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Based on input from key stakeholders,
HAB has created & released four (4)
sets of performance measures in the
areas of clinical care, medical case
management, oral health and AIDS Drug
Assistance Programs. These measures can
be used as defined or can be further
modified by the grantee to meet that
agency’s individual needs. Grantees are
encouraged to select measures that are
most important to their agencies and
the populations they serve. The
measures can be used by the Ryan White
HIV/AIDS Program, either at the
provider or system level. A brief
overview of each set is provided below.
| MEASURES |
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HAB HIV/AIDS Core Clinical
Performance Measures |
The HAB HIV/AIDS Core Clinical
Performance Measures for
Adults & Adolescents are
offered as a set of indicators
for use in monitoring the
quality of care provided.
Grantees are encouraged to
include the core clinical
performance measures in their
quality management plans. The
clinical performance measures
all are categorized into three
groups.
Group 1 measures provide an
excellent start and can serve
as a foundation on which to
build, especially if a
clinical program has no
performance measures.
Group 2 measures are important
measures for a robust clinical
management program and should
be seriously considered.
Group 3 measures represent
areas of care that are
considered "best practice,"
but may lack written clinical
guidelines or rely on data
that are difficult to collect.
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Medical Case Management
Performance Measures
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The
Medical Case Management
Performance Measures target
all clients, regardless of age
and focus on two key issues:
care plans and medical visits.
Medical case management
programs are encouraged to
utilize the core clinical
performance measures as
appropriate.
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Oral Health Performance Measures
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The
Oral Health Performance
Measures target all clients. The
measures are intended for use
by programs providing direct
oral health services.
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ADAP Performance Measures
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The
AIDS Drug Assistance Program
measures are intended for use
by the ADAP. Four (4) measures
are included and target all
clients, regardless of age.
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Use of Measures
While performance measure data are not
required to be submitted to HAB,
grantees are strongly encouraged to
track and trend data on the measures
to monitor the quality of care
provided. Grantees are encouraged to
identify areas for improvement and to
include these in their quality
management plans. This type of
information can provide rich
discussion opportunities with HAB
Project Officers.
Technical Assistance
To assist grantees in the use and
implementation of the performance
measures, two reference guides have
been developed:
Both documents will be updated as
necessary.
HAB is extremely interested in
receiving feedback regarding the
performance measures, particularly as
it relates to the use of the measures.
If you have any information you would
like to share in regards to the
utility, suggestions for improvement or
examples of how the information has
been used, please send an e-mail to
HIVmeasures@hrsa.gov.
For questions related to broader
topics on quality management and the
Ryan White HIV/AIDS Program, please
refer to Developing an Effective
Quality Management Program in
Accordance with the Ryan White HIV/AIDS
Treatment Modernization Act of 2006:
Frequently Asked Questions.
Related Performance Measures
Additional measures that grantees may
find helpful can be found at:
National Quality Measures Clearinghouse
National Quality Center
HIVQUAL Project-US
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The following questions related to the ADAP, medical case management and oral health performance measures
have been frequently asked and the corresponding answers are detailed in a companion guide.
Download the
Complete Document (PDF 176KB).
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ADAP Performance Measures |
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Application Determination |
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1. |
Should a wait list be considered when using the ADAP Application Determination measure? |
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2. |
How should applications submitted during the last two weeks of the measurement year be handled? Are they included in the subsequent measurement year? |
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3. |
What is considered a "complete application" for enrollment in the ADAP? |
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Eligibility Recertification |
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1. |
Is there a difference between reviewing a client for eligibility and "recertifying" a client for ADAP? |
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2. |
What type of documentation is needed for recertification? |
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3. |
Why is the timeframe for recertification 150 days? |
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Formulary |
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1. |
Why are the PHS Guidelines for the Use of Antiretroviral Agents published in the last 90 days of the measurement year excluded from the sample? |
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2. |
What if there are no new classes of drugs included in the PHS Guidelines during the measurement year? |
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Inappropriate Antiretroviral Regimen Components Resolved by ADAP |
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1. |
How can ADAPs identify inappropriate ARV regimen components? |
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2. |
Our ADAP provides only insurance coverage for prescriptions. How do we implement this measure? |
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3. |
How do we document that the ADAP reviewed and resolved the inappropriate regimen? |
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4. |
What criteria should we use to determine if an exception is adequately justified? |
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5. |
The exclusion criterion indicates ADAP is responsible only for the ARV medications funded by ADAP. Show we consider other information if we have it? |
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6. |
Shouldn't the denominator include all ADAP ARV prescriptions? Why is this limited only to those with inappropriate antiretroviral regimen or components? |
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Medical Case Management Performance Measures |
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Care Plan |
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1. |
What are the recommended or required components of a medical case management care plan? |
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2. |
What if the medical case management care plan didn't need to be updated? |
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3. |
Are clients required to indicate their acceptance and/or review of their medical case management care plan? |
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4. |
Is a medical case management care plan required for clients receiving "low intensity" medical case management services or for patients with lower acuity? |
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5. |
Do the outcome measures apply only to patients receiving medical case management services, or can they be used for the broader HIV/AIDS patient population? |
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Medical Visits |
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1. |
What type of documentation in the medical case management record of a patient's medical visit is acceptable? Is self-report acceptable? |
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2. |
Why does the medical case management medical visit measure focus on the case manager's documentation, rather than on the services that the patient needs and receives? |
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Oral Health Performance Measures |
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1. |
Within the Ryan White community, which providers should use the oral health performance measures? |
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2. |
How should we use the American Dental Association Current Dental Terminology (ADA CDT) billing codes? |
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3. |
How can the data be collected if ADA CDT Code data are not available for a specific procedure or if the oral health provider does not use ADA CDT Codes for billing or documentation purposes? |
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Phase I Dental Treatment Plan Completion |
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1. |
What should be included in a Phase I Treatment Plan? |
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2. |
What if we don't have the clinical capacity/resources to complete the Phase I treatment plans? |
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3. |
What if the treatment plan changes during the course of the year due to increasing complexity or patient needs? Should we readjust the 12 month initiation date of the treatment plan? |
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4. |
Should the dental treatment plan and the Phase I dental treatment plan performance measures be used together? |
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