Using AIRS to Collect and Report COBRA Client Outcomes

Using AIRS to Collect and Report COBRA Client Outcomes PowerPoint PPT Presentation


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Goals Today. Prepare you to collect COBRA client outcomes and record them in AIRS using:COBRA Outcomes Assessment page in AIRSData collection form Comprehensive Assessment and Reassessment, modified for reporting outcomesReview definitions of outcome indicators Introduce proposed AIRS reports t

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Using AIRS to Collect and Report COBRA Client Outcomes

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1. Using AIRS to Collect and Report COBRA Client Outcomes COBRA Outcomes Training

2. Goals Today Prepare you to collect COBRA client outcomes and record them in AIRS using: COBRA Outcomes Assessment page in AIRS Data collection form Comprehensive Assessment and Reassessment, modified for reporting outcomes Review definitions of outcome indicators Introduce proposed AIRS reports to assist supervisors to collect outcomes

3. Why Collect COBRA Client Outcomes? COBRA is a Medicaid program Fundamental purpose of COBRA is to improve access to, retention in, and benefit from HIV care, including improved medical outcomes Refocus staff and clients on this purpose To continue support for COBRA program, we need medically-related outcomes data

4. Process At comprehensive assessment and each reassessment, the Case Manager, Supervisor, or QA/QI staff will extract outcomes data Assigned staff will enter data into AIRS AIRS data will be reported to AIDS Institute in regular monthly extract COBRA programs will have access to reports to review and use their own data

5. Essential to this Process Accurate data Case Managers will need access to client’s basic HIV medical information Uniform Everyone uses the same definitions for each indicator Timely Outcomes data is entered at completion of assessments and reassessments Complete data Supervisors will need a mechanism to check data

6. Program To-Do List Orient agency staff to COBRA AIRS outcomes collection – why, what, and how. Ensure AIRS is upgraded, currently to version 8.2.264. Determine which staff will extract outcomes following each client’s assessment or reassessment, and who will enter into AIRS Train supervisors, Case Managers, and other direct staff on outcomes, definitions, and changes to assessment and reassessment

7. Program To-Do List con’t Work on program systems to improve: Timely completion of Assessments and Reassessments, so outcomes can be completed at regular intervals Access to accurate client medical information Start collecting and reporting on all clients as soon as possible

8. Reminder AIRS Outcomes page will be modified and an upgrade available later spring 2009: “Unknown” will be added as an option to each indicator Corrections made to AIRS screen and definitions An additional indicator added Does the client have chronic Hepatitis C?

9. Reminder Send feedback on issues, problems, concerns to [email protected] Part of upcoming Upstate TAGs may be used for updates, changes, TA, exchange of ideas

10. Indicators Five Categories HIV Medical Care Adherence to HIV Antiretrovirals Substance Use Treatment Mental Health Care Housing

11. Indicators and Definitions Outcomes data has been gathered for Initial Comprehensive Assessment Reassessment completed on ______ (date) Check off which assessment outcomes information has been gathered for. Enter the date of completion of assessment or reassessment.

12. HIV Medical Care 4. Does the client have an HIV medical provider? Yes No Answer “yes” if the client has a clinician for HIV medical care who they consider their primary HIV care provider.

13. HIV Medical Care 5. Name of provider: Clinician Name (optional) Medical Agency Name Address (number, street, city, zip) Type the first and last name of the client’s HIV medical care provider and the name of the practice, clinic, DAC, etc. if there is one. If the client sees several different clinicians, omit the clinician name and list the name of the HIV medical clinic. Use the same standard name for each HIV medical agency used by your program’s clients.

14. HIV Medical Care 6. Date of most recent HIV medical care visit Enter the date of the client’s most recent HIV medical care visit where they saw a doctor, nurse, nurse practitioner, or PA for medical services. NYS HIV Primary Care Clinical Guidelines recommend HIV medical visits once every four months. If a client in COBRA case management has not seen their HIV medical provider at least once in the past six months, this issue should be addressed with the client.

15. HIV Medical Care 7. Date of most recent Viral Load Test NYS HIV Primary Care Clinical Guidelines recommend CD4 and Viral load testing once every four months. If a client in COBRA case management has not received these lab tests at least once in the past six months, this issue should be addressed with the client.

16. HIV Medical Care 8. Viral Load test results Enter the results of the client’s most recent Viral Load test. When entering into AIRs, if Viral Load is expressed as “less than” or “<“ enter the number only. If “undetectable” enter “0”.

17. HIV Medical Care 9. Date of most recent CD4 count NYS HIV Primary Care Clinical Guidelines recommend CD4 and Viral load testing once every four months. If a client in COBRA case management has not received these lab tests at least once in the past six months, this issue should be addressed with the client.

18. HIV Medical Care 10. CD4 test results Enter the results of the client’s most recent CD4 count (absolute number).

19. HIV Medical Care 11. For women, date of most recent pap smear NYS HIV Primary Care Clinical Guidelines recommend that HIV+ women receive a pelvic exam annually. A pap smear is recommended at a baseline exam and six months after baseline, repeated annually as long as pap smear results are normal.

20. HIV Medical Care 11. pap smear, continued If an HIV+ women has not had a pelvic exam and pap smear at least once in the past 12 months, this issue should be addressed with the client. For transgender persons, the need for and frequency of this test may differ – consult appropriate resources.

21. HIV Medical Care 12. Is the client positive for Hepatitis C? Yes No Check “yes” if the client has been tested for Hepatitis C and is antibody positive, “no” if the client is antibody negative. NYS HIV Primary Care Clinical Guidelines recommend baseline Hepatitis C testing. If a COBRA client has never been tested for Hepatitis C, or their results are unknown, this issue should be addressed with the client, especially if a client is at risk for Hepatitis C infection.

22. HIV Medical Care 12.a. If yes, does the client have chronic Hepatitis C infection? Answer “yes” if the client is Hepatitis C positive, and a medical provider has determined that the client has chronic Hepatitis C infection based on the results of HCV viral load testing (qualitative HCV RNA testing).

23. HIV Medical Care 12.a. continued Answer “no” if a medical provider has determined that the client does not have chronic Hepatitis C based on the results of HCV viral load testing. Answer “unknown” if client has not had Hepatitis C viral load testing, or the results are unknown.

24. Adherence to HIV Antiretrovirals 13. Is client currently prescribed ARV therapy by their medical provider? Yes No Answer “yes” if the client’s primary HIV medical care provider has prescribed antiretroviral medications for the client and expects him/her to be taking these medications presently. Answer “no” if the client is not prescribed antiretrovirals currently, or if the medical provider has told the client to stop taking their antiretroviral medication.

25. Adherence to HIV Antiretrovirals 14. If yes, how well is client adhering to ARV therapy? Good adherence (score greater than 10) Poor adherence (score less than or = 10) Using the three question Client Adherence Questionnaire in the COBRA comprehensive assessment or reassessment ask the client each adherence question and possible answers, circling the client’s response. Add up the score of each answer and enter “good adherence” if the total score is greater than 10, “poor adherence” if the total score is less than or equal to 10.

26. Adherence to HIV Antiretrovirals 14. continued COBRA case managers screen clients for adherence problems at assessment and reassessment, and discuss adherence during the course of providing case management services. Clients experiencing difficulty with good adherence should be assisted getting help to address barriers to and problems with adherence.

27. Substance Use Treatment 15. Does the client have a history of problem alcohol or drug use? Yes No Answer “yes” if the client has a history of consistent or cyclical substance use (alcohol and/or drugs) at a level which impairs personal relationships, or puts the client’s job, income, health, housing, etc., in jeopardy. Answer “no” if the client has no history of problem substance use.

28. Substance Use Treatment 16. Does the client currently need help with problem alcohol or drug use? Yes No Answer “yes” if, based on the CM’s assessment or reassessment, the client currently needs to enter or to continue substance use services listed on the following slide. Answer “no” if, based on the CM assessment or reassessment, the client does not need the following substance use services:

29. Substance Use Treatment 16. continued Detox Inpatient or outpatient drug or alcohol treatment Methadone maintenance Buprenorphine/ Suboxone treatment Recovery Readiness Syringe Exchange Self Help Group Other substance use or harm reduction services

30. Substance Use Treatment 17. If yes, is the client currently in: Alcohol or Drug Treatment? Yes No Harm Reduction Program or Self Help Group? Yes No Answer “yes” to Alcohol or Drug Treatment if client is enrolled in detox, inpatient/outpatient drug or alcohol treatment, methadone maintenance or buprenorphine/Suboxone treatment. Answer “ no” if client is not enrolled in these services.

31. Substance Use Treatment 17. continued Answer “yes” to Harm Reduction Program or Self Help Group(s) if client participates in recovery readiness, syringe exchange, Alcoholics Anonymous/Narcotics Anonymous, or other self help-type community group which usually does not have attendance requirements. Answer “no” if not enrolled in harm reduction program or self help group(s)

32. Substance Use Treatment 17. a. If in Alcohol or Drug Treatment, what type of treatment? Inpatient Outpatient Answer “inpatient” if client is receiving services in a hospital or institution requiring overnight stays. Answer “outpatient” if the client is enrolled and receiving services at set times in an office or institution but returns home every night.

33. Substance Use Treatment 17.a.1. If client is in Outpatient Alcohol or Drug Treatment, client attendance over the past six months has been: Inconsistent Attendance Consistent Attendance Check “consistent attendance” if client has attended regularly over the past six months, missing less than 10% of their appointments. Check “inconsistent attendance” if the client has attended irregularly, missing more than 10% of their appointments.

34. Mental Health Care 18. Does the client currently need mental health care services? Yes No Answer “yes” if based on a case manager’s assessment or reassessment, client needs to receive (or continue) mental health care services such as:

35. Mental Health Care 18. continued Mental health assessment, by a mental health professional including the CCMS Psychotherapy Individual, family, or group counseling services with a mental health professional Psychiatric services Including psychiatric and medication evaluation, monitoring, and follow up

36. Mental Health Care 18. continued Medication evaluation and monitoring by the prescribing physician (non psychiatrist) Emergency mental health services/emergency psychiatric evaluation Answer “no” if none of the above are needed.

37. Mental Health Care 19. If yes, is the client currently in mental health care? Yes No Answer “yes” if the client is currently receiving mental health care services such as those listed under question 18. Answer “no” if the client is not currently receiving mental health services

38. Mental Health Care 19.a. If yes, what type of care? Inpatient Outpatient If Outpatient: Individual Group Both Answer “inpatient” if client is receiving mental health services in a hospital or institutional setting involving an overnight stay. Answer “outpatient” is client is enrolled and receiving services at set times in an office or institution but returns home every night.

39. Mental Health Care 19.a. continued If the client is receiving outpatient mental health services, check “individual” if services are for the client alone. Check “group” if client receives services with others (including family). Check “both” if client receives individual and group outpatient mental health care services.

40. Mental Health Care 19.a.1. If Outpatient, client attendance at mental health care services over the past six months has been: Inconsistent Attendance Consistent Attendance Answer “inconsistent attendance” if client has missed more than half their appointment over the past 6 months. Answer “consistent attendance” if client has attended more than half their appointments over the past 6 months.

41. Mental Health Care 20. Is client currently prescribed medications for mental health treatment? Yes No Answer “yes” if the client has been prescribed psychotropic medications and the client’s primary HIV medical care provider and/or psychiatrist expects him or her to be taking these medications currently. Answer “no” if the client is not prescribed psychotropic medications.

42. Mental Health Care 21. Is client taking medications as prescribed? Yes No Answer “yes” if the client is taking psychotropic medications in the amount and frequency their doctor or psychiatrist has prescribed Answer “no” if the client is not taking psychotropic medications as prescribed, or if they need a referral to address problems with adherence or other concerns about taking their psychotropic medications.

43. Housing 22. What best describes client’s current housing status? Homeless, on the street, or in short term temporary shelter Unsafe, physically inadequate, or unstable housing Safe, physically adequate, stable housing

44. Housing 22. continued Homeless, on the street, in short term temporary shelter Client is in an emergency situation

45. Housing 22. continued Unsafe, physically inadequate, or unstable housing: Housing has major deficiency such as: Lack of adequate space for all household members Major repairs needed Utilities or major appliances not working Key necessities missing (i.e., furniture) Serious sanitation problem (i.e., infested) Client/collateral health and/or security threatened

46. Housing 22. continued Or, client is at high risk for losing housing Living with someone temporarily Pending eviction More than one month in rent arrears Etc.

47. Housing 22. continued Safe, physically adequate, stable housing Client’s housing has no major inadequacies and is reasonably stable

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