ADAP Clinical Quality Management Tutorial Three: How to Develop ADAP Quality Indicators

1. ADAP Clinical Quality Management Tutorial Three:How to Develop ADAP Quality Indicators 1

2. Learning Objectives: You Will . . . • Review elements of a strong quality indicator and how indicators are used • Review different types of quality indicators • Identify steps in developing an ADAP quality indicator

3. What is a Quality Indicator? A quality indicator is a tool to assess specific aspects of care and services that are linked to better health outcomes while being consistent with current professional knowledge and meeting client needs.

4. Why use Quality Indicators? • Separates what you think ishappening from what is actually happening • Establishes a baseline for measuring performance over time • Allows for comparing performance across other ADAPs • Ongoing/periodic monitoring identifies problems as they emerge • Determines whether changes lead to improvements It’s very simple: “You can’t improve what you can’t measure!”

5. What makes a Good Indicator? • Relevance • Is the indicator directly associated with positive health outcomes for your ADAP clients? • Measurability • Can the indicator be realistically and efficiently measured? • Accuracy • Is the indicator based on accepted guidelines or developed through formal group-decision making models? • Improvability • Can the rate of performance associated with the indicator be realistically improved?

6. Types of Indicators

7. Process Indicators • Process indicators tell us whether parts or steps in the system are working as planned • Example: • Length of time to determine ADAP eligibility or ADAP re-certification

8. Process Indicators Examine... • Are ADAP services provided in a timely fashion? • Are ADAP services easily accessible? • Are customers satisfied with how ADAP services are provided? • Are there patterns of complaints and concerns?

9. Outcome Indicators • Outcome indicators reflect the impact of the program on the care provided to the clients • Examples: • Adherence to treatment regimens • Improvement in CD4 count and Viral Loads • Patient health status - such as the client’s own sense of his/her quality of life • Access and retention to the ADAP services

10. Test Question Which of the following statements are true regarding ADAP Quality Indicators? a) A sound indicator is relevant and measurable b) Process indicators examine how well a system functions; whereas outcome indicators reflect the impact of the program to clients served c) An example of an outcome indicator would be the improvement of a client’s CD4 count and Viral Load d) B and C e) All the above

11. Test Question The correct answer is: e) All the above

12. Steps in Defining an ADAP Indicator

13. Example of an ADAP Indicator Eligibility Who should be counted in the measurement population and in what time frame? • Includes • HIV Positive, “Payer of last resort”, Low-income • Under or uninsured individuals • Set a measurement period (e.g., calendar year, three month period, etc.) • Excludes • ADAP applications for new ADAP enrollment that were incomplete or incorrectly filled out. • Complete ADAP applications for new ADAP enrollment received by ADAP within the last 14 days of the measurement year.

14. Steps in Defining an ADAP Indicator • Specify the reasonable requirement for service All ADAP applications will be reviewed for eligibility within two weeks of receipt of completed application to the program in the measurement period • Define the indicator Percent of ADAP applications approved or denied for ADAP enrollment within two weeks of ADAP receiving a complete application in the measurement period

15. Steps in Defining an ADAP Indicator • Set the denominator Total number of complete ADAP applications for new ADAP enrollment received in the measurement year • Set the numerator Number of applications that were approved or denied for new ADAP enrollment within 14 days (two weeks) of ADAP receiving a complete application in the measurement year

16. Steps in Defining an ADAP Indicator • Now calculate your result Divide the numerator by the denominator to get the performance percentage Numerator Denominator Example: 100 applications approved/denied within 14 days 125 applications completed in measurement period = % = 80%

17. Steps in Defining an ADAP Indicator Eligible Clients Denominator Numerator

18. Collecting Data

19. Collecting Data Sampling • See how many clients are eligible to be in the measurement population • Determine if you will use a random sample or examine all client records • Order all client charts by client ID numbers (or unique identifier) • Use a free service to help you select records to review e.g. www.randomizer.org • Select records based on the randomizing criteria

20. Collecting Data Electronic Data Systems • Ability to examine 100% of client records • Provides automated reporting

21. Test Question Which of the following is NOT one of the steps in defining an ADAP indicator? • Specifying the program’s scope of work • Setting the numerator • Setting the denominator • Specifying the reasonable requirement for service

22. Test Question The correct answer is: • Specifying the program’s scope of work

23. Resources • Carey, Raymond G., Ph.D., Improving Health Care with Control Charts. Milwaukee: ASQ Quality Press, 2003 • Measuring Clinical Performance: A Guide for HIV Health Care Providers. A publication of the AIDS Education Training Centers and the New York State Department of Health, AIDS Institute, 2002. The guide can be downloaded at: http://nationalqualitycenter.org/index.cfm/6127/13908 • Roberts, Harry, Quality Is Personal, New York: Free Press, 1993 • HAB Performance Measures http://hab.hrsa.gov/special/habmeasures.htm • Agresti, Alan An Introduction to Categorical Data Analysis, Wiley Series in Probability and Statistics. Applied Probability and Statistics, May 1996. • Carey, R.G., and R.C. Lloyd. Measuring Quality Improvement in Healthcare. New York: Quality Resources, 1995. • CAREWare is a management information system that helps Ryan White Program grantees and service providers collect, manage and report client-level data. It is available on the HRSA web site at http://hab.hrsa.gov/careware.

24. For further information, contact: National Quality Center New York State Dept. of Health 90 Church Street, 13th floor New York, NY 10007-2919 Work: 212.417.4730 Fax: 212.417.4684 Email: Info@NationalQualityCenter.org Or visit us online at NationalQualityCenter.org