TITLE I HIV QUALITY MANAGEMENT PROGRAM

QUALITY PERFORMANCE INDICATORS FOR TREATMENT ADHERENCE

Review Eligibility:
Patients enrolled in the program for a minimum of 3 months.

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.

Applicability of Review Periods to Patients Reviewed: For three month indicators: In order to be reviewed for activities that should take place quarterly, the patient should have been in the program for a minimum of 3 months. For indicators where measurement occurs every 4, 6, or 12 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.

1. Treatment Education

Treatment Education is provided quarterly. At least one of the following topics is addressed.

• Interpretation of results from routine laboratory tests
• Management of side effects of ARV medications
• Importance of adherence and tools/techniques for maintaining adherence
• Resistance to ARV medications
• HIV disease process
• Instruction on how to take medications (timing/food interactions)

Patients Reviewed: All patients

Yes: Treatment education is provided on at least one of the topics listed above during the review period.
No: No documentation, during the review period, that education on at least one of the specified topics is provided.

2. HIV Treatment

A. The client is assessed for HIV antiretroviral treatment history at the initial visit.

Patients Reviewed: Patients are reviewed if they were admitted during the calendar year.

Yes: Documentation that the client is assessed for HIV antiretroviral treatment history at the initial visit.
No: No documentation of assessment for HIV antiretroviral treatment history at the initial visit.

B. The client’s HIV antiretroviral treatment regimen is assessed every 3 months.

Patients Reviewed: All patients on ARV medications.

Yes: Documentation that the patient’s HIV antiretroviral treatment regimen is assessed during the review period.
No: No documentation of assessment of the patient’s HIV antiretroviral regimen during the review period.

3. Initial Treatment Plan Development

A. The client, worker, and the clinician participate collaboratively in the development of the initial treatment plan.

Patients Reviewed: Patients enrolled during the review period.

Yes: The client, worker, and the clinician participated collaboratively in the development of the initial treatment plan.
No: No documentation that all three parties were involved in developing the initial treatment plan.

B. Communication between client, worker and the clinician about the treatment plan occurs at least once within each 6-month period.

Patients Reviewed: All patients are included.

Yes: Communication between the client, worker, and clinician about the treatment plan occurs during the review period.
No: Communication between the client, worker, and clinician about the treatment plan did not occur during the review period.

4. Adherence

Adherence to medications is assessed and described quantitatively every 4 months.

Patients Reviewed: Patients on ARV medications.

Yes: Documentation that adherence to medications is assessed and described quantitatively during the review period.
No: No documentation that adherence to medications is assessed and described quantitatively during the review period.

5. Assessment of Barriers to Treatment Adherence

The following barriers to treatment adherence are assessed every 3 months:

• Mental illness
• Medication access
• Primary care access

The following barriers to treatment adherence are assessed every 6 months:

• Lack of social support
• Substance use
• Inadequate housing

The following barriers to treatment adherence are assessed annually:

• Financial constraints
• Need for employment
• Need for transportation
• Need for home care

Patients Reviewed: All patients

Yes: Patient is assessed for the particular barriers, during the review period.
No: No documentation that the patient was assessed for the particular barriers, during the review period.

6. Side Effects Management

ARV-related side effects and their management are discussed every 6 months.

Patients Reviewed: Patients are included if they are on ARV antiretroviral medications.

Yes: Discussion of side effects and their management occurred during the review period.
No: Discussion of side effects and their management did not occur during the review period.

7. Continuity of Care

Assessment of whether patient is seeing his/her primary care provider occurs at least quarterly.

Patients Reviewed: All patients.

Yes: Documentation during the review period, that there was an assessment that the patient is seeing his/her primary care provider.
No: No documentation during the review period, that there was an assessment that the patient is seeing his/her primary care provider.

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?