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

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

Lab Test Turnaround Time (TAT) IPP Priority 3: Improve Appropriate and Timely Treatment for Persons Diagnosed with Chlamydial Infection and Their Partners. 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). 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).

TAT Analysis - Objectives Assess lab performance in meeting Region II IPP Benchmarks for processing a CT/GC lab test within 3 business days. 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. 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” Utilize TAT assessment results to enhance understanding of project area performance related to the National IPP Performance Measure “Time to Treatment for CT/GC”

TAT Analysis - Approach Follow-up to March 2007 TAT regional pilot analysis Follow-up to March 2007 TAT regional pilot analysis Study Participants: Study Participants: Labs providing diagnostic support to project area IPP Labs providing diagnostic support to project area IPP How is TAT Defined: 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 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 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

TAT Analysis - Methods Data collected for specimens received in lab from September 1 through 30, 2007 Data collected for specimens received in lab from September 1 through 30, 2007 Requested data elements: Requested data elements: CLIA Laboratory ID CLIA Laboratory ID Clinic/facility ID number (used to identify facility type) Clinic/facility ID number (used to identify facility type) Date of specimen collection Date of specimen collection Date the specimen is received in the lab Date the specimen is received in the lab Date the lab is able to report test result Date the lab is able to report test result Data was forwarded to Region II IPP Infrastructure and collated. Data was forwarded to Region II IPP Infrastructure and collated. Electronic Data Submission Electronic Data Submission Line-listed data or aggregated data tables accepted Line-listed data or aggregated data tables accepted

TAT Analysis – Mar ’07 Recap Laboratory Reporting tests # of Tests Time to Lab (Days) Avg. Time in Lab (Days) Avg. Total TAT (Days) Avg. NYS (CDD) 1, NYS (EC PHL)* PR DOH PHL 2, *Data reported for non-IPP facilities NOTE: CDD currently not able to separate out time in lab from total TAT

TAT Analysis – Sep ’07 Results Laboratory Reporting tests # of Tests Time to Lab (Days) Avg. Time in Lab (Days) Avg. Total TAT (Days) Avg. NYS (CDD) 1, NYS (EC PHL)* PR DOH PHL 2, NJ (NJ PHL) 6, USVI (NJ PHL) 1, *Data reported for non-IPP facilities NOTE: CDD currently not able to separate out time in lab from total TAT

TAT Analysis – Sep ’07 Results NYS (CDD) Facility type # of Tests Avg. Total TAT (Days) Proportion of all tests with Total TAT ≤3 Days STD Clinic Juvenile Detention Adolescent Clinic Alternate/Outreach Community HC University HC NOTE: CDD currently not able to separate out time in lab from total TAT

TAT Analysis – Sep ’07 Results NJ (NJ PHL) Facility type # of Tests Avg. Time to Lab (Days) Avg. Time in Lab (Days)* Avg. Total TAT (Days) STD Clinic 1, Family Planning 3, Juvenile Detention Adolescent Clinic Community HC University HC Other *Assumes same average Time in Lab for all NJ PHL specimens regardless of source.

TAT Analysis – Next Steps Refine methods and repeat analysis regionally with additional IPP labs 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 Share successful project area strategies for using TAT data to inform program objectives and improve timely treatment

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 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 Data Source: IPP Prevalence Monitoring Data

Measure 1: Screening Coverage in FP Region II Age Group (Years) # Females Screened # Females Eligible Estimated Screening Coverage (%) CY ,028 51, , , % ,541 67, , , % >24 75,895 75, , , % TOTAL 194, , , , % CY ,614 50, , , % ,288 69, , , % >24 79,355 79, , , % TOTAL 199, , , , % Data Source: FPAR Tables 1 & 11

Measure 1: Screening Coverage in FP FY2008 Performance Goal Increase estimated screening coverage among females years old and years old by 5% within each Title X Grantee. Est. Screening Coverage (%) Age yr Est. Screening Coverage (%) Age yr CY2006 FPAR CY2007 Goal CY2006 FPAR CY2007 Goal 45.7%48.0%49.4%51.9%

Measure 2: Test Utilization Region II Age (Years) CY 2005 CY 2006 # Females Tested % of Females Tested by Age # Females Tested % of Females Tested by Age ,660 58, % 64,071 64, % ,131 88, % 91,209 91, % ,986 45, % 47,087 47, % >29 54,362 54, % 55,096 55, % TOTAL 247, , % 257, , % Data Source: Region II IPP Prevalence Monitoring Data

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 and years of age by 5% within each Project Area. % Females Tested Age yr % Females Tested Age yr % Females Tested Age >29 yrs CY2006 FPAR CY2007 Goal CY2006 FPAR CY2007 Goal CY2006 FPAR CY2007 Goal 24.9%26.1%35.4%37.2%21.4%20.3%

Region II IPP Trends Female CT Testing and Positivity Among females tested for chlamydia each year Overall positivity is high (~6%) Overall positivity is high (~6%) Females aged yrs account for: Females aged yrs account for: ~60% of tests ~60% of tests ~80% of positives ~80% of positives Positivity is higher in STD and Detention settings although more cases are reported from FP clinics 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 Black/African American females account for ~25% of tests ~25% of tests ~40% of positives ~40% of positives Need more data for American Indian/Alaska Native, Native Hawaiian, and Asian populations to inform trends Need more data for American Indian/Alaska Native, Native Hawaiian, and Asian populations to inform trends

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

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

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

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 Overall prevalence is very low (<1%) – Need targeted testing Females aged yrs account for: Females aged yrs account for: ~55% of tests ~55% of tests ~75% of positives ~75% of positives STD clinics account for: STD clinics account for: ~19% of tests ~19% of tests ~49% of positives ~49% of positives Health disparities by race/ethnicity are even more pronounced Black/African American females account for Black/African American females account for ~27% of tests ~27% of tests ~64% of positives ~64% of positives Need more data for American Indian/Alaska Native, Native Hawaiian, and Asian populations to inform trends Need more data for American Indian/Alaska Native, Native Hawaiian, and Asian populations to inform trends

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

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

Region II IPP Trends *Data available through 2007 Q2 N = 119,207 N = 173,440N = 179,753 N = 87,915 † Insufficient volume of data for American Indian/Alaska Native, Asian, and Native Hawaiian

Use of NAAT Technology IPP Priority 4: Promote Use of High Quality, Cost Effective Diagnostic Tests for Chlamydia. IPP Priority 4: Promote Use of High Quality, Cost Effective Diagnostic Tests for Chlamydia. GOAL: All clinical providers will utilize NAATS by GOAL: All clinical providers will utilize NAATS by 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. 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.

Use of NAAT for CT Testing Among Females Region II IPP, CY2007* Project Area FPSTDAll Other # Tests% NAAT# Tests% NAAT# Tests% NAAT NJ25,75877%3,12568%5,080100% NYC6,6980%14,370100%5,14255% NYS48,22053%4,981100%1,344100% PR4,797100%2,240100%5,712100% USVI611100%138100%344100% Total86,08459%24,85496%17,62287% *Data available through 2007 Q2

NAAT Specimen Types for CT Testing Among Females Region II IPP, CY2007* Project Area FPSTDAll Other # Tests % of total # Tests % of total # Tests % of total Endocervix % % % Urine851417%702429%488632% Other†190.0%670.3%60.0% Total % % % *Data available through 2007 Q2 †Other specimen types include urethra, rectum, and “other” not specified

Project Area Data: Materials Facility Reference List Facility Reference List By county, facility type and grantee By county, facility type and grantee Includes active and inactive IPP sites Includes active and inactive IPP sites Female Chlamydia & Gonorrhea Trends Female Chlamydia & Gonorrhea Trends By age group By age group By race/ethnicity By race/ethnicity By facility type By facility type By lab test type By lab test type By specimen type By specimen type Female Chlamydia Site-Level Trends Female Chlamydia Site-Level Trends By age group and county By age group and county

Project Area Data: Key Questions What facilities are represented in your IPP data? What facilities are represented in your IPP data? Which clients 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? Where/among what populations are the greatest proportion of infections detected based on IPP data? Chlamydia Chlamydia Gonorrhea Gonorrhea What other epidemiologic data sources are available to you? What other epidemiologic data sources are available to you? Where/at which facilities is there an opportunity to: Where/at which facilities is there an opportunity to: Increase screening coverage among females ≤25 years of age? Increase screening coverage among females ≤25 years of age? Decrease screening among females >29 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? What other steps could be taken to increase the number of infections detected at each site? Consider test technology and specimen type Consider test technology and specimen type