LinkedIn



Adult Day Treatment

TITLE I HIV QUALITY MANAGEMENT PROGRAM

QUALITY PERFORMANCE INDICATOR DEFINITIONS AND CALCULATIONS FOR ADULT DAY TREATMENT CENTERS

General Eligibility: All patients enrolled in the Adult Day treatment Program for 4 consecutive months in the year of review.

Indicator 1: Initial Comprehensive Medical Exam

Eligibility: All patients admitted to the adult day treatment program during the 12-month review period

Measure: The number of patients with a comprehensive medical exam performed within 30 days of admission, which includes the following elements:

  • Medical history
  • Physical exam
  • Pneumococcal vaccine status documented
  • Laboratory tests
    • Baseline hematology/Baseline chemistry results
    • CD4 results
    • Viral load results
    • Cholesterol/triglycerides results for patients on ARV
    • Syphilis screen results

Indicator 1A: Annual Medical Exam

Eligibility: All patients admitted to the adult day treatment program prior to the year of review, and enrolled in the program for the entire 12-month review period. The minimum enrollment period for this indicator is 13 months.

Measure: The number of patients with annual medical monitoring performed during the year of review. Annual medical monitoring should include the following elements:

  • Physical exam
  • Pneumococcal vaccine status
  • Laboratory tests
    • Hematology/chemistry results
    • Cholesterol/triglycerides results for patients on ARV
    • Syphilis screen results

Indicator 2: Medication lists

Eligibility: All patients

Measure: The number of patients for whom medication lists were updated in the patient’s chart every 30 days and which included documentation of all current medications (including ARV, psychotropic and others)

Indicator 3: Laboratory Monitoring

Eligibility: All patients

Measure: The number of patients for whom results from CD4 monitoring and viral load tests were documented in the patient’s record on a quarterly basis.

Indicator 4: Adherence to ARV Therapy

Eligibility: All patients on ARV therapy

Measure: The number of patients for whom adherence to HIV medication was measured and quantified on a monthly basis in each of the 4 months prior to the patient’s last visit.

Indicator 5: Annual Screening and Examinations

Note: Documentation of the following exams or vaccinations must occur within 120 days for clients enrolled in the program during the year of review.

  • Pelvic exam
  • Mammogram
  • Dental exam
  • Influenza vaccine

Clients enrolled in the program prior to the year of review who have been enrolled in the program for a minimum of 15 consecutive months should also have the exams or vaccinations specified above documented during the 12-month review period. Clients enrolled prior to the year of review AND not enrolled for a minimum of 15 consecutive months are exempt from these indicators.

Indicator 5A: Pelvic Exam


Eligibility: All female patients.

Measure: The number of patients with a pelvic exam recorded in the past year. Components of pelvic exam include:

  • Pap smear
  • Chlamydia screen
  • Gonorrhea test

Indicator 5B: Mammogram

Eligibility: All female patients over age 50

Measure: The number of patients with a mammogram recorded in the past year.

Indicator 5C: Dental Exam

Eligibility: All patients

Measure: The number of patients with a dental exam documented during the past year

Indicator 5D: Influenza Vaccine

Eligibility: All patients

Measure: The number of patients with an influenza vaccine documented during the past year

Indicator 6: Discipline-specific assessments

Indicator 6A: Initial Discipline-specific assessments

Eligibility: All clients admitted to the Adult Day Health Care Program during the 12-month review period

Measure: The number of patients for whom discipline-specific assessments for the areas listed below are completed within 30 days of admission. Assessments should include all specified components in each area.

  • Psychosocial/mental health assessment (performed by a CSW)
    • Psychiatric history, including current and past treatment
    • Current and past psychiatric medications
    • Emotional state/affect
    • Stressors
    • Support
    • Family history
    • Occupational history
  • Nursing assessment (performed by a RN or Clinician)
    • Blood pressure
    • Pulse
    • Respiration
    • Temperature
    • Weight
    • Assessment of HIV knowledge
    • Medication review
    • Adherence assessment
  • Nutritional assessment (performed by a registered dietician)
    • Weight
    • BMI
    • Appetite
    • Laboratory tests
  • Albumin
  • Cholesterol
  • Glucose
  • Triglycerides
    • Nutritional needs
    • Eating habits
    • GI and oral health factors
  • Substance-use (performed by clinician, CASAC, or MSW)
    • Identification and assessment of current and prior substance use

Indicator 6B: Discipline-specific reassessments

Eligibility: All patients

Measure: The number of patients for whom discipline-specific re-assessments are performed for the following areas:

  • Psychosocial/mental health (every 90 days)
  • Nursing (every 90 days)
  • Nutrition (every 90 days if need identified in prior assessment; otherwise every 180 days)
  • Substance use (every 90 days if need identified in prior assessment; otherwise every 180 days)

Note: Specificity required in initial assessments not required for reassessments.

Indicator 7: Comprehensive Care Plan

Indicator 7A: Initial Comprehensive Care Plan

Eligibility: All clients admitted to the Adult Day Health Care Program during the 12-month review period

Measure: The number of patients for whom a comprehensive care plan containing goals and objectives was completed within 30 days of admission.

Indicator 7B: Review of Initial Comprehensive Care Plan

Eligibility: All patients

Measure: The number of patients for whom the comprehensive care plan was reviewed every 90 days.

Indicator 8: Client participation in care plan

Eligibility: All clients

Measure: The number of clients for whom client participation in the care plan was documented by patient signature for each 90-day review period.

Indicator 9: Coordination of Health-related Services

Eligibility: All patients referred for Substance Use or Mental Health services

Measure: The number of patients referred for mental health or substance use services who are receiving services within 4 weeks of the date where need is identified.

Indicator 10: Communication between the Adult Day Care Program and the Primary Care Provider

Indicator 10A: Communication from Adult Day Health Care Program to the Primary Care Provider

Eligibility: All patients with the exception of those who are documented as receiving their primary care at the Adult Day Health Care Program

Measure: The number of patients for whom the Adult Day Health Care medical provider provided a summary of the patient’s medical services to the patient’s primary care provider every 4 months.

Indicator 10B: Communication from the Primary Care Provider to the Adult Day Health Care Medical Provider

Eligibility: All patients with the exception of those who are documented as receiving their primary care at the Adult Day Health Care Program.

Measure: The number of patients for whom the whom the primary care provider provided a summary of the patient’s medical services to the Adult Day Health Care program.

Indicator 11: Case management summary of patient’s progress addressing problems identified in the care plan is documented monthly

Eligibility: All clients

Measure: The number of clients for whom a summary of the client’s progress addressing problems identified in the care plan was documented in each of the 4 months prior to the client’s last visit.

Indicator 12: Outreach to absentee clients

Eligibility: All clients absent from the program for more than one week

Measure: The number of patients for whom outreach efforts were made within the following week.

Primary Care Indicators
1. Access to Primary Care
Clients should have one visit with their primary care provider at least every six months.

  • For clients who have not had a visit with their primary care provider in the first or last six months of the calendar year, there should be documentation of referral to primary care
  • For patients with a referral to primary care, there should be documentation of follow up within 30 days to determine whether the primary care appointment was kept
  • If documentation of follow up exists, there should be documentation that the client kept the appointment

2. Assessment of whether clients eligible for ARV Therapy are receiving it.
Clients will be reassessed for ARV status at least once every six months.

  • For clients not on ARV, is there information on viral load or CD4 test results?
  • If yes, is the patient eligible for therapy based on viral load (>100,000 copies) or CD4 count (< 350 cells)?
  • If yes, is the patient referred to primary care for assessment of treatment eligibility?
  • If yes, is there documentation of follow up on patient’s status within 30 days?
  • If yes, was the patient placed on ART?

3. Viral load and CD4 Counts
Clients will have lab work completed to assess their viral load and CD4 counts at least once every six months.

  • For clients who have not had a CD4 or viral load test performed in the first or last six months of the calendar year, is there documentation of referral to primary care for these tests?
  • For patients with a referral to primary care, was there documentation of follow up within 30 days to determine whether the laboratory tests were performed?
  • If documentation of follow up exists, is there documentation that the client received the viral load and/or CD4 tests?