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Enhancing Treatment Adherence: Performance Review and Quality Management Insights

This report presents performance review findings from the Treatment Adherence Quality Workshop held on February 26, 2009. It details data collection strategies, sampling plans, and the evaluation of 21 Part A programs across NYC and Tri-county areas. Key performance indicators regarding adherence to Antiretroviral (ARV) therapy are assessed, highlighting critical areas for improvement. The report emphasizes the need for better integration with clinical services, improved documentation, and training of staff. It concludes with actionable insights for increasing patient adherence and enhancing program quality.

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Enhancing Treatment Adherence: Performance Review and Quality Management Insights

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  1. Part A Treatment Adherence Performance Review Data Report Part A Quality Management Program Treatment Adherence Quality Workshop Thursday, February 26th, 2009

  2. Review Background Data collection strategy developed Sampling plan derived from facility case size Records reviewed by professional analysts at each site (NYCHSRO) Data scored according to indicator specs Aggregate and facility specific reports produced

  3. Performance Reviews • 21 Part A Programs Reviewed (NYC and Tri-county) • 1002 total patients • For 11 sites--initial adherence review • New set of performance indicators used • Clinically based indicators • Review Eligibility: Those patients enrolled for 4 consecutive months in 2007

  4. Considerations in reviewing this data • Initial use of these indicators-do they reflect Part A Treatment Adherence program activities? • Assumption in indicators of integration with clinical programs • Note variable frequency and sample sizes in reports

  5. Using Performance Measurement • Prioritizing areas for improvement • Identification of common issues through performance data • Measuring progress • Benchmarking and goal setting

  6. Review Aggregates-ARV • ARV Status Assessed 302 37.4% (every 6 months, n=807) • ARV Regimen Assessment every 3 months (patients on ARV, n=785)169 21.5% • Adherence to ARV 245 31.2% every 4 months (patients on ARV, n=785)

  7. Treatment Education • Comprehensive Barrier Assessment New admits, in 30 days, n=578 121 21% • Treatment Education Every 4 months, n=1002 238 23.8% • Side Effect Management Every 6 months, n=646 220 34%

  8. Lab Assessment • CD4 testing: Every 6 months (n=807)40950.7% Every 4 months (n=1002) 25125.1% • Viral Load testing: Every 6 months (n=807) 443 54.9% Every 4 months (n=1002) 276 27.5%

  9. Primary Care Access • Primary Care Visit every 6 months, n=807 478 59.2% • Referrals for those with no Primary Care visit 0

  10. Program Management • Treatment Plan Developed (new admits, active 4 months, n=578) 13122.6% • Coordination of Services 105 10.5% (every 4 months, n=1002)

  11. Coping with Data Results • Anger: “The data are wrong….” • Denial: “The data are right, but it’s not a problem…” • Bargaining: “The data are right, it’s a problem, but it’s not my problem…” • Acceptance: “The data are right, it’s a problem, it’s my problem…” • And then take action

  12. Concerns • Obviously, concern with review scores • Low scores across all providers, whether CBO, Hospital, or Community Clinic • Disconnect between indicators and adherence program services • Identified documentation issues • Relationship between Part A programs and clinical services

  13. For Your Program • Review your individual data results • Understand reasons for data scores • Make changes as needed…think about your systems • Do your charts reflect everything you do for your patients? • Improve documentation and train staff • Increase involvement with clinical services

  14. TAQLN Learning Network • Focus on linking data reviews to quality improvement activities • Working together in Learning Network to identify performance priorities

  15. Questions?

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