assessing & improving quality of care newly developed quality of care tools president’s...
Post on 20-Jan-2016
218 Views
Preview:
TRANSCRIPT
Assessing & Improving Quality of Care
Newly Developed Quality of Care Tools
President’s Emergency Plan for AIDS ReliefTrack 1.0 ART Program Meeting
Seema Meloni, PhD, MPHAssistant Country Director, Harvard PEPFAR Nigeria
25 September 2007
Harvard PEPFAR Nigeria
Two Tools for Improving Care Quality Improvement
Treatment Response Utility: “Snapshot” of patient
Quality Assessment Site Assessment Database
Quality Improvement
Harvard PEPFAR Nigeria
Overview: Database System Electronic capture
of patient data from program inception
Data captured for Adult, Pediatric, and PMTCT program areas
Pre-
assessment
Entry
ARV naïve
ARV experienced
ART eligible
ART ineligible Palliative
Care
Visit
Lab
Pharmacy
ART eligible
Discontinue ToxicityFailure
VCT
Harvard PEPFAR Nigeria
Paper
records
Daily entry at program sites;
Merged & cleaned weekly
Uploaded to Server
Paper record placed in
patient chart
Best clinical management of
patients
Reports
Reports
Projections
Program Evaluations (QA)
Downloaded in Boston; merged
and reviewed
Treatment Response
Utility
Harvard PEPFAR Nigeria
Treatment Response UtilityGoal: Improve treatment process by providing clinicians quick and easy access to patients’ treatment-related data
Patient ID #
Quality Assessment
Harvard PEPFAR Nigeria
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
Harvard PEPFAR Nigeria
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
Harvard PEPFAR Nigeria
Site Assessment Indicators 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)
Harvard PEPFAR Nigeria
Site Assessment DatabaseBasic 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
Harvard PEPFAR Nigeria
Chart Review & Data EntryClick 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
Harvard PEPFAR Nigeria
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
Harvard PEPFAR Nigeria
Innovative AdditionsRed flags indicating possible virologic failure Calculator for 6- and 12-month CD4 & VL
Layout that provides data summary
Harvard PEPFAR Nigeria
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
Thank you
top related