An Introduction to Performance
Measurement for Quality
Improvement
Quality
Institute #1:
Performance Measurement
for Quality—How to Get
Started to Measure Quality
at My HIV Program
Session 2
Presenters: Lori DeLorenzo, Marlene
Matosky & Benjamin Harris
Wednesday, November 28, 3:30-5:00 pm
Virginia C
RWA-0239
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NQC and Quality Workshops at 2012 AGM
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NQC at 2012 AGM
• Networking Opportunities Interact with your peers…
• Tue, Nov 27 12pm: HIVQUAL
Regional Group– Thurgood Marshall
Ballroom West
• Wed, Nov 28 12pm: in+care Campaign
- Thurgood Marshall Ballroom South
• NQC Exhibit Booth - Stop by our
booth…
• NQC Office Hours - Meet one of
our NQC coaches...
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Who’s in the Audience?
• Part
• Role
• Experience with Performance Measurement
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Most Pressing Performance
Measurement Question?
• What are you struggling with the most as it relates to
performance measurement?
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Learning Objectives
• Understand the balance of performance measurement and
quality improvement activities
• Identify and implement key performance measurement steps
• Understand the purpose, definitions, and expectations of the
quality measures released by the HIV/AIDS Bureau
• Learn how to access existing resources on performance
measurement
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Key Question
Why is measurement so important
to quality, and how does
measurement support quality
improvement?
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Pop Quiz
How many people were estimated to be living with
HIV in the United States in the year 2010?
18,000
43,000
929,000
1,200,000
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Answer: About 1,200,000
• This is a measure.
What can we do with this measure?
• Estimate resources
• Make predictions
• Epidemic getting better?
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Why Measure?
It’s very simple:
“You can’t improve what you can’t measure!”
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Measurement and Quality Improvement are Interlinked
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What is a Quality Measure?
A quality measure is a tool to assess specific aspects of
care and services that are linked to better health
outcomes while being consistent with current
professional knowledge and meeting client needs.
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Measures Can Be Both…
• Outcomes
• The end result
• The effect on the individual or the population
• Processes
• The actions taken to produce the outcome
• The procedures for achieving the best outcomes
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Examples of Outcomes Include:
• Patient Health Status
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•
•
•
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Viral load suppression
Intermediate outcomes like immune & virological status
Disability
The patient’s own sense of his/her quality of life
Hospital and ER visits
• Patient Satisfaction
• Public Health Outcomes
• Retention in Care
• Access to Care
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Range of Performance Measures Available
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HRSA HIV/AIDS Bureau (HAB)
HHS HIV Measures
National Quality Forum (NQF)
National Quality Center (NQC)
In+care Campaign
HIVQUAL
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HAB Performance Measures
www.hab.hrsa.gov/deliverhivaidscare/habperformmeasures.html
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Clinical (Groups 1-3)
Medical Case Management
Pediatrics
Oral Health
ADAP
Systems-level
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http://blog.aids.gov/2012/08/secretary-sebelius-approvesindicators-for-monitoring-hhs-funded-hiv-services.html
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Measure
Numerator
Number of HIV positive tests in the
HIV Positivity
12-month measurement period
Number of persons with a diagnosis of
Late HIV
Stage 3 HIV infection (AIDS) within 3
Diagnosis
months of diagnosis of HIV infection
in the 12-month measurement period
Linkage to
Number of persons who attended a
HIV Medical routine HIV medical care visit within 3
Care
months of HIV diagnosis
Number of persons with an HIV
diagnosis who had at least one HIV
medical care visit in each 6 month
Retention in
period of the 24 month measurement
HIV Medical period, with a minimum of 60 days
Care
between the first medical visit in the
prior 6 month period and the last
medical visit in the subsequent 6 month
period
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Denominator
Number of HIV tests conducted in the
12-month measurement period
Number of persons with an HIV
diagnosis in the 12-month measurement
period
Number of persons with an HIV
diagnosis in 12-month measurement
period
Number of persons with an HIV
diagnosis with at least one HIV medical
care visit in the first 6 months of the
24‐month measurement period
Measure
Numerator
Antiretroviral
Therapy
Number of persons with an HIV
(ART) Among diagnosis who are prescribed ART in
Persons in HIV the 12-month measurement period
Medical Care
Viral Load
Suppression
Number of persons with an HIV
Among
diagnosis with a viral load <200
Persons in
copies/mL at last test in the 12–month
HIV Medical measurement period
Care
Number of persons with an HIV
diagnosis who were homeless or
Housing Status
unstably housed in the 12-month
measurement period
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Denominator
Number of persons with an HIV
diagnosis and who had at least one HIV
medical care visit in the 12-month
measurement period
Number of persons with an HIV
diagnosis and who had at least one HIV
medical care visit in the 12-month
measurement period
Number of persons with an HIV
diagnosis receiving HIV services in the
last 12 months
HRSA/CDC Found
Suitable for NQF Endorsement
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•
•
•
Medical visit frequency
Gap in medical care
Prescribed HIV antiretroviral therapy
Viral load suppression
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Useful at Many Levels of HIV Care
• To align the work on the different Ryan White
Program Parts
• At the system level
• At the provider level
• Within a program’s quality management plan
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HAB Does Not Require Grantees to Use These Measures
But it strongly urges you to use the measures to:
• Track and trend performance
• Identify areas for improvement
• Strengthen quality management plans
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Key Question
What should we be measuring to assess
and improve the quality of our HIV
care and services?
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Selecting & Prioritizing Measures
Consider the following:
• Epidemic
• Population served
• Primary modes of
transmission
• Change in trends
• Subpopulations
affected
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Race/ethnicity
Gender
Age
Risk factors
Culture
• Influencing Factors
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Balanced Measures
• 1 or 2 measures are not sufficient
• Consider the purpose of the measures
• Primary focus of your program will impact the set of
measures selected
• State or region-focus vs. stand alone clinic
• Support services program vs. clinical program
• Consider different types of indicators
• Process vs. outcome
• Access, coordination, screening, prophylaxis, etc.
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Erie Family Health Center: Lending Hands for Life
Humboldt Park, Chicago, IL
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Considerations for Data Collection
• Create a performance measurement plan
• Who, what, where, when & why
• Sampling—use only when absolutely necessary
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Establish Accountability for Data Collection
& Ensure Data Integrity
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DATA COLLECTION: Process
Erie Family Health Center
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Notify providers
Select and confirm measures
Define timeframe
Run custom Crystal Reports
Export to Excel for translation and interpretation
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DATA COLLECTION: Challenges
Erie Family Health Center
• Open charts
• Variation in documentation
• New EMR forms
• Updating and troubleshooting Crystal Reports
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You’ve Got the Data—Now What?
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Translation & Interpretation
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Erie Family Health Center
Lending Hands for Life
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Erie Family Health Center
Lending Hands for Life
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Breaking Down the Data
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What stands out to you?
Any immediate red flags?
What trends do you see?
What are the areas of priority?
What would teams do with the data?
What additional questions do we need to ask?
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Erie Family Health Center
Lending Hands for Life
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Use the Data to Guide your Improvement
Work
Look at the data
• Doing well, or not?
• Performance stable, or a trend?
• Compared to other grantees?
Decide how to act
on the data
• Which areas need improvement?
• What are our priorities for
improvement?
Begin
improvement work
• Identify project team
• Define improvement goal
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NQC Offerings
NQC Website
HIVQUAL
Regional Groups
in+care Campaign
Quality Academy
On-Site TA
NQC Trainings
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NQC Resources
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Performance Measurement Resources
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Performance Measurement Resources
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Quality Academy
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Marlene Matosky, MPH, RN
Nurse Consultant/Quality Advisor
HRSA HIV/AIDS Bureau
[email protected]
301-443-0798
Lori DeLorenzo, RN, MSN
NQC Consultant
National Quality Center (NQC)
Benjamin Harris
Quality Improvement Analyst
Erie Family Health Center
National Quality Center
212-417-4730
NationalQualityCenter.org
[email protected]