STOP HIV/AIDS Core Collaborative Measures Reporting Tool SECTION 1

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1 STOP HIV/AIDS Core Collaborative Measures Paper Based Reporting Tool v1 1 STOP HIV/AIDS Core Collaborative Measures Reporting Tool Please note that reporting can also be performed electronically using the Excel based reporting tool and the a pdf narrative reporting tool. Directions: Please complete monthly and submit to Christina Clarke or fax to To complete this form, please fill in the white blank boxes that correspond to each Core Collaborative measure to calculate your practice s results for each month. If you have access to Microsoft Excel, there is also an electronic version of this reporting tool. Date of Report: Name of Reporter: Practice Name: Telephone: Core Measure 1 Primary Care Visits Program/ Practice Target SECTION 1 Result 1 Numerator Denominator Calculation *add to Core Collaborative measures tracking sheet Total number of those in the denominator who had at least one visit to a HIV primary care provider in the past 4 months Total number of active HIV patients included in the Population of Focus Data limitations? Data collection challenges? 2 HIV Viral load Total number of those in the denominator who had at least one HIV plasma Viral Load (pvl) test in the past 4 months Total number of active HIV patients included in the Population of Focus. Data limitations? Data collection challenges? 1 Add the each value from the results column to Section 3: Core Collaborative Measures Tracking Sheet to track measures over time. 1

2 STOP HIV/AIDS Core Collaborative Measures Paper Based Reporting Tool v1 2 3 Antiretroviral Therapy (ART) uptake among those unequivocally in need of ART Total number of those in the denominator who are currently taking ARV Total number of active HIV patients included in the Population of Focus who have ever had a CD4 cell count <200 cells/mm 3 Data limitations? Data collection challenges? 4 Achieving maximal HIV virologic control if prescribed ART Total number of those in the denominator who have a pvl less than 200 copies/ml at last pvl measure Total number of active HIV patients included in the Population of Focus who have been on continuous ARV for six months or more Data limitations? Data collection challenges? Experience: Q1 Sum of all responses that were Excellent and Very Good for question 1 on the Patient Sum of all responses from question 1 in the Patient Experience: Q2 Sum of all responses that were Excellent and Very Good for question 2 on the Patient Sum of all responses from question 2 in the Patient 2

3 STOP HIV/AIDS Core Collaborative Measures Paper Based Reporting Tool v1 3 Experience: Q3 Sum of all responses that were Excellent and Very Good for question 3 on the Patient Sum of all responses from question 3 in the Patient Experience: Q4 Sum of all responses that were Excellent and Very Good for question 4 on the Patient Sum of all responses from question 4 in the Patient Experience: Q5 Sum of all responses that were YES for question 5 from the patient access surveys. Sum of all responses from question 5 in the Patient 3

4 STOP HIV/AIDS Core Collaborative Measures Paper Based Reporting Tool v1 4 SECTION 2 Narrative Reporting Narrative Report Instructions: Please keep adding on to this report each month. The idea is to keep a running report throughout the course of your work, so you can more easily track your progress and see the breadth and depth of your tests of change and their implementation and spread within your practice. Just change the date at the top of the report each month and keep adding dates and lines to your report. To add lines to the tables, put your cursor in the last cell of the table and hit the tab key. If you have questions, please call your practice coach. Aim Statement(s): List the members of the team responsible for the incorporation of the care and improvement models into your organization. Add more lines as needed. Team Member Name Role/Title Address Phone/Extension Senior Clinical Leader Clinical/Technical Expert Day-to-day leader Define your Population of Focus (POF). (All patients? Whose patients? How many patients?) 4

5 STOP HIV/AIDS Core Collaborative Measures Paper Based Reporting Tool v1 5 What was your best practice or innovative change this month as a result of your participation in the Collaborative? Month/Year Best Practice/Innovative Change What has been your biggest challenge to sustaining and spreading 2 your work this month? Month/Year Biggest Challenge What do you plan to do next month? Make a prediction about how your work will affect at least one key measure. Month/Year Next Steps Prediction Describe your tests of change (PDSAs) in each Extended Chronic Care Model area (these correspond to the change concepts in your change package), noting successive tests to refine your processes. Note: Which changes are actually implemented and have become adopted into your policies, procedures and daily routine. Note: Also your plan for and accomplished spread within your organization. Community Linkages 2 Please note that this section can be left blank during preparation activities and early in the Collaborative. As changes are tested and implemented, it can be filled in. 5

6 STOP HIV/AIDS Core Collaborative Measures Paper Based Reporting Tool v1 6 Decision Support Self-Management Support Delivery System Design 6

7 STOP HIV/AIDS Core Collaborative Measures Paper Based Reporting Tool v1 7 Health System Please attach any forms, templates, processes, policies, procedures, etc. that you have developed this month (e.g., MOGE criteria, sampling, etc,). Thank you for sharing your successes! 7

8 STOP HIV/AIDS Core Collaborative Measures Paper Based Reporting Tool v1 8 SECTION 3 Core Collaborative Measures Tracking Sheet *track monthly measures over time using run charts. See example in Section 4. Core Collaborative Measures Dec -10 Jan- Feb- Mar- Apr- May- June- July- Aug- Sept- Oct- Nov- Dec- Jan Primary Care Visits 2 HIV Viral load 3 Antiretroviral Therapy (ART) uptake among those unequivocally in need of ART 4 Achieving maximal HIV virologic control if prescribed ART Experience 8

9 STOP HIV/AIDS Core Collaborative Measures Paper Based Reporting Tool v1 9 SECTION 4 Run Charts 1. Primary Care Visits 9

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