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Performance measures are used to assess clinical outcomes, determine gaps in clinical data, report quality assurance data to HRSA, identify changes in health outcomes over time, or can produce client lists to inform staff in regards to data completion for other HRSA reports like the RSR, ADR, or EHE Triannual reports. Performance measures produce a percentage based on the unduplicated counts of clients based on the denominator and numerator filters. These filters based on the Demographics Report Type from custom reports. When running a performance measure, the count for the denominator filter is generated first and then the numerator filter is applied to the list of clients that are in the denominator. This produces a number of clients that are considered for the measure in the denominator and a number of those denominator clients that meet the measure in the numerator.
HRSA Defined Performance Measures
CAREWare includes a number of HRSA defined pre-built performance measures meant to meet HIV Quality Assurance measurements. These measures are created by HRSA and published on the DISQ site for CAREWare Performance Measures. They include the CORE measures; HIV CORE 01 - Viral Load Suppression, CORE 02 - Prescription of HIV Antiretroviral Therapy, CORE 03 – Medical Visit Frequency, and CORE 04 – Gap in Medical Visits. Additional performance measures like the HAB measures, the CORE 05 – Retention in Care measure, or the Linkage to Care measure can be downloaded and imported by following the instructions here. HRSA defined measures are created by HRSA for reporting purposes and meant to remain as they were originally designed, unless updated by HRSA. Those measures are locked from editing in CAREWare. If a provider needs to make adjustments to those measures for internal reporting purposes, they need to make a copy of the measure and edit it under Setup, Copy, and Customize Performance Measures.
HIVQM Performance Measure Groups
Performance measures can be used to report HIVQM results to HRSA by using the HIVQM format in performance measure groups and selecting all of the required HIVQM measures in that group. Once the performance measure group is exported in the HIVQM format, it can be uploaded to the HRSA site EHB, by following the instructions here. HIVQM measures are meant to monitor client care for clients of all ages in HIV treatment. These measures are aligned with HHS initiatives to promote better outcomes in this population. Monitoring and reporting these outcomes informs HRSA of progress toward the National HIV/AIDS Strategy.
Running Performance Measures
Performance measures can be evaluated in a number of ways, individually by provider, as a group of providers, or by including shared data from other providers for the results of a single provider. When running performance measures it is important to determine which filters should include shared data and which filters should exclude shared data. This is primarily done using the subfilter Cross-Provider, however for shared data to work correctly data sharing settings need to be setup by following the instructions here. Once data sharing settings are complete, changing the subfilter Cross-Provider from No to Yes, sets CAREWare to include data for that filter from an provider sharing that data with the provider running the measure. For instance, a performance measure can be set to exclude shared data for services and include shared data for labs. This may be useful when using performance measures for HRSA reports as shared clinical data is often included, however only services delivered by the provider running the report count for that HRSA report. For instructions on running performance measures click here.
Creating Performance Measure Client Lists
When performance measures are run, they produce an unduplicated count of clients that can be viewed using the Create Client List option. This unduplicated list may be the result of clients that meet the measure (In Numerator), clients that do not meet the measure (Not in Numerator), or clients that are excluded from the measure entirely (Not in Denominator). Understanding how this list works is a useful communication tool for staff. If there are clients that meet the measure for the Gap in Medical Visits performance measure, that may indicate those clients require Outpatient Ambulatory Health Service appointments to be scheduled.
Performance Measures for HRSA Defined Reports
Performance Measures can be used as indicators of missing data for reports like the RSR, ADR, and EHE Triannual reports. A performance measure can be created to monitor clients with Outpatient Ambulatory Health Services who are receiving Viral Load labs during the year. If clients appear in the Not in Numerator result for that measure, that is an indication clients need to be scheduled to receive labs as that is a requirement in HRSA reports when clients are receiving Outpatient Ambulatory Health Services. This can be a useful tool in monitoring clients missing data through out the year leading up to the RSR. The results of these measures can be reported to users in a number of ways in CAREWare, by email, by running the measure in the client record, or by displaying them on the front page using the Provider Summary.
Monitoring Performance Measure Results over time
Performance measures can be used to compare changes in clinical data over time. By running a performance measure every quarter, staff can observe if they are getting more and more complete data or if gaps in clinical outcomes are growing. For instance, running the Gap in Medical Visits performance measure may show a high percentage at the beginning of the year, however that percentage may decrease getting closer to December as more clients complete their medical visits meeting their requirements for being in care. Performance measures can be run at different times by selecting a different As of Date each time they are run or they can be run for several different times all at once by Creating an Aggregate Report. Running a performance measure as an aggregate report can show results of a performance measure every month, every quarter, or every year depending on settings selected and the date spans in the filters for the measure. This can show a change in outcomes through out the year.
Monitoring individual clients using Performance Measures
Performance measures can be setup as a way of monitoring each individual client and as a way for quick access to correct gaps in clinical data. Performance measures can be activated in client records by setting up the client tab for performance measures. Once activated, those measures can be quickly reviewed for that one client, verifying if the client meets the measure or not. Knowing if a client meets the viral load suppression measure or not can give clinicians insight in patient care or inform case management staff of missing clinical data. As the status of the client for those measures is visible right in the client record, clinicians and case managers can quickly navigate to the appropriate tab to verify those records and enter them as needed to correct the data.
Performance measures in CAREWare are a relatively easy way to monitor and track clinical outcomes and make sure that clinical data is complete for reports. They provide insight into client and needs. Performance measures are a guidance tool to meet HIV Care Continuum goals for RW clients. In CAREWare, they can be established by simply adding two filters to a measure or be as complex as assessing dozens of performance measures at once to gain a complete understanding of clinical outcomes.
Instructions for Performance Measures can be found in the following user guides:
