Objectives

1. NAP Clinical and Financial Performance Measures Technical Assistance CallOverview of the Clinical Performance Measures September 23, 2010Candace Kugel, FNP, CNM, MSBPHC Clinical Consultant

2. Objectives • Identify the clinical performance measures for the New Access Point (NAP) grant application • Describe how the clinical performance measures forms should be completed • Identify data resources to support the clinical measures

3. Six Required Clinical Performance Measures • Outreach/Quality of Care Indicators • Percentage of pregnant women beginning prenatal care in first trimester • Percentage of children with 2nd birthday during the measurement year with appropriate immunizations • Percentage of women age 21-64 who received one or more Pap tests during the measurement year or during the two years prior to the measurement year

4. Six Required Clinical Performance Measures • Health Outcomes and Disparities • Percentage of births less than 2,500 grams to health center patients • Percentage of adult patients with diagnosed hypertension whose most recent blood pressure was less than 140/90 • Percentage of diabetic patients whose HbA1c levels are less than or equal to 9 percent • See HRSA NAP website and UDS manual for measure details and caveats

5. Additional Clinical Measures • Required two additional measures • One Oral Health • One Behavioral Health • Optional measures • Grantee may add additional measures – especially those which permit it to follow through on previously selected clinical performance measures • Measures that address unique needs of special populations (migrant, homeless, public housing)

6. Clinical Measure ≠ Clinical Guideline • Clinical measure = • a tool for measuring performance • quantifiable • Clinical guideline = • detailed protocol for management of a particular healthcare condition

7. Clinical Performance Measures Format

8. “Applicable” Clinical Performance Measures • Only applicants that provide or assume primary responsibility for some or all of a patient’s prenatal care services, regardless of whether or not the applicant does the delivery, are required to include the two prenatal performance measures: • Percentage of pregnant women beginning prenatal care in the first trimester and • Percentage of births less than 2,500 grams to health center patients • If marked “not applicable” must justify in comments section • NO other clinical measures can be marked as “not applicable”

9. “Applicable” Measures 9

10. Baselines • Starting point from which to measure trends • State baseline value for the measure (if available) • Baseline year: state year • Measure type: percentage or ratio • Numerator: number of patients that meet the identified criteria • Denominator: all the patients to which the measure applies

11. Clinical Performance Measures Baseline

12. Setting Goals for Improvement • Goal is to demonstrate improvement over time or maintain high rate • Ideally 100% of patients in compliance with measure • Primary purpose is to determine internal trends • Benchmarks may be helpful in setting goals: • 330 Program averages (national, state) • Other National and State data (for similar type patients)

13. A Word About Benchmarks… • Guidelines only! • Benchmarks useful in setting feasible and challenging goals. Most relevant when patient populations are similar (urban/rural, insured/uninsured, etc.). • The most important comparisons are internal • UDS data since 2008 • Method of reporting (EHR vs. random sampling vs. self reporting) affects accuracy of data

14. Clinical Performance Measures Goals

15. Key Factors and Major Planned Actions • Special circumstances or conditions • An opportunity to personalize your application • Contributing factors • Restricting factors • Planned strategies • Comments section: 1,000 characters

16. Contributing and Restricting Factors

17. Sample Clinical Measure

18. Sample Clinical Measure

19. Additional Required Measures • Some examples of oral health measures: • Percent of dental patients with a Phase I treatment plan completed within a 12 month period • Percent of pregnant women with comprehensive dental exam completed while pregnant • Percent of children 12-60 months with dental evaluation completed in last 12 months Source: http://www.healthcarecommunities.org/

20. Additional Required Measures • Some examples of behavioral health measures: • Percent of patients with a PHQ-9 screening score >9 who receive counseling from a BH Specialist • Percent of diabetes patients who have received depression screening • Percent of clinically significant depression patients with a 50 percent or greater reduction in Patient Health Questionnaire (PHQ) score 4 months or longer after the last new episode PHQ

21. Optional/Supplemental Measures • Special populations (recommended if applying for special populations funding) • Migrant measures: Migrant Clinicians Network • Homeless/Public Housing • Others • Special initiatives • Measures monitored over time: HDC, program specific • Reporting not required

22. Resources • HRSA/BPHC: http://www.bphc.hrsa.gov/ • NAP website: http://www.hrsa.gov/grants/apply/assistance/nap • Appendix B of NAP guidance • NAP User Guide for Grant Applicants • UDS data and manual: http://www.hrsa.gov/data-statistics/health-center-data/index.html • Clinical Performance Measures: • http://www.hrsa.gov/grants/apply/assistance/NAP/performancemeasures.pdf • http://bphc.hrsa.gov/about/performancemeasures.htm

23. Resources • National Quality Center—Improving HIV Care • National Quality Forum • National Committee for Quality Assurance • Institute for Healthcare Improvement

24. Contact • Candace Kugel, FNP, CNM, MS • ckugel@migrantclinician.org