NEW YORK CITY TITLE I HIV QUALITY MANAGEMENT PROGRAM

Review Eligibility:
Patients admitted in the reviewed calendar year who have been enrolled in the Food and Nutrition program for a minimum of 1 month.

Review Periods:
The review period is defined as the calendar year. For patients discharged during this calendar year, the review period will extend from the beginning of the year, to the date of discharge.

Indicator 1: A baseline nutritional screening is performed within 30 days of intake and contains the following elements:

• Weight (may include usual body weight (UBW); weight when diagnosed; recent weight history; record of weight lost/gained)
• Determination of nutritional risk. Examples may include any of the following:
• Severe weight loss (more than 5% of UBW unintentionally over a 2-3 month period) See Note.
• Level of appetite/nutritional intake
• History of diabetes or lipid disorders
• GI-related issues (e.g. nausea, diarrhea, difficulty swallowing)

Note: Rapid loss of weight (more than 5% of UBW over a 2-3 month period) and lean body mass are highly associated with impending hospitalization and mortality. … A careful nutritional assessment should be conducted by a registered dietitian for any patient who has involuntary weight loss of at least 5% of the UBW, demonstrates clinical evidence of LBM loss, or follows a restrictive diet involving major food groups. (From HIV Guidelines, Adult HIV Guidelines, General Nutrition, Weight Loss and Wasting Sydrome, 2004 – New York State AIDS Institute)

Indicator 2: A list of HIV medications prescribed to the patient is documented in the patient’s chart

Indicator 3: A baseline screening for food security is performed and contains the following elements.

• Access to food on a regular basis (congregate meals, food pantries, etc.)
• Housing status
• Access to cooking facilities
• Financial status (entitlements, insurance status, etc.)

Program level indicators

Indicator 4: Nutritional education is provided monthly, addressing at least one of the following topics:

• Appropriate dietary habits for people living with HIV
• Food Safety
• Diet and adherence to ARV treatment plan (e.g., meal planning)
• Diet and special concerns (e.g., diabetes, lipodystrophy)
• Budgeting and shopping
• Nutritional related symptom management (e.g., diabetes, lipodystrophy)
• Food preparation and cooking            

Indicator 5: A client satisfaction survey is conducted annually.  Components of the survey should address the following areas:

• Overall quality of the program services
• Quality of the food provided
• Quality of the nutritional education services
• Selection of food items meets your dietary needs
• Selection of food items meets your cultural needs        

Indicator 6: A resource list of community food and nutrition services is provided to the client.

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?