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Assessing & Improving Quality of Care Newly Developed Quality of Care Tools

Assessing & Improving Quality of Care Newly Developed Quality of Care Tools. President’s Emergency Plan for AIDS Relief Track 1.0 ART Program Meeting Seema Meloni, PhD, MPH Assistant Country Director, Harvard PEPFAR Nigeria 25 September 2007. Two Tools for Improving Care.

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Assessing & Improving Quality of Care Newly Developed Quality of Care Tools

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  1. Assessing & Improving Quality of CareNewly Developed Quality of Care Tools President’s Emergency Plan for AIDS Relief Track 1.0 ART Program Meeting Seema Meloni, PhD, MPH Assistant Country Director, Harvard PEPFAR Nigeria 25 September 2007

  2. Two Tools for Improving Care • Quality Improvement • Treatment Response Utility: “Snapshot” of patient • Quality Assessment • Site Assessment Database

  3. Quality Improvement

  4. Overview: Database System VCT • Electronic capture of patient data from program inception • Data captured for Adult, Pediatric, and PMTCT program areas Visit ART ineligible Pre- assessment Palliative Care ARV naïve ART eligible Lab ART eligible Entry ARV experienced Pharmacy Discontinue Failure Toxicity

  5. Best clinical management of patients Paper records Paper record placed in patient chart Reports Daily entry at program sites; Merged & cleaned weekly Treatment Response Utility Reports Downloaded in Boston; merged and reviewed Projections Uploaded to Server Program Evaluations (QA)

  6. Patient ID # Treatment Response Utility Goal: Improve treatment process by providing clinicians quick and easy access to patients’ treatment-related data

  7. Quality Assessment

  8. Evolution of Internal QA Program • JSI Quality Assessments at 3 sites • Informal quality improvement efforts through ongoing monitoring of site progress and visits from clinical officers • Internal development of a quality assessment protocol • Technical assistance on indicator selection provided by JSI • Full assessment: 3 sites (different from JSI QA) • Follow-up assessment on 1 site previously assessed by JSI

  9. Site Assessment Goals • Assess quality of care provided to HIV/AIDS patients • Identify strengths and weaknesses in clinical processes/systems • Evaluate health outcomes of patients as related to clinical processes • Promote accountability for patient care • Facilitate the process of joint problem identification and solving

  10. Informed consent coverage CTX coverage TB screening coverage Lab data % Charts missing values Toxicity % patients with panic values % patients with appropriate clinical response(s) CD4 and Viral Load % patients with values at baseline, 3, 6, and 12 months % patients with CD4>200 and/or suppressing viral load at 6 and 12 months Treatment failure % patients in failure at 6 and 12 months % patients with appropriate clinical response(s) Site Assessment Indicators

  11. Site Assessment Database • Basic procedure: • Random sample of patient IDs selected from master databases. SA database preloaded with data from master Entry, Lab, Pharmacy, and Visit databases • Database taken to site; data in charts compared to data loaded into SA database • In addition, evaluate a few additional indicators to further evaluate quality of patient care

  12. Chart Review & Data Entry Click through tabs to access data for various indicators Data in unshaded fields are pulled from master files in Boston Fields shaded in yellow are meant for SA team to enter notes Pulled from Tx Response Utility

  13. Chart Review & Data Entry • Electronic tool makes it easy for on-site analyses • Jump to analysis screen and “find” all records that address given indicator

  14. Red flags indicating possible virologic failure Calculator for 6- and 12-month CD4 & VL Layout that provides data summary Innovative Additions

  15. Tools Have Improved Quality & Efficiency • Treatment Response Utility • Minimizes time clinician must spend reviewing patient charts • Provides evaluation of adherence and treatment failures • Will be adapted and used for transfer patients - allows for continuity of care • Site Assessment Database • Has sped up process of site assessments and allows us to evaluate our program more in-depth • Allows for detailed debriefing the day after chart review is complete • Can be used by sites for their own QA/QI initiatives

  16. Thank you

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