1. NAP Clinical and Financial Performance Measures Technical Assistance Call Overview of the Clinical Performance Measures September 23, 2010 Candace Kugel, FNP, CNM, MS BPHC Clinical Consultant 1

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 2

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 3

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 4

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) 5

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

7. Clinical Performance Measures Format 7

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” 8

9. “Applicable” Measures 9 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 10

11. Clinical Performance Measures Baseline 11

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: o 330 Program averages (national, state) o Other National and State data (for similar type patients) 12

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 13

14. Clinical Performance Measures Goals 14

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 15

16. Contributing and Restricting Factors 16

17. Sample Clinical Measure 17

18. Sample Clinical Measure 18

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/http://www.healthcarecommunities.org/ 19

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 20

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 21

22. Resources HRSA/BPHC: http://www.bphc.hrsa.gov/http://www.bphc.hrsa.gov/ NAP website: http://www.hrsa.gov/grants/apply/assistance/nap 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.htmlhttp://www.hrsa.gov/data- statistics/health-center-data/index.html Clinical Performance Measures: –http://www.hrsa.gov/grants/apply/assistance/NAP/perfor mancemeasures.pdfhttp://www.hrsa.gov/grants/apply/assistance/NAP/perfor mancemeasures.pdf –http://bphc.hrsa.gov/about/performancemeasures.htmhttp://bphc.hrsa.gov/about/performancemeasures.htm 22

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

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