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Assessing & Improving Quality of Care Newly Developed Quality of Care Tools. President’s Emergency Plan for AIDS Relief Track 1.0 ART Program Meeting Seema Meloni, PhD, MPH Assistant Country Director, Harvard PEPFAR Nigeria 25 September 2007. Two Tools for Improving Care.

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assessing improving quality of care newly developed quality of care tools

Assessing & Improving Quality of CareNewly Developed Quality of Care Tools

President’s Emergency Plan for AIDS Relief

Track 1.0 ART Program Meeting

Seema Meloni, PhD, MPH

Assistant Country Director, Harvard PEPFAR Nigeria

25 September 2007

two tools for improving care
Two Tools for Improving Care
  • Quality Improvement
    • Treatment Response Utility: “Snapshot” of patient
  • Quality Assessment
    • Site Assessment Database
overview database system
Overview: Database System

VCT

  • Electronic capture of patient data from program inception
  • Data captured for Adult, Pediatric, and PMTCT program areas

Visit

ART ineligible

Pre-

assessment

Palliative Care

ARV naïve

ART eligible

Lab

ART eligible

Entry

ARV experienced

Pharmacy

Discontinue

Failure

Toxicity

slide5

Best clinical management of patients

Paper

records

Paper record placed in patient chart

Reports

Daily entry at program sites;

Merged & cleaned weekly

Treatment Response Utility

Reports

Downloaded in Boston; merged and reviewed

Projections

Uploaded to Server

Program Evaluations (QA)

treatment response utility

Patient ID #

Treatment Response Utility

Goal: Improve treatment process by providing clinicians quick and easy access to patients’ treatment-related data

evolution of internal qa program
Evolution of Internal QA Program
  • JSI Quality Assessments at 3 sites
  • Informal quality improvement efforts through ongoing monitoring of site progress and visits from clinical officers
  • Internal development of a quality assessment protocol
    • Technical assistance on indicator selection provided by JSI
    • Full assessment: 3 sites (different from JSI QA)
    • Follow-up assessment on 1 site previously assessed by JSI
site assessment goals
Site Assessment Goals
  • Assess quality of care provided to HIV/AIDS patients
  • Identify strengths and weaknesses in clinical processes/systems
  • Evaluate health outcomes of patients as related to clinical processes
  • Promote accountability for patient care
  • Facilitate the process of joint problem identification and solving
site assessment indicators
Informed consent coverage

CTX coverage

TB screening coverage

Lab data

% Charts missing values

Toxicity

% patients with panic values

% patients with appropriate clinical response(s)

CD4 and Viral Load

% patients with values at baseline, 3, 6, and 12 months

% patients with CD4>200 and/or suppressing viral load at 6 and 12 months

Treatment failure

% patients in failure at 6 and 12 months

% patients with appropriate clinical response(s)

Site Assessment Indicators
site assessment database
Site Assessment Database
  • Basic procedure:
  • Random sample of patient IDs selected from master databases. SA database preloaded with data from master Entry, Lab, Pharmacy, and Visit databases
  • Database taken to site; data in charts compared to data loaded into SA database
  • In addition, evaluate a few additional indicators to further evaluate quality of patient care
chart review data entry
Chart Review & Data Entry

Click through tabs to access data for various indicators

Data in unshaded fields are pulled from master files in Boston

Fields shaded in yellow are meant for SA team to enter notes

Pulled from Tx Response Utility

chart review data entry13
Chart Review & Data Entry
  • Electronic tool makes it easy for on-site analyses
  • Jump to analysis screen and “find” all records that address given indicator
innovative additions

Red flags indicating possible virologic failure

Calculator for 6- and 12-month CD4 & VL

Layout that provides data summary

Innovative Additions
tools have improved quality efficiency
Tools Have Improved Quality & Efficiency
  • Treatment Response Utility
    • Minimizes time clinician must spend reviewing patient charts
    • Provides evaluation of adherence and treatment failures
    • Will be adapted and used for transfer patients - allows for continuity of care
  • Site Assessment Database
    • Has sped up process of site assessments and allows us to evaluate our program more in-depth
    • Allows for detailed debriefing the day after chart review is complete
    • Can be used by sites for their own QA/QI initiatives