Needs Assessment

1. Needs Assessment Data Analysis and Application Nancy Warren, MPH nancy.warren@ucsf.edu 415-597-9287

2. Learning Objectives • Re-acquaintance with use of different measures (numbers, rates, %, etc) for needs assessment • Interpretation and summary of these measures • Integrating qualitative and quantitative data

3. Needs Assessment Context: One Model --PAETC

4. Programs ISSUE(S) RESPONSE RESULTS Program rationale Program activities Program outcomes (needs assessment)(work plan) (evaluation) Evidence?Evidence?Evidence?

5. Shift in Needs Assessment Strategy • Traditional: Survey of membership/related organizations and clinicians: what do they want? • Current: • Focus on interpretation of existing datasets: where are the needs and gaps? What needs to be improved? • Limited collection of key informant data

6. Needs Assessment Strategy Approach: (evidence based) • Epidemiology (local and regional) • Clinical Indicator data (local hospitals/clinics) • Qualitative data (key informant interviews/focus groups) • Benefit programs (ADAP; Medicaid) Two tiered focus Outcome oriented: (HRSA guidelines) • based on Ryan White Program indicators

7. What do we base this on?

8. Who are Target population: HIV providers from minority communities Big 6 MDs Nurses Nurse Practitioners Physician Assistants Pharmacists Dentists and hygienists Who serve Clinics/Hospitals Ryan White Other clinics Target population: HIV patients Minority pts Homeless pts Incarcerated pts Who work at Who serve Build Capacity Train Pacific AETC Improve adherence to DHHS guidelines Group 1 Measures Antiretroviral Therapy for Pregnant Women Antiretroviral Therapy CD4 T-Cell Count Medical Visits PCP Prophylaxis Group 2 Measures Adherence Assessment and Counseling Cervical Cancer Screening Hepatitis B Vaccination Hepatitis C Screening HIV Risk Counseling Lipid Screening Oral Exam Syphilis Screening TB Screening HRSA Indicators (proxy=HIVQUAL measures) Improve patient outcomes HIV+ patient indicators Decrease mortality Decrease time btwn testing + and AIDS diagnosis Increase quality of life

9. Needs Assessment Answers Questions About: Target population Purpose of training/education/capacity development Program design

10. I. Target Population 1. Where is the target population? Of patients? (source: epidemiology, hospital/clinic data; CHIS) Of providers? (source: hospital/clinic data) Of clinics/hospitals? (source: hospital/clinic data) 2. Who is the target population? (demographics, epi data, workforce data) 3. Do you currently serve the AETC target population? (source: PIF data) Clinicians/clinics who work in Ryan White funded clinics/hospitals Clinicians/clinics who serve HIV+ clients and work in areas serving minority pts Clinicians/clinics who work in areas serving minority pts.

11. II. Train/educate/capacitate to what end? • What education, training or capacity strengthening does your target population (providers/clinic) need? • Where is your target population re: indicators*? • How do your trainings correspond to these indicators and the clinic results for these indicators? • *source: clinic/hospital data, HIVQUAL data

12. Visit Every 4 Months Visit Every 6 Months CD4 Count Every 4 Months CD4 Count Last 4 Months Viral Load Last 4 Months Viral Load Every 4 Months ARV Management Stable ARV Management Unstable Adherence Assessment HAART CD4 < 200 HAART Viral Load > 100K PCP Prophylaxis TB Testing Pelvic Exam Mental Health Substance Use Tobacco Use Hepatitis C Screening Syphilis Screening Dental Examination Lipid Profile Ophthalmology Care Pneumococcal Vaccine General HIV Education HIVQUAL indicators

13. Support Documents: gathering info • “How to” data and epidemiology workbook (handout) • Key resources: • Local HIV Services Planning Council • Local Health Dept • Related data sources (STD, TB, etc) • List of additional data resources and locations

14. We have found our data, but what does it mean?

15. All measures are not created equally • Number – raw number of cases • Percent – % of total cases • Rate – based on population (denominator) usually represented per 100,000

16. Which measure would you use? HIV incidence in No Name county for 2008 † Rates are per 100,000 population.

17. Which measure would you use? HIV/AIDS prevalence in No Name county for 2008 † Rates are per 100,000 population.

18. What information are we missing? • Race/ethnicity • Gender (including Transgender) • Age • Sexual orientation • Exposure category • Trends over time

19. Who has the greatest problem? HIV incidence by race in No Name county for 2008 † Rates are per 100,000 population.

20. How will we discuss these data? Prevalence in No Name county † Rates are per 100,000 population.

21. Data interpretation: Exercises 1-2 What states would you rank highest for AIDS infection among Latino (Hispanic) people?

22. Data interpretation: Exercise 3 Interpret data from a state. Identify important locations, demographics and translate this into 3 statements.

23. What do you do when you receive qualitative data, i.e. focus group and key informant interviews? • Balance it with quantitative data • Add it on to the quantitative data • Use it to interpret quantitative data

24. Key Informant format • Identify interviewees • Conduct interviews (preferably in person) with one other person (to take notes) and be your second “ears” • Enter into survey monkey type application (central office created)

25. Integrate Qualitative and Quantitative Data: Exercise 4 • Results from your qualitative data are in…

26. How did you weigh key informants and their comments?

27. Clinical Indicators Regional (HIVQUAL) LPS level: (health dept, local clinics and hospitals) Target population Your own PIF data! PIF data on prevalence incidence maps Other sources

28. PAETC Training Participant data(work zip-in blue)

29. PAETC Training Participant data(work zip-in blue)by county level living AIDS cases (2008)

30. LPS questions/consults

31. Thank you!