HAB Performance Measures Companion Guide -
Scope of HAB Core Clinical Performance Measures

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Yes, the HAB PMs can be used by all programs funded by the Ryan White HIV/AIDS Program that provide HIV care or other relevant services. The measures can be used either at the provider or system level. The measures can be rolled up to look at issues from a system perspective, such as with Part A and B Programs. Further guidance on the use of measures at this level will be forthcoming. Programs can also work with their subcontractors, vendors or subgrantees to implement the performance measures at the provider level. Grantees are encouraged to include the core clinical performance measures in their quality management plan.

In April 2007, a draft set of performance measures were released for public comment. Based on the tremendous feedback received, the performance measures were revised to address many of the issues raised. The modified performance measures are being released in stages. The measures included in Group 1 represent the five (5) performance measures that are deemed critical for HIV programs to monitor. Group 2 includes nine (9) additional measures that reflect important aspects of care that impact HIV-related morbidity and focus on treatment decisions that affect a sizable population. Group 3 measures will be released in late 2008.

HAB considers all of the clinical performance measures that were released in April 2007 critical to good care. The measures are being released in phases to allow for staged implementation. If a clinical program has no performance measures, Group 1 measures provide an excellent start and can serve as a foundation on which to build.  Group 2 measures are important measures for a robust clinical management program and should be seriously considered.

National performance measures have been established for a wide range of general health conditions, such as immunizations, prenatal care and screenings. Since there are currently no national consensus performance measures for HIV care, the HAB HIV Core Clinical Performance Measures focus on key elements of care that are unique to the HIV-infected patient population served by the Ryan White HIV/AIDS Programs.

Because these measures focus on medical care, case management measures for case management and other supportive services have not been included. Separate performance measures will be released for public comment in summer 2008 related to case management, oral health, AIDS Drug Assistance Program (ADAP) and systems of care.

A performance measure provides an indication of an organization's performance in relation to a specified process or outcome. Standards of care are guidelines that outline the expectations of care around a specific issue or topic and are created by a group of subject matter or clinical experts. Because performance measures and standards of care each serve a different purpose, they are not always in accordance. For instance, with the Medical Visit performance measure, the standard of care states that routine monitoring should occur at least every three to four months depending on the stage of disease. For the purpose of the performance measure, the time frame of six months was determined by clinical expert consensus to allow for those patients that are well controlled clinically and stable on their current regimen. Per the guidelines, patients can and should be seen at more frequent intervals as dictated by their current health status.

As a general rule of thumb, data for quality improvement purposes are not designed to be punitive or used to consider funding levels/decisions. Quality improvement data should be used to document areas of strength, identify areas for improvement and help guide, shape and enhance the delivery and quality of care. The intent is to minimize wide fluctuations in care and maintain a consistent level of service.