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Harm Reduction


PART A HIV QUALITY MANAGEMENT PROGRAM


New York State Department of Health


AIDS Institute

 



Quality Performance Indicator Definitions and Calculations for


Part A HIV Harm Reduction Services


 


February, 2009



 


Review Eligibility:


All clients receiving services in the Harm Reduction program for a minimum of 6 months.


 


Review Periods:

The review period is defined as the calendar year being reviewed, e.g. 2008.  For clients discharged during this calendar year, the review period will extend from the beginning of the year to the date of discharge.


 


Indicator 1.  A comprehensive assessment for all clients receiving harm reduction services will occur within 30 days of initial client contact and annually for those clients whose initial assessment is over 12 months old.  This assessment should include the following components:


 


1.A. Substance Use and Risk Behavior


Includes:


§         Substance use history, including patterns and history of substance use


Documentation of types and routes of substance use


Substance use treatment and treatment history


(include name of current treatment provider/type of treatment)


§         Any current substance use


o       treatment referral offered to current substance users

o       active and recent injection users offered ESAP referral if agency has ESAP


o       offered syringe exchange referral if agency does not have ESAP


§         Any history of overdose


§         Sexual risk behavior assessment


o       Discussion of behavioral risk reduction,

o       Number of partners


o       Use of barrier protection, eg. Condoms, female condoms


 


1.B.  Supportive Services


      Housing Status


            Entitlements and insurance

            Client support systems



 


Indicator 2.  A general service plan, based on the findings of the initial assessment, will be developed for each client within 30 days.


 


Indicator 3.  Follow-up on service plan goals and referrals will occur on at least a monthly basis for each client.


 


Indicator 4.  All clients with history of opiate use, should receive individual counseling, or participate in groups that include information on buprenorphine treatment.  All clients with current use or history of opiate use or who live with persons who use or have recently have used opiates will be offered naloxone and overdose prevention training.

 


Indicator 5.  All clients will be assessed for incremental changes in risk behavior at least every quarter, based on behaviors noted in the most recent assessment.  Changes in risk behavior should be documented in chart, e.g. if patient indicated sexual risk behavior in initial assessment, then any behavior changes should be discussed and documented in chart; if the patient indicated current kind of substance use, then any changes in use should be discussed and documented in chart.


 


6.  Access to Primary Care


 


Clients will be assessed for primary care status at least every six months


 


A.  Ask client about regular primary care provider

      Include name of provider/and or clinic


      Document dates of primary care visits


 


B.  If client does not have a primary care provider


      Make referral to a primary care provider


      Assess if patient attended medical appointment within 30 days

 


7.  ARV Therapy


 


Clients will be assessed for ARV status at least once every six months.


 


      Is patient receiving ARV therapy?


      If yes, document that patient receives ARV.


For clients not on ARV, the patient should be referred to primary care for assessment of treatment eligibility

There should be documentation of follow up on patient’s ARV status within 30 days?


If the patient eligible for therapy based on viral load (>100,000 copies) and CD4 count (< 350 cells), document if the patient is receiving ARV therapy


 


8.  Viral load and CD4 Counts         


 


Clients will have viral load and CD4 lab assessments at least 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, there should be documentation of referral to primary care