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Analyzing laboratorial test turnaround time to improve timely treatment for chlamydia, assessing screening coverage, test utilization, and evaluating gonorrhea trends to enhance project effectiveness and inform actions.
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IPP Measures of Effectiveness Utilization of Data to Evaluate and Inform Project Activities December 12, 2007 Kelly Morrison Opdyke, MPH Region II Infertility Prevention Project
Project Area Data • Laboratory Test Turnaround Time (TAT) • IPP Measures of Effectiveness • Screening Coverage • Test Utilization • Gonorrhea trends • Key Questions
Lab Test Turnaround Time (TAT) • IPP Priority 3: Improve Appropriate and Timely Treatment for Persons Diagnosed with Chlamydial Infection and Their Partners. • Regional Plan Objective 3A: At least every two years, assess turnaround time within lab to assure compliance with 3 business days (develop tracking system clinic to clinic).
TAT Analysis - Objectives • Assess lab performance in meeting Region II IPP Benchmarks for processing a CT/GC lab test within 3 business days. • Assess impact that time elapsed from when a provider takes a specimen to when specimen reaches lab for processing has on length of time it takes to have an actionable test result available to the provider. • Utilize TAT assessment results to enhance understanding of project area performance related to the National IPP Performance Measure “Time to Treatment for CT/GC”
TAT Analysis - Approach • Follow-up to March 2007 TAT regional pilot analysis • Study Participants: • Labs providing diagnostic support to project area IPP • How is TAT Defined: • Part I. Time to Lab – Number of days* from date of specimen collection to date specimen is received in lab • Part II. Time in Lab – Number of days* from date specimen is received in lab and date lab reports the test result *Including weekends and holidays
TAT Analysis - Methods • Data collected for specimens received in lab from September 1 through 30, 2007 • Requested data elements: • CLIA Laboratory ID • Clinic/facility ID number (used to identify facility type) • Date of specimen collection • Date the specimen is received in the lab • Date the lab is able to report test result • Data was forwarded to Region II IPP Infrastructure and collated. • Electronic Data Submission • Line-listed data or aggregated data tables accepted
TAT Analysis – Mar ’07 Recap NOTE: CDD currently not able to separate out time in lab from total TAT *Data reported for non-IPP facilities
TAT Analysis – Sep ’07 Results NOTE: CDD currently not able to separate out time in lab from total TAT *Data reported for non-IPP facilities
TAT Analysis – Sep ’07 Results NOTE: CDD currently not able to separate out time in lab from total TAT
TAT Analysis – Sep ’07 Results *Assumes same average Time in Lab for all NJ PHL specimens regardless of source.
TAT Analysis – Next Steps • Refine methods and repeat analysis regionally with additional IPP labs • Share successful project area strategies for using TAT data to inform program objectives and improve timely treatment
IPP Measures of Effectiveness Measure 1: Screening Coverage in FP Proportion of female Family Planning users screened for chlamydia, by age group • Data Source: FPAR Tables 1 & 11 Measure 2: Test Utilization Proportion of chlamydia tests conducted on females, stratified by age group • Data Source: IPP Prevalence Monitoring Data
Measure 1: Screening Coverage in FP Data Source: FPAR Tables 1 & 11
Measure 1: Screening Coverage in FP FY2008 Performance Goal Increase estimated screening coverage among females 15-19 years old and 20-24 years old by 5% within each Title X Grantee.
Measure 2: Test Utilization Data Source: Region II IPP Prevalence Monitoring Data
Measure 2: Test Utilization FY2008 Performance Goal Decrease the proportion of tests conducted among females >29 years of age by 5%, and increase the proportion of tests conducted among females 15-19 and 20-24 years of age by 5% within each Project Area.
Region II IPP TrendsFemale CT Testing and Positivity Among females tested for chlamydia each year • Overall positivity is high (~6%) • Females aged 15-24 yrs account for: • ~60% of tests • ~80% of positives • Positivity is higher in STD and Detention settings although more cases are reported from FP clinics Health disparities by race/ethnicity are evident • Black/African American females account for • ~25% of tests • ~40% of positives • Need more data for American Indian/Alaska Native, Native Hawaiian, and Asian populations to inform trends
Region II IPP Trends *Data available through 2007 Q2 N=172,465 N=244,293 N=257,069 N=127,577
Region II IPP Trends *Data available through 2007 Q2 N=172,465 N=244,293 N=257,069 N=127,577
Region II IPP Trends *Data available through 2007 Q2 N=172,465 N=244,293 N=257,069 N=127,577
Region II IPP Trends:Female GC Testing and Positivity Among females tested for gonorrhea each year • Overall prevalence is very low (<1%) – Need targeted testing • Females aged 15-24 yrs account for: • ~55% of tests • ~75% of positives • STD clinics account for: • ~19% of tests • ~49% of positives Health disparities by race/ethnicity are even more pronounced • Black/African American females account for • ~27% of tests • ~64% of positives • Need more data for American Indian/Alaska Native, Native Hawaiian, and Asian populations to inform trends
Region II IPP Trends *Data available through 2007 Q2 N = 119,207 N = 173,440 N = 179,753 N = 87,915
Region II IPP Trends *Data available through 2007 Q2 N = 119,207 N = 173,440 N = 179,753 N = 87,915
Region II IPP Trends *Data available through 2007 Q2 N = 119,207 N = 173,440 N = 179,753 N = 87,915 † Insufficient volume of data for American Indian/Alaska Native, Asian, and Native Hawaiian
Use of NAAT Technology • IPP Priority 4: Promote Use of High Quality, Cost Effective Diagnostic Tests for Chlamydia. • GOAL: All clinical providers will utilize NAATS by 2008. • Regional Plan Objective 4A: Increase use of FDA approved NAAT alternate specimen types (urine, vaginal swab) in females among participating IPP Clinics to identify chlamydial infection when a pelvic exam is not being conducted.
Use of NAAT forCT Testing Among FemalesRegion II IPP, CY2007* *Data available through 2007 Q2
NAAT Specimen Types forCT Testing Among FemalesRegion II IPP, CY2007* *Data available through 2007 Q2 †Other specimen types include urethra, rectum, and “other” not specified
Project Area Data:Materials • Facility Reference List • By county, facility type and grantee • Includes active and inactive IPP sites • Female Chlamydia & Gonorrhea Trends • By age group • By race/ethnicity • By facility type • By lab test type • By specimen type • Female Chlamydia Site-Level Trends • By age group and county
Project Area Data:Key Questions • What facilities are represented in your IPP data? • Which clients are represented in your IPP data? • Where/among what populations are the greatest proportion of infections detected based on IPP data? • Chlamydia • Gonorrhea • What other epidemiologic data sources are available to you? • Where/at which facilities is there an opportunity to: • Increase screening coverage among females ≤25 years of age? • Decrease screening among females >29 years of age? • What other steps could be taken to increase the number of infections detected at each site? • Consider test technology and specimen type