A SPECIAL THANKS TO . . .

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A SPECIAL THANKS TO . . .

• All Bluegrass Care Clinic staff for filling out
  the educational needs assessment

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Upcoming KY AETC Events

• Fri. 02/13 KY State ReformatoryHIV The
  ElderlyKaren Krigger, MD
• Wed., 02/25 UK HG611 TeleconferenceHIV
  Clinical Case ConferenceCarl LeBuhn, MD

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Ryan White HIV/AIDSProgram Service Report

• Jana D. Collins, MS
• Program Coordinator

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Presentation Outline

• Out With The Old - Bye, Bye Aggregate Data
• In With the New The Who, What, When, and Where
  of Client Level Data
• Changes at the Bluegrass Care Clinic

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Out With The Old

• As of 2009 the Health Resources Services
  Administration (HRSA) is moving from aggregate
  data to Client Level Data

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Out With The Old

• Ryan White Providers
• Submitted annual data on the entire patient
  population served
• Included only summary data of the entire patient
  population (ie. of males/ of females)
• Reported on all Ryan White ELIGIBLE services

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Out With The Old

• Limitations of Aggregate Data
• Lacks client identifiers, therefore can not
  provide an unduplicated service population
  nationally
• Lacks detail per client type and can not assess
  quality of care,
• Can not account for the specific services
  provided by Ryan White funds

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In With the New

• In 2009 Ryan White providers will submit
  encrypted client level data to the federal
  government.
• Ryan White Providers will
• Submit data semi-annually for the patient
  population served using Ryan White funds
• Include a host of new client specific measures
• Report only on patients and services that use
  Ryan White Funded services

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In With the New

• The New Ryan White HIV/AIDS program Service
  Report will consist of three reports
• The Grantee Report
• The Service Provider Report
• The Client Report

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In With the New

• The Grantee Report this will provide
  information specific to the grantee organization
  (the official entity that receives funding
  directly from HRSA) and the service provider
  contracts funded during the reporting period

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In With the New

• The Service Provider Report will collect basic
  information about the service provider agency and
  the services delivered under each contract.
• ALL Third-party administrators that process
  fee-for-service reimbursements to providers of
  eligible services are considered a service
  provider and should report all services paid for
  with Ryan White Funds.

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In With the New

• The Service Provider Report, cont.
• This Means ALL service providers (vendors) will
  complete a report.
• This includes
• Off-site Specialty Care Providers
• Cab Companies
• Patient Assistant Programs (RX Outreach/Bioscript)

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In With the New

• The Client Report collects on de-identified
  record for each client served.
• Each record includes information on
• Demographic status
• HIV Clinical Information
• HIV-care medical/support services

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In With the NewClient Level Data Requirements

• Date of first visit
• Enrollment status
• Active, continuing in the program
• Referred to another program for services
• Removed from treatment due to violation of rules
• Incarcerated
• Relocated
• Deceased (date needed)
• Unknown
• Date of Birth

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In With the NewClient Level Data Requirements

• Ethnicity (Hispanic/Latino)
• Race (White, Black/African American, Asian,
  Native Hawaiian/Pacific Islander, American
  Indian/Alaska Native, Unknown)
• Current Gender (Male, Female, Transgender,
  Unknown)
• Transgender (Male to Female, Female to Male)
• Percent of Federal Poverty Level

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In With the NewClient Level Data Requirements

• Housing Status (Stable/Permanent, Temporary,
  Unstable, Unknown)
• Geographic Unit Code
• HIV/AIDS Status (HIV negative HIV, not AIDS
  HIV, AIDS status unknown CDC-defined AIDS HIV
  indeterminate (infants) Unknown
• Year of AIDS diagnosis is applicable

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In With the NewClient Level Data Requirements

• Risk Factor (MSM, IDU, Hemophilia/coagulation
  disorder, heterosexual, receipt of blood
  transfusion, perinatal transmission, other,
  unknown)
• All sources of health insurance (Private,
  Medicare, Medicaid, Other Public, No insurance,
  Other, Unknown

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In With the NewClient Level Data Requirements

• Number of Visits for each type
• Outpatient Ambulatory Care
• Oral Health Care
• Early Intervention Services (Part A and B)
• Home Health Care
• Home and community-based health services
• Hospice Services
• Mental Health Services
• Medical Nutrition Therapy
• Medical Case Management
• Substance Abuse Services

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In With the NewClient Level Data Requirements

• Did patient receive Local AIDS Pharmaceutical
  Assistance (not ADAP)?
• Was Health Insurance Program funding provide to
  this client?

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In With the NewClient Level Data Requirements

• Were the following support services provided
  (during each quarter)? (Yes, No, or Unknown)
• Non-medical Case Management
• Child care services
• Developmental assessment/early intervention
  services
• Emergency financial assistance
• Food bank/home delivered
• Health education/risk education
• Housing Services
• Legal Services
• Linguistic Services

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In With the NewClient Level Data Requirements

• Were the following support services provided
  (during each quarter)? (Yes, No, or Unknown)
• Transportation Services
• Outreach Services
• Permanency Planning
• Psychosocial Support
• Health care/supportive services
• Rehabilitation Services
• Respite Care
• Substance Abuse Services
• Treatment Adherence

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In With the NewClient Level Data Requirements

• Was HIV risk reduction screening/counseling
  provided to this client?
• Date of first outpatient/ambulatory care visit
• List of ALL dates of the clients outpatient
  ambulatory care visits in the HIV care setting
  with a clinical provider.
• ALL CD4 counts and their dates.
• All Viral Load counts and their dates.
• Was client prescribed PCP prophylaxis? (Yes No
  Not medically indicated No, client refused
  Unknown)

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In With the NewClient Level Data Requirements

• Was client prescribed HAART?
• Yes
• No, not medically indicated
• No, not ready (as determined by clinician)
• No, client refused
• No, intolerance, side-effect toxicity
• No, HAART payment assistance unavailable
• No, other reason
• Unknown

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In With the NewClient Level Data Requirements

• Was client screened for TB?
• If response is no or not medically indicated
  has the client been screened for TB since
  his/her HIV diagnosis.
• Was client screened for Syphilis during this
  reporting period?
• Was the client screened for Hepatitis B during
  this reporting period?
• If response is no or not medically indicated
  has the client been screened for Hepatitis B
  since his/her HIV diagnosis.

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In With the NewClient Level Data Requirements

• Has the client completed the Hepatitis B vaccine?
• Was the client screened for Hepatitis C during
  this reporting period?
• If response is no or not medically indicated
  has the client been screened for Hepatitis C
  since his/her HIV diagnosis.
• Was the client screened for substance use
  (alcohol and drugs) during this reporting period?

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In With the NewClient Level Data Requirements

• Was the client screened for mental health during
  this reporting period?
• Did the client receive a pap smear during this
  reporting period?
• Was the client pregnant during this reporting
  period?
• If yes, when did the client enter prenatal care
  (first trimester, second trimester, third
  trimester, at time of delivery, not applicable,
  unknown)?
• Was the client prescribed antiretroviral therapy
  to prevent maternal to child (vertical)
  transmission of HIV?

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Changes at the Bluegrass Care Clinic

• NEW FORMS (Part C)
• New required data fields
• Replaced written notes with check boxes
• Streamlined data collection and electronic
  translation

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Changes at the Bluegrass Care Clinic

• NEW FORMS (Part B Medical Documentation Form)

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Changes at the Bluegrass Care Clinic

• NEW Systems
• Data input is one day behind real time
• Patient charts are collected at the end of clinic
• Patient information is entered into LabTracker
  during the next business day.

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Down the Road

• Currently writing a grant application for
  Electronic Medical Record (EMR) at the Bluegrass
  Care Clinic
• Grant will provide funds for
• 10 desk top computers (patient rooms/doctor and
  provider areas)
• 3 mobile computers
• Customized physicians note reflecting grant data
  requirements
• Interface between UKs approved EMR Eclipsys and
  the BCCs LabTracker Database.

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Questions/Comments/Suggestions