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Breakdown of Performance Measures GY 2010
Ryan White Part A, Las Vegas TGA
Indicator
Type Label Indicator Numerator Denominator Target % Source
A quality indicator is a tool to measure
specific aspects of care and services that National
are optimally linked to better health target or
outcomes while being consistent with Who among those who benchmark/ Location of
Key aspect Short name of indicator for current professional knowledge and should have received Who should have received our TGA's data for
of care. reference. meeting client needs. the care actually did. the care being measured. goal collection
Core Medical Services
Ambulatory/Outpatient Medical Care
Number of HIV-infected clients who
had a medical visit with a provider
Accessibility of care with prescribing privileges in an HIV Number of HIV-infected clients who
HAB01 Medical Visits Percent of clients with HIV infection who care setting two or more times at had a medical visit with a provider
(see HAB had two or more medical visits in an HIV least 3 months apart during the with prescribing privileges at least 80%
exclusions) care setting in the measurement year. measurement year. once in the measurement year. CAREWare
Accessibility of care Number of HIV-infected clients who Number of HIV-infected clients who
HAB02 Percent of clients with HIV-infection who had 2 or more CD4 T-cell counts had a medical visit with a provider
(see HAB CD4 T-Cell Count had 2 or more CD4 T-cell counts performed at least 3 months apart with prescribing privileges at least
exclusions) performed in the measurement year. during the measurement year. once in the measurement year. 63% CAREWare
Number of HIV-infected clients who:
Appropriateness had a medical visit with a provider
of care Number of HIV-infected clients with with prescribing privileges at least
HAB03 Percent of clients with HIV-infection and a CD4 T-cell count below 200 once in the measurement year, and
(see HAB CD4 < 200 with PCP Prophylaxis a CD4 T-cell count below 200 cells/mm³ cells/mm³ who were prescribed PCP had a CD4 T-cell count below 200
exclusions) who were prescribed PCP prophylaxis. prophylaxis. cells/mm³. 95% CAREWare
Number of clients who; have a
diagnosis of AIDS (history of a CD4 T-
Appropriateness cell count below 200 cells/mm³or
of care AIDS Clients on HAART other AIDS defining condition), and
HAB04 Percent of clients with AIDS who are Number of clients with AIDS who had at least one medical visit with a
(see HAB prescribed HAART were prescribed a HAART regimen provider with prescribing privileges in
exclusions) within the measurement year. the measurement year. 100% CAREWare
Number of HIV-infected pregnant Number of HIV-infected pregnant
Percent of pregnant women with HIV- women who were prescribed women who had a medical visit with a
Percent of Pregnant Women infection who are prescribed antiretroviral therapy during the provider with prescribing privileges at 80%
HAB05 Prescribed ART antiretroviral therapy. 2nd and 3rd trimester. least once in the measurement year. CAREWare
1
Breakdown of Performance Measures GY 2010
Ryan White Part A, Las Vegas TGA
Appropriateness Percent of clients with HIV-infection on Number of HIV-infected clients, as Number of HIV-infected clients on
of care ARVs who were assessed and counseled part of their primary care, who were ARV therapy who had a medical visit
HAB06 Adherence Assessment and for adherence two or more times in the assessed and counseled for with a provider with prescribing
(see HAB Counseling measurement year as part of their adherence two or more times at privileges at least once in the
exclusions) primary care. least three months apart. measurement year. 56% CAREWare
Number of HIV-infected female
clients who: were ≥18 years old in the
Appropriateness measurement year or reported having
of care Cervical Cancer Screening Number of HIV-infected female a history of sexual activity, and had a
HAB07 Percent of women with HIV-infection clients who had pap screen results medical visit with a provider with
(see HAB who have a pap screening in the documented within the prescribing privileges at least once in
exclusions) measurement year. measurement year. the measurement year. 70% CAREWare
Appropriateness
of care Number of HIV-infected clients with Number of HIV-infected clients who
HAB08 Percent of clients with HIV-infection who documentation of having ever had a medical visit with a provider
(see HAB Hepatitis B Vaccination completed the vaccine series for Hepatitis completed the vaccination series for with prescribing privileges at least
exclusions) B. Hepatitis B. once in the measurement year. 45% CAREWare
Number of HIV-infected clients who
Appropriateness Percent of clients for who Hepatitis C Number of HIV-infected clients who had a medical visit with a provider
of care Hepatitis C Screening (HCV) screening was performed at least have a documented HCV status in with prescribing privileges at least
HAB09 once since diagnosis of HIV infection. chart. once in the measurement year. 90% CAREWare
Number of HIV-infected clients who
Appropriateness of Percent of clients with HIV-infection who Number of HIV-infected clients, as had a medical visit with a provider
care HIV Risk Counseling received HIV risk counseling within the part of their primary care, who with prescribing privileges at least
HAB10 last 12 months. received HIV risk counseling. once in the measurement year. 80% CAREWare
Number of HIV-infected clients who
Number of HIV-infected clients are on HAART and who had a medical
Appropriateness Percent of clients with HIV-infection on who: were prescribed HAART, and visit with a provider with prescribing
of care Lipid Screening HAART who had a fasting lipid panel had a fasting lipid panel in the privileges at least once in the
HAB11 within the last 12 months. measurement year. measurement year. 85% CAREWare
Number of HIV-infected clients who:
1) were ≥18 years old in the
Appropriateness Number of HIV-infected clients who measurement year or had a history of
of care had a serologic test for syphilis sexual activity at <18 years, and 2) had
HAB13 Percent of adult clients with HIV- performed at least once during the a medical visit with a provider with
(see HAB Syphilis Screening infection who had a test for syphilis measurement year. prescribing privileges at least once in
exclusions) performed within the last 12 months. the measurement year. 80% CAREWare
2
Breakdown of Performance Measures GY 2010
Ryan White Part A, Las Vegas TGA
Number of HIV infected clients who:
do not have a history of previous
Number of clients who received documented culture-positive TB
testing with results for LTBI with disease or previous documented
any approved test (tuberculin skin positive TST or IGRA; and had a
Appropriateness Percent of adult clients who received test [TST] or interferon gamma medical visit with a provider with
of care TB Screening testing for LTBI (latent TB infection) at release assay [IGRA]) since HIV prescribing privileges at least once in
HAB14 least once since HIV diagnosis. diagnosis. the measurement year. 56% CAREWare
Number of HIV-infected clients who:
were either: a) newly enrolled in care;
Appropriateness b) sexually active; or c) had a STI
of care Percent of clients with HIV-infection at Number of HIV-infected clients who within the last 12 months, and had a
HAB15 risk for sexually transmitted infections had a test for Chlamydia within the medical visit with a provider with
(see HAB Chlamydia Screening (STI) who had a test for Chlamydia last 12 months. prescribing privileges at least once in
exclusions) within the measurement year. the measurement year. 80% CAREWare
Number of HIV-infected clients who:
were either: a) newly enrolled in care;
Appropriateness Percent of clients with HIV- b) sexually active; or c) had a STI
of care infection at risk for sexually within the last 12 months; and had a
HAB16 transmitted infections (STI's) Number of HIV-infected clients who medical visit with a provider with
(see HAB Gonorrhea Testing who had a test for gonorrhea within had a test for gonorrhea within the prescribing privileges2 at least once in
exclusions) the measurement year. last 12 months. the measurement year. 80% CAREWare
Appropriateness
of care Number of HIV-infected clients who
HAB17 Percent of clients with HIV infection who Number of HIV-infected clients who had a medical visit with a provider
(see HAB Hepatitis B Screening have been screened for Hepatitis B virus have documented Hepatitis B with prescribing privileges at least
exclusions) infection status. infection status in the health record. once in the measurement year. 80% CAREWare
Appropriateness
of care Number of HIV-infected clients who
HAB19 Percent of clients with HIV infection who Number of HIV-infected clients who had a medical visit with a provider
(see HAB Influenza Vaccination have received influenza vaccination received influenza vaccination with prescribing privileges at least
exclusions) within the last 12 months. within the measurement year. once in the measurement period. 80% CAREWare
Appropriateness Percent of clients with HIV-infection and Number of HIV-infected clients who
of care a CD4 count <50 cells/mm³ who were had a: CD4 count <50 cells/mm³; and
HAB20 prescribed Mycobacterium Acium Number of HIV-infected clients with medical visit with a provider with
(see HAB MAC Prophylaxis Complex (MAC) prophylaxis within the CD4 count <50 cells/mm³ who were prescribing privileges at least once in
exclusions) measurement year. prescribed MAC prophylaxis. the measurement year. 85% CAREWare
3
Breakdown of Performance Measures GY 2010
Ryan White Part A, Las Vegas TGA
Number of HIV-infected clients who:
were new during the measurement
Appropriateness of Percent of new clients with HIV- Number of HIV-infected clients who year, and had a medical visit with a
care Mental Health Screening infection who have had a mental health received a mental health screening provider with prescribing privileges at
HAB21 screening within the last 12 months. within the measurement year. least once in the measurement year. 42% CAREWare
Appropriateness
of care Number of HIV-infected clients who
HAB22 Percent of clients with HIV infection who had a medical visit with a provider
(see HAB Pneumococcal Vaccination have ever received pneumococcal Number of HIV-infected clients who with prescribing privileges at least
exclusions) vaccine. ever received pneumococcal vaccine. once in the measurement year. 80% CAREWare
Number of HIV-infected clients who:
Appropriateness were new during the measurement
of care Percent of new clients with HIV-infection Number of new HIV-infected clients year, and had a medical visit with a
HAB23 who have been screened for substance who were screened for substance medical provider with prescribing
(see HAB Substance Use use (alcohol and drugs) in the last 12 use within the measurement year as privileges at least once in the
exclusions) months. part of their medical visit. measurement year. 80% CAREWare
Appropriateness
of care Percent of clients with HIV-infection for Number of HIV-infected clients who
HAB25 whom a Toxoplasma screening was Number of HIV-infected clients who had a medical visit with a provider
(see HAB Toxoplasma Screening performed at least once since the have a documented Toxoplasma with prescribing privileges at least
exclusions) diagnosis of HIV-infection. status in health record. once in the measurement year. 80% CAREWare
Number of HIV-infected clients with
initial CD4 T-cell count of who are
Stabilize CD4 T-Cell Count Percent of clients who have stabalized or Number of HIV-infected clients with currently in the care system
Effectiveness of increased their CD4 T-cell count from an increased CD4 T-cell count of recieveing at least one CD4 count lab 80%
care initial count. ≥200 from initial count. within the measurement year. Chart Review
Number of HIV-infected clients with
initial viral load lab who are currently
Undetectable Viral Load Percent of clients who have an in the care system receiving at least
Effectiveness of undetectable viral load count from initial Number of HIV-infected clients with one viral load lab within the 80%
care count. a viral load of ≤50 from initial count. measurement year. Chart Review
Number of HIV-infected clients who
Number of minority clients with at had a medical visit with a provider
Increase service utilization in Percent of minority clients accessing least one medical visit within the with prescribing privileges at least 60%
Accessibility of care communities of color (MAI). Ambulatory/Outpatient Medical Care. measurement year. once in the measurement year. CAREWare
4
Breakdown of Performance Measures GY 2010
Ryan White Part A, Las Vegas TGA
Number of clients who; were
prescribed new medication and had at
Percent of clients who were prescribed Number of clients who received least one medical visit with a provider
Patient perspective new medication and received medication medication education concurrently with prescribing privileges in the
issues Medication Education education concurrently. to their prescription. measurement year. 80% Chart Review
Oral Health Care
Number of HIV-infected patients
Appropriateness of Gingival/Periodontal Infection Percent of clients who received an annual Number of patients who received an accessing oral health care services at 70%
care Avoidance periodontal exam. annual periodontal exam least once in the measurement year. Chart Review
Number of patients who have a Number of HIV-infected patients
Appropriateness of Percent of clients with an annually written treatment plan that is accessing oral health care services at 70%
care Updated Treatment Plan updated treatment plan. updated annually. least once in the measurement year. Chart Review
Number of patients who had an Number of HIV-infected patients
Appropriateness of HIV Associated Skin Percent of clients who had an annual annual extra-oral (head and neck) accessing oral health care services at 70%
care Manifestations extra-oral (head and neck) examination. examination. least once in the measurement year. Chart Review
Number of clients who had an oral Number of HIV-infected clients who
Appropriateness of Percent of clients with HIV-infection who exam by a dentist during the had a medical visit with a provider
care received an oral exam by a dentist at least measurement year, based on patient with prescribing privileges at least CAREWare
HAB12 Oral Health Care once during the last 12 months. self report or other documentation once in the measurement year. 40% Chart Review
Percent of clients who had an annual Number of patients who received an Number of HIV-infected patients
Appropriateness of intra-oral exam with a dental caries and annual intra-oral exam with a dental accessing oral health care services at 70%
care Dental Caries/Soft Tissue Exam soft tissues exam. caries and soft tissue exam. least once in the measurement year. Chart Review
HIV Medications
Number of clients who were
prescribed supplemental medication Number of HIV-infected clients who
Percent of clients who receive from a provider with prescribing had a medical visit with a provider
Effectiveness of Supplemental Medications to supplemental medications to improve privileges within the measurement with prescribing privileges at least 25% Chart Review
care Maintain or Improve Health and maintain health. year. once in the measurement period. CAREWare
Medical Case Management
Number of clients who accessed Number of clients who had a medical
Percent of clients who are in medical care medical case management services visit with a provider with prescribing
Increase Medical Case and in medical case management at least once in the measurement privileges at least once in the 85%
Continuity of care Management Utilization services. period. measurement period. CAREWare
5
Breakdown of Performance Measures GY 2010
Ryan White Part A, Las Vegas TGA
Number of clients who had a Number of clients in the care system
Percent of clients in the care system thatmedical case management visit at that accessed medical and/or support 75%
Received Medical Case have at least one medical case least once in the measurement services at least once in the
Continuity of care Management Services management visit. period. measurement period. CAREWare
Number of clients who had a
Percent of clients who are in medical case medical visit with a provider with Number of clients who had a medical
Medical Care management and had at least one prescribing privileges at least once case management visit at least once in 65%
Continuity of care medical visit. in the measurement year. the measurement period. CAREWare
Patient perspective Number of HIV-infected clients who
issues-no Percent of clients who are in compliance Percentage of clients who are in had a medical visit with a provider
medication Adherence to Prescription with their prescription medication compliance with their prescription with prescribing privileges at least 80%
regimen prescribed Medication regimen. medication regimen. once in the measurement period. Chart Review
Number of clients with adherence to Number of HIV-infected clients who
Medical Appointment Percent of clients with adherence to primary care (ambulatory outpatient had a medical case management visit
Patient perspective Adherence primary care (ambulatory outpatient medical care) visits during the at least once in the measurement 80% Chart Review
issues medical care) visits. measurement period. period. CAREWare
Number of clients who had a case Number of HIV-infected clients who
Percent of clients who have a case management care plan documented had a medical case management visit
Updated Care Plan management care plan documented and and updated every six months at least once in the measurement
Continuity of care updated at least every six months. within the measurement period. period. 100% Chart Review
Number of clients who had a client Number of HIV-infected clients who
Percent of clients who have a client acuity performed, documented and had a medical case management visit
acuity documented and updated at least updated every six months within the at least once in the measurement
Updated Client Acuity every six months. measurement period. period. NA Chart Review
Number of high acuity clients with
Percent of high acuity clients with adherence to primary care Number of HIV-infected clients who
adherence to primary care (ambulatory/outpatient medical had a medical case management visit
Maintain High Acuity Clients in (ambulatory/outpatient medical care) care) visits within the measurement at least once in the measurement 5%
Continuity of care Medical Care visits. period. period. Chart Review
Number of HIV-infected clients who
Number of patients who are referred had a medical case management visit
Appropriateness of Substance Abuse Screening and Percent of clients who were in need and to a substance use treatment at least once in the measurement
care (NQC 111-2C) Referrals referred to a substance abuse program. program. period. 30% Chart Review
Substance Abuse Outpatient Treatment
6
Breakdown of Performance Measures GY 2010
Ryan White Part A, Las Vegas TGA
Number of HIV-infected clients who
1) had a medical visit with a provider
with prescribing privileges at least
Number of clients who have (at once in the measurement period and
Percent of clients who had (at least) one least) one medical care consultation 2) accessed substance abuse
Medical Care Consultation medical care consultation during the during the substance abuse outpatient treatment at least once in 90% Chart Review
Continuity of care substance abuse treatment episode. treatment episode. the measurement period . CAREWare
Number of patients who were asked
Substance Use Screening in Percent of clients who were asked about about their use of alcohol, Number of HIV-infected patients with
Patients with Documented their use of alcohol, marijuana, cocaine, marijuana, cocaine, crack cocaine, documented mental health disorder
Appropriateness of Mental Health Disorder crack cocaine, amphetamines, opiates, amphetamines, opiates, and and no current or past history of Chart Review
care (NQC 104) and benzodiazepines in the past year. benzodiazepines in the past year. alcohol/substance use. 30% CAREWare
Substance Use Screening in Number of patients who were asked
Patients with Documented Percent of clients who were asked about about their use of alcohol, Number of HIV-infected patients with
Mental Health Disorder- their use of alcohol, marijuana, cocaine, marijuana, cocaine, crack cocaine, documented mental health disorder
Appropriateness of quarterly crack cocaine, amphetamines, opiates, amphetamines, opiates, and and current or past history of Chart Review
care (NQC 104) and benzodiazepines in the last quarter. benzodiazepines in the quarter. substance use. 30% CAREWare
Offering Tobacco Cessation Number of current smokers or users Number of HIV-infected patients who
Percent of current smokers or users of
Appropriateness of Programs to Tobacco- other tobacco products who received of other tobacco products who are current smokers or users of other Chart Review
care (NQC 115) Dependent Patients assistance with cessation. received assistance with cessation. tobacco products. 30% CAREWare
Number of HIV-infected patients
accessed substance abuse
Discussion of Tobacco Use in Number of patients whose outpatient treatment at
Appropriateness of the Past Year with all HIV- Percent of clients whose smoking smoking status was assessed least once in the
care (NQC 113) infected Clients status was assessed in the past year. in the past year. measurement period . 30% Chart Review
Number if opioid-dependent Number of HIV-infected patients
Appropriateness of Opioid Agonist Therapy for Percent of opioid-dependent clients patients who are receiving with current diagnosis of opioid Chart Review
care (NQC 111) Opioid-Dependent Clients receiving opioid agonist therapy. opioid agonist therapy. dependence. 30% CAREWare
Number of HIV-infected patients
Screening for HIV Transmission Number of patients who were asked who accessed Substance Abuse
Risk via Shared Intravenous Percent of clients who were asked at least at least once if they had injected any Outpatient Treatment at
Appropriateness of Drug Equipment and Referral to once if they had injected any non- non-prescribed drugs since their last least once in the measurement Chart Review
care (NQC 110-A) Drug Treatment Program prescribed drugs since their last visit. visit. year. 30% CAREWare
7
Breakdown of Performance Measures GY 2010
Ryan White Part A, Las Vegas TGA
Number of HIV-infected patients
who accessed Substance Abuse
Screening for HIV Transmission Outpatient Treatment at
Risk via Shared Intravenous Percent of clients who have been asked if Number of patients who have been least once in the measurement
Appropriateness of Drug Equipment and Referral to they are sharing needles and drug asked if they are sharing needles and year and reported injecting any non- Chart Review
care (NQC 111-B) Drug Treatment Program injection paraphernalia. drug injection paraphernalia. prescribed drugs. 50% CAREWare
Mental Health Services
Number of clients for whom a
Percent of clients for whom a mental mental health assessment was Number of HIV-infected clients that
Appropriateness Mental Health Screening health assessment was performed during performed during the measurement accessed mental health services at Chart Review
of care the past year. period. least once in the measurement period. 50% CAREWare
Number of clients who are
hospitalized and who receive at least
Percent of clients who are hospitalized one consultation or case
and who receive at least one consultation management encounter while Number of clients who are
Appropriateness Discharge Planning or case management encounter while hospitalized within the hospitalized at least once in the Chart Review
of care hospitalized within the last 12 months. measurement period. measurement period. 80% CAREWare
Number of clients who had a six
month follow-up outcomes Number of HIV-infected clients that
Appropriateness Percent of clients who had a six month assessment within the measurement accessed mental health services at Chart Review
of care Improve Functional Status follow-up outcomes assessment. year. least once in the measurement period. 50% CAREWare
Percent of clients who have one medical Number of clients who have one Number of HIV-infected clients that
Appropriateness Medical Care Consultation care consultation during the mental medical care consultation during the accessed mental health services at 80% Chart Review
of care health treatment episode. mental health treatment episode. least once in the measurement period. CAREWare
Number of clients who have
Percent of clients who have biopsychosocial assessment Number of HIV-infected clients that
Appropriateness Biopsychosocial Assessment biopsychosocial assessment completed completed within 30 days from first accessed mental health services at 80% Chart Review
of care within 30 days from first service contact. service contact. least once in the measurement period. CAREWare
Percent of HIV-infected clients who have Number of clients who have Number of HIV-infected clients that
Appropriateness of Depression Screening received an annual screening for received an annual screening for accessed mental health services at 80% Chart Review
care (NQC 93) depression. depression. least once in the measurement period. CAREWare
Number of HIV-infected clients that
Number of patients with depression accessed mental health services at
Percent of clients with depression with with documented response to least once in the measurement period
Appropriateness of documented response to treatment treatment within 4 weeks of and have undergone treatment for 80% Chart Review
care (NQC 97) Management of Depression within 4 weeks of treatment initiation. treatment initiation. depression. CAREWare
8
Breakdown of Performance Measures GY 2010
Ryan White Part A, Las Vegas TGA
Number of patients who were asked
Percent of clients who were asked about about their use of alcohol, Number of HIV-infected patients with
Substance Use Screening in their use of alcohol, marijuana, cocaine, marijuana, cocaine, crack cocaine, documented mental health disorder
Appropriateness of Clients with Documented crack cocaine, amphetamines, opiates, amphetamines, opiates, and and no current or past history of Chart Review
care (NQC 95-A) Mental Health Disorder and benzodiazepines in the past year. benzodiazepines in the past year. alcohol/substance use. 50% CAREWare
Number of patients who were asked
Substance Use Screening in Percent of clients who were asked about about their use of alcohol, Number of HIV-infected patients with
Clients with Documented their use of alcohol, marijuana, cocaine, marijuana, cocaine, crack cocaine, documented mental health disorder
Appropriateness of Mental Health Disorder- crack cocaine, amphetamines, opiates, amphetamines, opiates, and and current or past history of Chart Review
care (NQC 95-B) quarterly and benzodiazepines in the last quarter. benzodiazepines in the last quarter. substance use. 50% CAREWare
Number of patients whose records
Percent of clients whose records have have specific documentation of
Coordination of Care between specific documentation of communication or exchange of data Number of HIV-infected clients that
Continuity of care Medical and Psychiatric communication or exchange of data between mental health and medical accessed mental health services at Chart Review
(NQC 99) Providers between health and medical providers. providers. least once in the measurement period. 50% CAREWare
Health Insurance Continuation Services
Number of HIV-infected clients that
Percentage of clients notified of their Number of clients notified of their accessed Health Insurance
Notification of Status status for Health Insurance Continuation status for Health Insurance Continuation Services at least once in Chart Review
Efficiency of care within 5 business days. Continuation within 5 business days. the measurement period. 90% CAREWare
Percent of HIV-infected clients who had Number of HIV-infected clients who Number of HIV-infected clients that
a medical visit with a provider with had a medical visit with a provider accessed Health Insurance
Medical Care prescribing privileges at least once in the with prescribing privileges at least Continuation Services at least once in 65%
Continuity of care measurement year. once in the measurement year. the measurement period. CAREWare
Medical Nutrition Therapy
Number of clients who report
Percent of clients who report decreased decreased or maintained severity in Number of HIV-infected clients who
Prescribed Supplements or maintained severity in their HIV their HIV and/or HIV-medication- accessed Medical Nutrition Therapy
Effectiveness of and/or HIV-medication-related side related side effects and symptoms Services at least once in the Chart Review
care effects and symptoms over time. from utilizing supplements. measurement period. 75% CAREWare
Percent of HIV-infected clients who had
a medical visit with a provider with Number of HIV-infected clients who Number of HIV-infected clients who
prescribing privileges at least once in the had a medical visit with a provider accessed Medical Nutrition Therapy
Medical Care measurement year and accessed medical with prescribing privileges at least Services at least once in the 65%
Continuity of care nutrition therapy. once in the measurement year. measurement period. CAREWare
Support Services
Case Management (non-Medical)
9
Breakdown of Performance Measures GY 2010
Ryan White Part A, Las Vegas TGA
Number of clients that accessed
Percent of clients who received case Number of clients that accessed case medical care and/or supportive
Provide Continuity of Care to management services that access medical management services at least once services at least once in the 65%
Continuity of care Clients and/or supportive services. in the measurement year. measurement year. CAREWare
Number of clients that accessed non-
Percent of non-medical case medical case management services
Accessibility Service Utilization in management service utilization for at least once in the measurement Number of clients in communities 65%
of care Communities of Color clients in communities of color. year. of color during the measurement year. CAREWare
Number of clients who had a
Percent of clients receiving non-medical documented, complete psychosocial Number of clients accessing case 80%
Appropriateness Psychosocial Assessments case management and had at least one assessment at least once in the management services at least once in
of care psychosocial assessment. measurement year. the measurement year. Chart Review
Number of clients who are screened
Percent of clients who are screened and referred, if necessary, for Number of clients accessing case
Screening and Referrals for annually and referred, if necessary, for substance abuse services at least management services at least once in 65%
Continuity of care Substance Abuse substance abuse service needs. once in the measurement year. the measurement year. Chart Review
Number of client who are screened
Percent of clients who are screened and referred, if necessary, for mental Number of clients accessing case
Screening and Referrals for annually and referred, if necessary, for health service needs at least once in management services at least once in 65%
Mental Health mental health service needs. the measurement year. the measurement year. Chart Review
Number of clients who have a case
Case Management Care Plan Percent of clients who have a case management care plan documented Number of clients accessing case
Appropriateness Update Twice per Year management care plan documented and and updated twice during the management services at least once in 65%
of care updated at least every six months. measurement year. the measurement year. Chart Review
Percent of HIV-infected clients who had
a medical visit with a provider with Number of HIV-infected clients who
prescribing privileges at least once in the had a medical visit with a provider Number of clients accessing case
measurement year and accessed case with prescribing privileges at least management services at least once in 65%
Continuity of care Medical Care management services. once in the measurement year. the measurement year. CAREWare
Number of clients who had a client
Percent of clients who have a client acuity performed and documented Number of clients accessing case
Appropriateness of acuity documented and updated at least at least once in the measurement management services at least once in
care Updated Client Acuity once annually. period. the measurement year. NA Chart Review
Emergency Financial Assistance-Utility Assistance
Number of clients who have
Resource Directory Percentage of HIV infected clients who reported having received an updated Number of clients who have had at Client
received a current resource directory in resource directory within the least one medical or support service satisfaction
Continuity of care the past year. measurement year. visit in the measurement year. 75% survey
10
Breakdown of Performance Measures GY 2010
Ryan White Part A, Las Vegas TGA
Requests Fulfilled Within 48 Percent of clients who received Number of clients receiving EFA Number clients with an approved
Hours approved EFA payments within 48 of payments within 48 hours of request for EFA within the
Accessibility of care request. request. measurement year. 75% Chart Review
Number of client charts
Percent of clients requesting EFA that documenting a planning session
have a planning session with a provider with provider and client regarding at Number clients with an approved
Alternate Funding Sources documenting alternate funding sources, least three alternate funding sources request for EFA within the
Continuity of care at least three. for EFA. measurement year. 75% Chart Review
Percent of clients requesting EFA that Number of clients that have a
have a planning session with a provider documented planning session with a Number clients with an approved
Effectiveness of regarding a plan to financially stabilize provider regarding a plan to request for EFA within the
care Planning Session the client. financially stabilize the client. measurement year. NA Chart Review
Number of HIV-infected clients who
had a medical visit with a provider Number of clients accessing EFA-
Medical Care Percent of clients accessing EFA-utility with prescribing privileges at least utility assistance within the 65%
Continuity of care assistance and in medical care. once in the measurement year. measurement year. CAREWare
Food Bank-Home Delivered Meals
Chart Review/
CAREWare
Number of clients satisfied with the Client
Effectiveness of Percent of clients satisfied with the overall quality of the program Number of clients access food services Satisfaction
care Quality of Program overall quality of the program services. services. within the measurement year. 75% Survey
Chart Review/
Number of clients who received a CAREWare
Percent of clients who received a resource list of community food and Client
Resource Directory of Nutrition resource list of community food and nutrition services within the Number of clients accessing food Satisfaction
Continuity of care Services nutrition services. measurement period. services within the measurement year. 75% Survey
Percent of HIV-infected clients who had Number of HIV-infected clients who
a medical visit with a provider with had a medical visit with a provider
Medical Care prescribing privileges at least once in the with prescribing privileges at least Number of clients access food services 65%
Continuity of care measurement year. once in the measurement year. within the measurement year. CAREWare
Emergency Financial Assistance-Housing Services/Housing Services
Percent of clients with a housing Number of clients having their Number of eligible clients accessing
payment made within 7 days of approved housing payment made within 7 Housing Assistance within the
Efficiency of care Timely Payments application. days of approved application. measurement period. 90% Chart Review
Percent of clients that received a Number of clients that received a
planning session regarding alternate planning session regarding alternate Number of eligible clients accessing
Alternate Funding Sources funding source investigation for housing funding source investigation for Housing Assistance within the
Efficiency of care assistance. housing assistance. measurement period. 90% Chart Review
11
Breakdown of Performance Measures GY 2010
Ryan White Part A, Las Vegas TGA
Number of HIV-infected clients who
had a medical visit with a provider Number of eligible clients accessing
Medical Care Percent of clients accessing EFA-housing with prescribing privileges at least EFA-housing assistance within the 65%
Continuity of care assistance and in medical care. once in the measurement year. measurement period. CAREWare
Patient Perspective Issues/Client Satisfaction
Percent of clients indicating how satisfied Number of clients who have
they are with their service provider's reported being satisfied with
knowledge of other community services, provider's knowledge of other
ability to connect them with those community services, ability to
Patient Perspective Increase Client Satisfaction services, and the overall quality they connect them with services, and the Number of clients who have had at 80% Client
Issues/Client receive overall quality they receive from least one medical or support service Satisfaction
Satisfaction from the agencies. that agency. visit in the measurement year. Survey
Patient Retention
Number of clients who had at least Number of clients who had at least
Patient Perspecitve one visit with this provider in the one visit with this provider in the
Issues Patient Retention Percent of clients current year. prior year. 75% CAREWare
Psychosocial Support Services
Linguistic Services
Medical Transportation Services
Referrals for Health Care/Supportive Services
Substance Abuse Residential
Child Care Services
Substance Abuse Residential Treatment
12
Las Vegas TGA Ryan White Part A Quality Management Program Tracking March 1, 2010-February 28, 2011
GOAL #1- Improve the quality of HIV/AIDS core medical and supportive services in the Las Vegas TGA.
Staff/
Activities Lead Resources Deadline Finalized Progress Notes
1.1 Review the agency specific QM annual plans
and return evaluation to the agency. QM Coordinator April 30, 2010
1.2 Establish a Quality Management Team to
review data and initiate quality improvement
strategies. QM Coordinator April 12, 2010
3/7/201113
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