TREATMENT ADHERENCE INDICATORS

12/05/2007

General Eligibility: All clients enrolled in the treatment adherence program for 4 consecutive months in the year of review.

Indicator 1: HIV Treatment 

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.

Indicator 2: Adherence to ARV therapy

Measure 2a:  Proportion of clients whose adherence to ARV therapy has been quantified and documented every 4 months.
(Eligibility: All clients active in the treatment adherence program for at least 4 consecutive months during the 12-month review period and on ARV therapy)
Measure 2b:  Proportion of clients whose chart includes documentation of whether the client is either adherent or not adherent.  Client adherence can be based on quantitative assessment or on the judgment of the care team and is documented every 4 months.
(Eligibility: All clients active in the treatment adherence program for at least 4 consecutive months during the 12-month review period and on ARV therapy)

Indicator 3: HIV Monitoring

Measure:  Proportion of clients who have CD4 and viral load testing every 4 months.
(Eligibility: All clients active in the treatment adherence program for at least 4 consecutive months during the 12-month review period

Indicator 4: Clinical stability based on CD4 and viral load laboratory values

Measure:  Proportion of clients who maintain stable clinical status during the review period based on their CD4 and viral load laboratory values. This measure is calculated by dividing the number of clients who maintained their stable clinical status for all three of the four-month periods of the year being reviewed (numerator) by the total number of eligible clients (denominator).

(Eligibility: All clients active in the treatment adherence program for all 12 months of the review period)

Indicator 5: Comprehensive barrier assessment completed

A comprehensive barrier assessment occurs at initial client contact (i.e., baseline) and at least every 4 months thereafter, with referrals made as necessary. Components of the assessment include the need for the following services:

Mental health
Medication access
Social support
Substance use, including alcohol
Housing
Financial support
Literacy issues
Transportation

Note: Performance for each of these  components will be assessed separately and in combination, and will be reported separately for clients by clinical status (i.e., stable and unstable)
Measure 5a:  Proportion of clients who have barriers to adherence assessed within 30 days of initial contact.
(Eligibility: All clients admitted to the treatment adherence program during the review period.)
Measure 5b:  Proportion of clients who have barriers to adherence reassessed at least every 4 months.
(Eligibility: All clients active in the treatment adherence program for at least 4 consecutive months during the 12-month review period)

Indicator 6: Treatment plan development 

A treatment plan is developed that is based on the needs identified in the barrier assessment. The treatment plan includes long- and short-term goals and clearly defined follow-up activities, such as referrals, and documentation of outcomes.

Measure 6a:  Proportion of clients for whom an initial treatment plan is developed within 30 days of program enrollment.
(Eligibility: All clients admitted to the treatment adherence program during the review period.)
Measure 6b:  Proportion of clients for whom an initial treatment plan is developed in collaboration with the client, the adherence counselor, and the clinician.
( Eligibility: All clients admitted to the treatment adherence program during the review period .)
Measure 6c:  Proportion of clients for whom communication about the treatment plan occurred among the client, the adherence counselor, and the clinician at least once within each 6-month period.
( Eligibility: All clients admitted to the treatment adherence program during the review period .)
Measure 6d:  Proportion of clients who had barriers to adherence reassessed at least every 4 months and had their treatment plan reviewed and adjusted if necessary.
(Eligibility: All clients active in the treatment adherence program for at least 4 consecutive months during the 12-month review period)
Measure 6e:  Proportion of clients for whom clearly defined follow-up activities to address barriers (e.g., nutrition counseling) are noted in the treatment plan.
(Eligibility: All clients active in the treatment adherence program during the 12-month review period who had any barrier assessed and noted)

Indicator 7: Side Effects Management

Arv-related side effects and their management are discussed every six months.
(Eligibility: All clients active in the treatment adherence program during the 12-month review period)

Indicator 8: Clients receiving treatment/health education and/or counseling

Measure:  Proportion of clients who are provided treatment education (individually and/or in a group setting) at least every 4 months on at least one of the following topics:

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 fit taking medications into daily schedule/routine (e.g., timing, food interactions)

(Eligibility: All clients active in the treatment adherence program for at least 4 consecutive months during the 12-month review period)

NEW Indicator 9: Coordination of services

Measure:  Proportion of clients for whom coordination of services (i.e., communication among/between clinical and non-clinical treatment adherence support staff) is documented at least every 4 months. 

(Eligibility: All clients active in the treatment adherence program for at least 4 consecutive months during the 12-month review period)

Indicator 10: Primary care access/retention

Measure 10a:   Proportion of clients with one visit with their primary care provider at least every 6 months.
(Eligibility: All clients active in the treatment adherence program during the 12-month review period)
Measure 10b:  Of clients who have not had a visit with their primary care provider in first or last 6 months of the calendar year, the proportion for whom there is documentation of referral to primary care provider.
(Eligibility: All clients active in the treatment adherence program during the 12-month review period)
Measure 10c:  Of clients who have been referred to their primary care provider the proportion for whom there is documentation of follow-up within 30 days of the referral to determine whether the primary care appointment was kept.
(Eligibility: All clients active in the treatment adherence program during the 12-month review period)
Note : Performance for each of these indicators/measures will be reported separately for clients by clinical status (i.e., stable and unstable). 

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