Medical Case Management: Medical Visits

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Percentage of HIV-infected medical case management clients who had two or more medical visits in an HIV care setting in the measurement year.

Number of HIV-infected medical case management clients who had a documented medical visit with a provider with prescribing privileges [ 1 ] two or more times at least three months apart in the measurement year.

Number of HIV-infected medical case management clients who had at least one medical case management encounter in the measurement year.

1. Medical case management clients who initiated medical case management services in the last six months of the measurement year.
2. Medical case management clients who were discharged from medical case management services in the last six months of the measurement year.

1. Is the client HIV-infected (Y/N)
   1. If yes, did the client have a medical case management encounter in the measurement year? (Y/N)
      1. If yes, did the medical case manager document that the client had two or more medical visits in an HIV care setting in the measurement year? (Y/N)
         1. If yes, list the dates of these visits.

• Ryan White Data Report (RDR) Section 3, Item 33k may provide useful data regarding the number of clients identified as receiving medical case management.
• Electronic databases, such as CAREWare, Provide, ARIES, Lab Tracker, Electronic Medical Record/Electronic Health Record
• Case management record [ 2 ] chart abstraction by grantee of a sample of records

None available at this time.

• Rate of HIV-related hospitalizations in the measurement year
• Mortality rates

The Ryan White HIV/AIDS Treatment and Modernization Act of 2006 (P.L. 109-415) indicates that medical case management is a core service. Additionally, medical case management services increase access to and retention in medical care.

Definition: “Medical Case management services (including treatment adherence) are a range of client-centered services that link clients with health care, psychosocial, and other services. Medical case management services are involved in the coordination and follow-up of medical treatments. These services ensure timely and coordinated access to medically appropriate levels of health and support services and continuity of care, through ongoing assessment of the client’s and other key family members' needs and personal support systems. Medical case management includes the provision of treatment adherence counseling to ensure readiness for, and adherence to, complex HIV/AIDS treatments. Key activities include (1) initial assessment of service needs; (2) development of a comprehensive, individualized service plan; (3) coordination of services required to implement the plan; (4) client monitoring to assess the efficacy of the plan; and (5) periodic re-evaluation and adaptation of the plan as necessary over the life of the client. It includes client-specific advocacy and/or review of utilization of services. This includes all types of case management including face-to-face, phone contact, and any other forms of communication.” [ 3 ]

Case Management is beneficial in dealing with complex needs of people living with HIV/AIDS:

• Reduce cost of care by decreasing hospitalization [ 4 ]
• Clients enrolled in case management are 1.5 times more likely to follow drug regimens [ 5 ]
• Improve chances of newly diagnosed HIV-infected persons entering care [ 5 ]

See HAB HIV Core Clinical Performance Measures for Adult/Adolescent Clients: Group 1, “Medical Visits”. [ 6 ]

[1] A “provider with prescribing privileges” is a health care professional who is certified in their jurisdiction to prescribe ARV therapy.

[2] The client’s medical record may be used if case management documentation is located in the client’s medical record.

[3] “Instructions for Completing the 2007 Ryan White HIV/AIDS Program Data Report”, page 17.

[4] Cruise, P.L. and Liou, K.T. (1993). AIDS Case management: a study of an innovative health service program in Palm Beach County, Florida. Journal of Health and Human Resources Administration, 16, 96-110.

[5] Gardner, L.I. Mensch, L.R., Anderson-Mahoney, P., Loughlin, A.M. Et al. Efficacy of a brief case management intervention to link recently diagnosed HIV-infected persons to care. AIDS 2005 Mar 4; 19(4): 423-31.

[6] Available online at the HRSA Web site.