TITLE I HIV QUALITY MANAGEMENT PROGRAM

Directly Observed Therapy for Tuberculosis (DOT)
Directly Observed Preventive Therapy for Tuberculosis (DOPT)

Eligibility:
Patients enrolled in the program for a minimum of one 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 year, to the date of discharge.

Calculations:
For monthly indicators: The patient should have been in the program for a minimum of one month. If the patient was enrolled for a shorter period of time, 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.

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. Initiation of Directly Observed Therapy

Eligibility: All DOT and DOPT clients

A. Initiation of Directly Observed Therapy (DOT) for patients with TB infection within 48 hours of patient’s referral to the program, or discharge from the hospital, whichever comes later.
Yes: DOT initiated within 48 hours of patient’s referral to the program or discharge from the hospital.
No: No documentation that DOT was initiated within 48 hours of patient’s referral to the program or discharge from the hospital.

B. Initiation of Directly Observed Preventive Therapy (DOPT) for clients exposed to TB within 48 hours of patient’s referral to the program.
Yes: DOPT initiated within 48 hours of patient’s referral to the program.
No: No documentation that DOPT was initiated within 48 hours of patient’s referral to the program.

2. Medication Documentation

Eligibility: All DOT and DOPT clients

• Documentation of all medications, including TB medications and others, noted in the client’s record on a monthly basis.

Yes: TB medications and other medications are noted in the record during the review period.
No: No documentation of TB and other medications noted in the record during the review period.

3. Appointment Adherence

Eligibility: All DOT and DOPT clients

• Adherence to appointments measured quantitatively every month

Yes: Adherence to appointments is measured quantitatively during the review period.
No: No documentation that adherence to appointments is measured quantitatively during the review period.

4. Patient Education

Eligibility: All DOT and DOPT clients

Monthly patient education provided on one of the following topics:

• Importance of adherence to medications
• Disease process / transmission
• Importance of medical follow-up

Yes: Patient education on one of the listed topics was provided during the review period.
No: No documentation that patient education was provided during the review period.

5. Client Outreach and Tracking

Eligibility: All DOT and DOPT clients

• Attempt to contact client initiated within 24 hours after a missed appointment.

Yes: Attempt is made to contact client within 24 hours after a missed appointment. The attempt may be by telephone, mail or in-person visit.
No: No documentation of attempt to contact client within 24 hours after a missed appointment.

Eligibility: All DOT clients

A report filed with the NYCDOH for tracking/detection purposes within 30 days after 2 weeks of loss of contact patient.

Yes: A report is filed with the NYC DOH for tracking / detection purposes within 30 days after loss of contact.

No: No documentation that a report is filed with the NYC DOH for tracking / detection purposes within 30 days of loss of contact.

6. Primary Care

Eligibility: All DOT clients

• Monthly visits to the primary care provider

Yes: Monthly visit to the primary care provider during the review period.
No: No documentation of primary care provider visits during the review period.

Eligibility: All DOPT clients

• Monthly visits to the primary care provider for two (2) months after initiation of therapy.

Yes: Monthly visits to the primary care provider during the review period
No: No documentation of primary care provider visits 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?