IPP Measures of Effectiveness

1. 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

2. Project Area Data • Laboratory Test Turnaround Time (TAT) • IPP Measures of Effectiveness • Screening Coverage • Test Utilization • Gonorrhea trends • Key Questions

3. 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).

4. 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”

5. 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

6. 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

7. 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

8. 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

9. TAT Analysis – Sep ’07 Results NOTE: CDD currently not able to separate out time in lab from total TAT

10. TAT Analysis – Sep ’07 Results *Assumes same average Time in Lab for all NJ PHL specimens regardless of source.

11. 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

12. 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

13. Measure 1: Screening Coverage in FP Data Source: FPAR Tables 1 & 11

14. 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.

15. Measure 2: Test Utilization Data Source: Region II IPP Prevalence Monitoring Data

16. 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.

17. 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

18. Region II IPP Trends *Data available through 2007 Q2 N=172,465 N=244,293 N=257,069 N=127,577

19. Region II IPP Trends *Data available through 2007 Q2 N=172,465 N=244,293 N=257,069 N=127,577

20. Region II IPP Trends *Data available through 2007 Q2 N=172,465 N=244,293 N=257,069 N=127,577

21. 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

22. Region II IPP Trends *Data available through 2007 Q2 N = 119,207 N = 173,440 N = 179,753 N = 87,915

23. Region II IPP Trends *Data available through 2007 Q2 N = 119,207 N = 173,440 N = 179,753 N = 87,915

24. 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

25. 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.

26. Use of NAAT forCT Testing Among FemalesRegion II IPP, CY2007* *Data available through 2007 Q2

27. 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

28. 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

29. 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