Before You Begin

Review the Recipient Resources page on the federal Health Resources and Services Administration (HRSA) website. The site includes access to HRSA-defined performance measures, reporting requirements, policy notices, instruction manuals, and other information.

Using Performance Measures in CAREWare

Performance measures in CAREWare provide a practical way to track clinical outcomes, find missing report data, and support HIV Care Continuum goals for Ryan White clients. A measure may use only two filters, or staff may review many measures together for a broader view of clinical outcomes.

HRSA-Defined Performance Measures

Performance measures help staff review clinical outcomes, find missing clinical data, report quality data to HRSA, track changes over time, and create client lists. They can also help staff prepare data for reports such as the Ryan White Services report (RSR), ADAP Data Report (ADR), and Ending the HIV Epidemic (EHE) Triannual reports.

Performance Measures Built into CAREWare

CAREWare includes prebuilt measures created by HRSA for HIV quality assurance. CORE measures include Viral Load Suppression, Prescription of HIV Antiretroviral Therapy, Medical Visit Frequency, and Gap in Medical Visits. Staff can also download and import measures such as HIV/AIDS Bureau (HAB) measures, Retention in Care, and Linkage to Care.

HRSA-defined measures are designed for reporting and should not be modified until HRSA issues updates to the measures. HRSA-defined measures are locked in CAREWare to prevent users from editing the denominator and numerator filters. Users can copy and edit the measures for internal purposes. See Performance Measures for Data Quality and Setup Copy and Customize Performance Measures.

How CAREWare Calculates Performance Measures

CAREWare performance measures use the same filters that are available for custom reports. First, CAREWare uses the denominator filter to create an unduplicated list of clients who are included in the measure. It then applies the numerator filter to that list. The result shows how many included clients meet the measure and the percentage they represent.

HIVQM Performance Measure Groups

CAREWare includes the HRSA-defined HIV Quality Measures (HIVQM) format in the options for Performance Measure Groups. After the CSV file is exported from CAREWare, it can be uploaded directly into the HRSA Electronic Handbooks (EHB). HIVQM measures monitor care for people of all ages who receive HIV treatment. They support federal Department of Health & Human Services (DHHS) efforts to improve outcomes and help HRSA track progress toward the National HIV/AIDS Strategy.

Data Sharing and Performance Measures

HRSA-defined measures are configured to not include Cross-Provider labs or services. As a result, measures may appear lower than expected if labs and outpatient/ambulatory health services exist in other domains. Before evaluating a measure, decide which measures should include shared or cross-provider data. Complete the data-sharing setup first. After setting up data sharing, set the Cross-Provider subfilter to Yes for each filter that should include shared data.

Running Performance Measures

Measures can be evaluated for one provider, a group of providers, or one provider with shared data from other providers. See Run Performance Measures for steps on how to evaluate performance measures in CAREWare.  

Creating Performance Measure Client Lists

CAREWare includes the option to view real-time client lists for performance measures. The list can include clients who meet the measure (In Numerator), do not meet it (Not in Numerator), or are excluded (Not in Denominator). These lists help staff follow up with clients and correct missing data. The steps are outlined in the Create Client List Knowledge Base article. 

Performance Measures for HRSA-Defined Reports

Performance measures help identify missing data for the RSR, ADR, and EHE Triannual reports. Results can be printed and shared amongst staff. Each client record also includes the option for a Client Summary that shows client-level results for specific performance measures. Staff can share results by email, run a measure from a client record, or display results on the main page of CAREWare with the Provider Summary.

Monitoring Results Over Time

Monitoring performance measures over time helps identify issues with data quality and areas for Clinical Quality Management efforts. Depending on the timeframe used for the measure, performance measures may improve naturally over time, such as when few clients have medical visits early in the year and the number of medical visits or labs increases as the year progresses.

Quality management staff may want to consider changing the As of Date for performance measures to capture a more “real time” perspective of where their clients fall within specific performance measures. CAREWare also includes the Create Aggregate Report options to compare monthly, quarterly, or yearly results. The available time periods depend on the report settings and the date ranges in the measure filters.

Monitoring Individual Clients

Add measures to client records by setting up the client tab. Staff can then check whether a specific client meets the criteria for a performance measure. A viral load suppression result may guide care, while a missing result may show that clinical data needs to be entered. Clinicians and case managers can move from the measure to the correct tab to review or update the record.

 

Related References