USING URS for QUALITY MANAGEMENT

1. USING URS for QUALITY MANAGEMENT • Case Study 1: • “How many of the women currently enrolled in the RWCA case management program are actually receiving routine gynecological care?” • Eligible Patients: HIV+ women enrolled in the T-I Case Management program for the 2005 calendar year.  • Review Period: 2005 calendar year. • Indicator: Women should receive/report an annual gyn exam.

2. Relation to URS • Identifying the population of interest: in this case, women enrolled in the RWCA case management program for 2005 • Identifying data sources for the indicator, in this case, referral followup.

3. Data Source in URS-Identify Clients Using Client Listing by Program

4. Report Output

5. Or use Clients Served by Program with date range.

6. Use Agency Referral Report to View Referrals made by your Program for that date range

7. Detail on Referrals can be Viewed

8. Status of each Referral is included • The status will only be available in this manner if staff have been using the URS referral tracking feature to its full capabilities • Data can be exported to an Access database or spreadsheet or Crystal Report for further analysis and reporting. • This is done using the URS data export feature

9. Referral Tracking Features

10. Referral Data • Referral Service Category, specific service • Organization (from referral library) • Dates for need identification, referral, referral status. • Type of followup method is now available • Notation of whether appointments are being kept.

11. CASE STUDY #2 • evaluate the effect of group visits designed to assist clients with building their HIV/AIDS self management skills. • collect the following data at baseline and following the group interventions: A. % of clients reporting (with documentation by the case manager in the record) T-cell and Viral Load test result at least every 6 months. B. T-Cell and Viral Load Results

12. In URS, Use Lab Test History

13. Data can be exported using URS Extract

14. Evaluate trends in CD4 and Viral Load • Cross Reference the URS Client Data (client characteristics) with URS Service data (what services they received) with Lab Test data (Viral Load and CD4). • All of this data can be exported from URS if it has been collected and entered conscientiously.

15. CASE STUDY #3 • review performance measures/indicators for 2006. • First, determine eligible population: • Patients admitted in 2006 that have been enrolled in the Case Management program for a minimum of 3 months • Use client enrollment reports as in Case Study #1.

16. Identify Indicators for Review Period • The review period is defined as the (2006) calendar year. • Indicator 1: Clients should have a documented primary care visit at least once every 6 months. • Indicator 1a: For clients who have not had a PCP visit within the aforementioned time frame a referral to a PCP should be noted. • Indicator 1b: For clients with a referral to primary care provider, there should be documentation of follow up within 30 days to determine whether the primary care appointment was kept. • Indicator 1c: If documentation exists, there should be documentation that the client kept the appointment.

17. In CURRENT URS, use Referrals and CM Intake Data • Referral tracking offers ability to note where the client is receiving care, whether they have obtained services, and whether or not appointments are being kept. • CM Intake gives notation of pre-existing PCP relationship, and whether that is ongoing and date of most recent visit.

18. Case Management Intake Screen

19. IN AIRS (VFPURS), new PCP Screen will be available

20. CASE STUDY #4 • A QI project that focuses on improving the quality and completeness of URS data entry • test whether the following interventions will result in an improvement in the process: • 1)Training staff on the required data elements in URS and in particular focusing on how to document lab test results and HAART medications.  • 2)Identifying a URS report that the program director can run on a routine basis (monthly) to capture the completeness and accuracy of client level data entered.

21. Documenting Lab and HAART • Lab results can be entered in the Lab/Psych Test History as needed. Any tests not available can be added via the lab test maintenance function. • HAART is monitored in the Medications History. Both ARV type and status and specific meds may be entered, but only ARV type and status are required.

22. Lab Tests available

23. Medications History

24. Reports Available in System • Clients Without ARV Therapy is a CADR Quality Report

25. Detail on Individual Clients is Available in the Client Profile or Flow Sheet Reports

26. Data Quality Checks • Run Program enrollment by Worker, look for last date of service • Run Activities and Services Report by Worker, look at level of activity and clients served • Select client profiles for a sample group to review completeness of records for clients seen during the report period. • Process is much faster than chart abstraction

27. CASE STUDY #5 • Determine if the following conditions posed a barrier to one’s access to, or maintenance in, primary care: • Clients who were living at home (with parents); • Clients living in single room occupancy • Homeless clients • Clients in need of food/nutritional services • Clients w/ documented Substance Use problems

28. Data Sources in URS to Identify Clients meeting the profile • Housing Status on Intake • Adequate Housing Flag on Intake • Service Needs Identified during CM visits • Referrals Made • Substance Use History • Special Populations • Use data on PCP as noted in Case Study #3 • AIDS Institute Aggregate Reports offer summary data on many Intake elements

29. Majority of Data in First URS Extract Table

30. Use of Data • Use “canned” reports wherever possible • Export to Spreadsheet and sort • Export to Access Database and Run report wizard • Export to Crystal Reports • Use product of your choice