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NAP Clinical and Financial Performance Measures Technical Assistance Call Overview of the Clinical Performance Measures September 23, 2010 Candace Kugel, FNP, CNM, MS BPHC Clinical Consultant. Objectives. - PowerPoint PPT Presentation
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NAP Clinical and Financial Performance Measures Technical Assistance Call
Overview of the Clinical Performance Measures
September 23, 2010
Candace Kugel, FNP, CNM, MSBPHC Clinical Consultant
Objectives
• Identify the clinical performance measures for the New Access Point (NAP) grant application
• Describe how the clinical performance measures forms should be completed
• Identify data resources to support the clinical measures
Six Required Clinical Performance Measures
• Outreach/Quality of Care Indicators
– Percentage of pregnant women beginning prenatal care in first trimester
– Percentage of children with 2nd birthday during the measurement year with appropriate immunizations.
– Percentage of women age 21-64 who received one or more Pap tests during the measurement year or during the two years prior to the measurement year.
Six Required Clinical Performance Measures
• Health Outcomes and Disparities
– Percentage of births less than 2,500 grams to health center patients.
– Percentage of adult patients with diagnosed hypertension whose most recent blood pressure was less than 140/90
– Percentage of diabetic patients whose HbA1c levels are less than or equal to 9 percent
• See HRSA NAP website and UDS manual for measure details and caveats
Additional Clinical Measures
• Required two additional measures
– One Oral Health
– One Behavioral Health
• Optional measures
– Grantee may add additional measures – especially those which permit it to follow through on previously selected clinical performance measures
– Measures that address unique needs of special populations (migrant, homeless, public housing)
Clinical Measure ≠ Clinical Guideline
• Clinical measure =
– a tool for measuring performance
– quantifiable
• Clinical guideline =
– detailed protocol for management of a particular healthcare condition
Clinical Performance Measures Format
OMB No.: 0915-0285. Expiration Date: 08/31/2010
FOR HRSA USE ONLY
Grant Number Application Tracking Number
DEPARTMENT OF HEALTH AND HUMAN SERVICES Health Resources and Services Administration
CLINICAL PERFORMANCE MEASURES
Project Period Date Focus Area: Diabetes
Performance Measure: Percentage of diabetic patients whose HbA1c levels are less than or equal to 9 percent Is this Performance Measure Applicable to your Organization? [_] Yes [_] No Target Goal Description Numerator Description Number of adult patients age 18 to 75 years with a diagnosis of Type 1 or Type 2 diabetes
whose most recent hemoglobin A1c level during the measurement year is <= 9%, among those patients included in the denominator.
Denominator Description Number of adult patients age 18 to 75 years as of December 31 of the measurement year with a diagnosis of Type 1 or Type 2 diabetes, who have been seen in the clinic at least twice during the reporting year and do not meet any of the exclusion criteria
Baseline Data Baseline Year: Measure Type: Numerator: Denominator:
Projected Data (by End of Project Period)
Data Source & Methodology Key Factor and Major Planned Action #1 Key Factor Type: [_] Contributing [_] Restricting [_] Not Applicable
Key Factor Description: Major Planned Action Description:
Key Factor and Major Planned Action #2 Key Factor Type: [_] Contributing [_] Restricting [_] Not Applicable Key Factor Description: Major Planned Action Description:
Key Factor and Major Planned Action #3 Key Factor Type: [_] Contributing [_] Restricting [_] Not Applicable Key Factor Description: Major Planned Action Description:
Comments
“Applicable” Clinical Performance Measures
• Only applicants that provide or assume primary responsibility for some or all of a patient’s prenatal care services, regardless of whether or not the applicant does the delivery, are required to include the two prenatal performance measures: Percentage of pregnant women beginning prenatal care in the first trimester and Percentage of births less than 2,500 grams to health center patients.
• If marked “not applicable” must justify in comments section.
• NO other clinical measures can be marked as “not applicable”.
“Applicable” Measures
9
OMB No.: 0915-0285. Expiration Date: 08/31/2010
FOR HRSA USE ONLY
Grant Number Application Tracking Number
DEPARTMENT OF HEALTH AND HUMAN SERVICES Health Resources and Services Administration
CLINICAL PERFORMANCE MEASURES
Project Period Date Focus Area: Diabetes
Performance Measure: Percentage of diabetic patients whose HbA1c levels are less than or equal to 9 percent Is this Performance Measure Applicable to your Organization? [_] Yes [_] No Target Goal Description Numerator Description Number of adult patients age 18 to 75 years with a diagnosis of Type 1 or Type 2 diabetes
whose most recent hemoglobin A1c level during the measurement year is <= 9%, among those patients included in the denominator.
Denominator Description Number of adult patients age 18 to 75 years as of December 31 of the measurement year with a diagnosis of Type 1 or Type 2 diabetes, who have been seen in the clinic at least twice during the reporting year and do not meet any of the exclusion criteria
Baseline Data Baseline Year: Measure Type: Numerator: Denominator:
Projected Data (by End of Project Period)
Data Source & Methodology Key Factor and Major Planned Action #1 Key Factor Type: [_] Contributing [_] Restricting [_] Not Applicable
Key Factor Description: Major Planned Action Description:
Key Factor and Major Planned Action #2 Key Factor Type: [_] Contributing [_] Restricting [_] Not Applicable Key Factor Description: Major Planned Action Description:
Key Factor and Major Planned Action #3 Key Factor Type: [_] Contributing [_] Restricting [_] Not Applicable Key Factor Description: Major Planned Action Description:
Comments
Baselines
• Starting point from which to measure trends
• State baseline value for the measure (if available)
– Baseline year: state year
– Measure type: percentage or ratio
– Numerator: number of patients that meet the identified criteria
– Denominator: all the patients to which the measure applies
Clinical Performance Measures Baseline
OMB No.: 0915-0285. Expiration Date: 08/31/2010
FOR HRSA USE ONLY
Grant Number Application Tracking Number
DEPARTMENT OF HEALTH AND HUMAN SERVICES Health Resources and Services Administration
CLINICAL PERFORMANCE MEASURES
Project Period Date Focus Area: Diabetes
Performance Measure: Percentage of diabetic patients whose HbA1c levels are less than or equal to 9 percent Is this Performance Measure Applicable to your Organization? [_] Yes [_] No Target Goal Description Numerator Description Number of adult patients age 18 to 75 years with a diagnosis of Type 1 or Type 2 diabetes
whose most recent hemoglobin A1c level during the measurement year is <= 9%, among those patients included in the denominator.
Denominator Description Number of adult patients age 18 to 75 years as of December 31 of the measurement year with a diagnosis of Type 1 or Type 2 diabetes, who have been seen in the clinic at least twice during the reporting year and do not meet any of the exclusion criteria
Baseline Data Baseline Year: Measure Type: Numerator: Denominator:
Projected Data (by End of Project Period)
Data Source & Methodology Key Factor and Major Planned Action #1 Key Factor Type: [_] Contributing [_] Restricting [_] Not Applicable
Key Factor Description: Major Planned Action Description:
Key Factor and Major Planned Action #2 Key Factor Type: [_] Contributing [_] Restricting [_] Not Applicable Key Factor Description: Major Planned Action Description:
Key Factor and Major Planned Action #3 Key Factor Type: [_] Contributing [_] Restricting [_] Not Applicable Key Factor Description: Major Planned Action Description:
Comments
Setting Goals for Improvement
• Goal is to demonstrate improvement over time or maintain high rate
• Ideally 100% of patients in compliance with measure
• Primary purpose is to determine internal trends
– Benchmarks may be helpful in setting goals: o 330 Program averages (national, state)oOther National and State data (for similar type
patients)
A Word About Benchmarks…
• Guidelines only!
• Benchmarks useful in setting feasible and challenging goals. Most relevant when patient populations are similar (urban/rural, insured/uninsured, etc.).
• The most important comparisons are internal
• UDS data since 2008
• Method of reporting (EHR vs. random sampling vs. self reporting) affects accuracy of data
Clinical Performance Measures Goals
OMB No.: 0915-0285. Expiration Date: 08/31/2010
FOR HRSA USE ONLY
Grant Number Application Tracking Number
DEPARTMENT OF HEALTH AND HUMAN SERVICES Health Resources and Services Administration
CLINICAL PERFORMANCE MEASURES
Project Period Date Focus Area: Diabetes
Performance Measure: Percentage of diabetic patients whose HbA1c levels are less than or equal to 9 percent Is this Performance Measure Applicable to your Organization? [_] Yes [_] No Target Goal Description Numerator Description Number of adult patients age 18 to 75 years with a diagnosis of Type 1 or Type 2 diabetes
whose most recent hemoglobin A1c level during the measurement year is <= 9%, among those patients included in the denominator.
Denominator Description Number of adult patients age 18 to 75 years as of December 31 of the measurement year with a diagnosis of Type 1 or Type 2 diabetes, who have been seen in the clinic at least twice during the reporting year and do not meet any of the exclusion criteria
Baseline Data Baseline Year: Measure Type: Numerator: Denominator:
Projected Data (by End of Project Period)
Data Source & Methodology Key Factor and Major Planned Action #1 Key Factor Type: [_] Contributing [_] Restricting [_] Not Applicable
Key Factor Description: Major Planned Action Description:
Key Factor and Major Planned Action #2 Key Factor Type: [_] Contributing [_] Restricting [_] Not Applicable Key Factor Description: Major Planned Action Description:
Key Factor and Major Planned Action #3 Key Factor Type: [_] Contributing [_] Restricting [_] Not Applicable Key Factor Description: Major Planned Action Description:
Comments
Key Factors and Major Planned Actions
• Special circumstances or conditions
• An opportunity to personalize your application
– Contributing factors
– Restricting factors
– Planned strategies
• Comments section: 1,000 characters
Contributing and Restricting Factors
Performance Measure Description: Percentage of diabetic patients age 18 to 75 whose HbAlc levels are less than or equal to 9 percent Is this Performance Measure Applicable to your Organization?
Target Goal Description By End of Project Period, increase the % of adult patients age 18 to 75 years with type 1 or 2 diabetes whose most recent hemoglobin A1c (HbA1c) is ≤ 9% (under control).
Numerator Description Number of adult patients age 18 to 75 years with a diagnosis of Type 1 or Type 2 diabetes whose most recent hemoglobin A1c level during the measurement year is ≤ 9%, among those patients included in the denominator.
Denominator Description Number of adult patients age 18 to 75 years as of December 31 of the measurement year (for measurement year 2009, date of birth on or after January 1, 1934 and on or before December 31, 1991) with a diagnosis of Type 1 or Type 2 diabetes, who have been seen in the clinic at least twice during the reporting year and do not meet any of the exclusion criteria
Baseline Data Baseline Year: Measure Type: Numerator: Denominator:
Projected Data (by End of Project Period)
Data Source & Methodology Key Factor and Major Planned Action #1 Key Factor Type: [_] Contributing [_] Restricting [_] Not Applicable
Key Factor Description: Major Planned Action Description:
Key Factor and Major Planned Action #2 Key Factor Type: [_] Contributing [_] Restricting [_] Not Applicable Key Factor Description: Major Planned Action Description:
Key Factor and Major Planned Action #3 Key Factor Type: [_] Contributing [_] Restricting [_] Not Applicable Key Factor Description: Major Planned Action Description:
Comments
Sample Clinical Measure
Sample Clinical Measure
Additional Required Measures
• Some examples of oral health measures:
– Percent of dental patients with a Phase I treatment plan completed within a 12 month period
– Percent of pregnant women with comprehensive dental exam completed while pregnant
– Percent of children 12-60 months with dental evaluation completed in last 12 months
Source: healthdisparities.net
Additional Required Measures
• Some examples of behavioral health measures:
– Percent of patients with a PHQ-9 screening score >9 who receive counseling from a BH Specialist
– Percent of diabetes patients who have received depression screening
– Percent of clinically significant depression patients with a 50 percent or greater reduction in Patient Health Questionnaire (PHQ) score 4 months or longer after the last new episode PHQ
Optional/Supplemental Measures
• Special populations (recommended if applying for special populations funding)
– Migrant measures: Migrant Clinicians Network http://www.migrantclinician.org/
– Homeless/Public Housing
• Others
– Special initiatives
– Measures monitored over time: HDC, program specific
• Reporting not required
Resources
• HRSA/BPHC: http://www.bphc.hrsa.gov/
• NAP website: http://www.hrsa.gov/grants/apply/assistance/nap
• Appendix B of NAP guidance
• NAP User Guide for Grant Applicants
• UDS data and manual: http://www.hrsa.gov/data-statistics/health-center-data/index.html
• Clinical Performance Measures:
– http://www.hrsa.gov/grants/apply/assistance/NAP/performancemeasures.pdf
– http://bphc.hrsa.gov/about/performancemeasures.htm
Resources
• National Quality Center—Improving HIV Care: http://www.nationalqualitycenter.org/index.cfm/22
• National Quality Forum: http://www.qualityforum.org/
• National Committee for Quality Assurance: http://www.ncqa.org/
• Institute for Healthcare Improvement: http://www.ihi.org/
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