TITLE I HIV QUALITY MANAGEMENT PROGRAM

Review Eligibility:
Patients enrolled in the program for a minimum of 1 month.

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

Applicability of Review Periods to Patients Reviewed:
For one month indicators: In order to be reviewed for activities that should take place monthly, the patient must be in the program for a minimum of one month. For indicators where measurement occurs every 2, 3, 4, or 6 months, and the patient has been enrolled in the program for a shorter amount of time than the indicator measures, a “yes” will be added to the numerator if the activity was performed in that period, but a “no” will not be given if the activity was not performed.

Calculations:
Scores will be calculated in three separate ways:

1. Performance in the most recent period: the number of patients who met the indicator in the most recent period is divided by the total number of eligible patients.
2. Performance in all periods: the number of periods where the indicator was met in any applicable period is divided by the number of eligible review periods.
3. Performance over the entire review period: the number of patients who met the indicator in all applicable periods is divided by the entire number of eligible patients in the population.

Indicators

1. HIV-related Education

HIV-related education is provided monthly on at least one of the following topics:

• HIV disease and progression
• HIV transmission and infection control
• HIV disclosure and confidentiality

Yes: HIV-related education is provided in at least one of the three areas, during the review period.
No: No documentation that HIV-related education is provided during the review period.

2. Biopsychosocial Assessment

A complete biopsychosocial assessment, including physical exam, mental status, psychological assessment, and nutritional assessment is performed monthly.

Note: Performance on each of the four components of a biopsychosocial assessment is assessed separately.

Yes: Physical exam, and mental status, psychological, and nutritional assessments are performed during the review period.

Acceptable documentation for each area included the following:

• Physical Exam – OASIS assessment completed; or status of body systems documented.
• Mental Status Assessment – Alertness or orientation assessed; or total score on MMSE; or brief summary of findings on thought processes, emotions, and interpersonal qualities.
• Psychological Assessment – Mood or affect assessed; or summary of patient’s functional level; or coping resources and mechanisms assessed; or ability to deal with problems and lives/environment assessed.
• Nutritional Assessment – Nutritional assessment completed on the OASIS form; or nutritional assessment completed by clinician or worker.

No: No documentation in the record that physical exam, and mental status, psychological, and nutritional assessments, are performed during the eligible review period.

3. Home Health Care Needs

A. The patient is assessed every 60 days for need in the following home health areas:

Note: Adherence with each component is assessed separately.

• Durable medical equipment
• Therapies (physical, speech, occupational)
• Registered Dietician
• Home Health Aide or PCA
• Medical Social Worker

Yes: Patient is assessed within the eligible review period, for the need for durable medical equipment, therapies, dietician, home health aide or PCA, and medical social worker.
No: Need for durable medical equipment, therapies, dietician, home health aide, PCA, and medical social worker is not assessed during the eligible review period

B. Provision of services is documented within one week of assessment, if need in any of the above home health areas is identified.

Eligibility: The indicator is applied only if a need for a particular service was identified.

Yes: Service was provided within one week of assessed need.

No: Service was not provided within one week of assessed need.

4. Treatment adherence

Treatment adherence is discussed and measured every four months with the measured result recorded in the medical chart.

Eligibility: All patients on antiretroviral therapy.

Yes: Treatment adherence is discussed and measured during the eligible review period, with measured result recorded in the chart.
No: No documentation that adherence to medications is discussed and measured quantitatively during the eligible review period.

5. Adherence to Plan of Care

Patient’s adherence to plan of care is assessed and documented in the patient’s record at least monthly.

Note: Adherence with each of these three components of the plan of care is assessed separately.

Criteria to demonstrate adherence to plan of care is met with documentation in the patient’s chart of the following:

• Patient is or is not keeping MD appointments
• Patient is or is not following RN instructions
• Assessment of whether patient knows what plan of care is

Yes: Patient’s adherence to plan of care is assessed during the review period. Assessment components include: keeping MD appointments; following RN instructions; and knowledge of plan of care.
No: No documentation of an assessment during the review period.

6. Pain Management

A. Patient is assessed for pain monthly

Yes: Documentation that the patient is assessed for pain during the review period.
No: No documentation of pain assessment, or recording of result, during the review period.

B. Patients in pain receive pain management

Eligibility: Patients stating that they are in pain.

Yes: Pain management documented during the review period.
No: No pain management documented during the review period.

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?