Attempts made to reschedule appointments

MCM oral health substance use mental health0

20

40

60

80

100

53%

36%44%

64%

78%

54%

86%

96%

2012-132013-14

Eligibility Information

Eligibility Requirements

amb care/ income

amb care/ Medi-cal

MCM/income MCM/Medi-cal0

20

40

60

80

100 89%99%

90%100%

68%

97%

80%88%

2012-132103-14

Evaluation of the Chart ReviewGood:• 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