Site Reports and STD Testing in Family Planning Settings

Transcription

1 Women s Health - Family Planning/Reproductive Health Program Annual Business Meeting September 24, 2014 Site Reports and STD Testing in FP Settings What should we do with all of this data? Read my lips: It s about the patient (not the data).. or is it?* STD testing and positivity trends in PPW and non-ppw FP settings: CT and GC testing in males and females in 2013 & 2014 (Jan-June) Selective Screening Criteria (SSC) Why do we use SSC & non-ssc? Site Reports and STD Testing in Family Planning Settings Lori Amsterdam John Pfister On, off, and non-ssc criteria STD positivity trends Re-testing Why is it important to get patients back for re-testing? Proportion of patients re-tested and STD positivity trends *Author unknown 2 Site Reports and STD Testing in FP Settings What should we do with all of this data? Read my lips: It s about the patient (not the data).. or is it?* STD testing and positivity trends in PPW and non-ppw FP settings: CT and GC testing in males and females in 2013 & 2014 (Jan-June) Pregnancy testing Why test for an STD when I just want to know if I m pregnant? Proportion of pregnancy test patients and STD positivity trends Alternative specimens Location, location, location: vaginal, urine, rectal, pharyngeal? Proportion of specimens by type and STD positivity trends Site Reports and STD Testing in FP Settings What should we do with all of this data? Read my lips: It s about the patient (not the data).. or is it?* STD testing and positivity trends in PPW and non-ppw FP settings: CT and GC testing in males and females in 2013 & 2014 (Jan-June) HEDIS CT Measure testing 2012 & 2013 Why do the WI SSC differ from CDC recommended SSC and the HEDIS CT Measure? Look at your site reports and use your data- it s about your patients!!! *Author unknown *Author unknown 3 4 1

2 Wisconsin STD Testing using SSC in FP Settings Why do we use SSC & non-ssc? Wisconsin evidence based criteria established through universal testing and risk assessment SSC have been evaluated and re-evaluated over the past 30 years during periods of universal testing and risk assessment to re-assess the sensitivity of risk factors for identifying infection Current SSC in FP clinics have an ~84% overall efficiency for detecting infection for CT SSC provide cost efficient and justifiable use of limited health $$$ SSC reduce number of false positive results and subsequent overuse of antibiotics Wisconsin STD Testing using SSC in FP Settings Why do we use SSC & non-ssc? SSC provide a consistent risk assessment tool for documenting sexual history SSC provide measurable baselines for QA/QI measures Non-SSC were recently established to document reasons clinicians test in the absence of SSC as a result of findings from the 2008 universal screening evaluation in 14 PPW clinics, and are now being piloted in non-ppw clinics. Current evaluation of non-ssc in 2014 to determine positivity associated with clinician discretion driven reasons for testing offcriteria 5 6 Universal Screening Study in 14 PPW Clinics to Evaluate Chlamydia SSC Efficiency Among FP Women 2008 Universal Screening Study in 14 PPW Clinics to Evaluate Chlamydia SSC Efficiency Among FP Women 2008 SSC Meets Criteria % of Total (Tested) % of All Positives Detected Positivity Tests per Positive Cost per Positive 64.6% 83.8% 8.4% 12.0 $300 SSC % of Total % of All Positives Detected Positivity Tests per Positive Cost per Positive Overall Increase in Program Costs Overall Annual Program Cost for CT Testing Current SSC 64.6% 83.8% 8.4% 12.0 $300 Baseline $1.0 M No Criteria 35.4% 16.2% 2.9% 33.8 $850 Add Age % 96.4% 3.3% 30.2 $ % $1.38 M Add Universal Testing 100% 100% 2.2%% 46.5 $1, % $1.55M 2

3 Average Number of Chlamydia Tests per Month, Jan 2013 Apr 2014 (PPW) Jun 2014 (NPP) 2,500 2,000 1,500 2,252 3,000 2,500 2,000 1,500 Chlamydia Testing Volume, Jan 2013 Jun , , Jan '13 Feb Mar Apr May Jun '13 '13 '13 '13 '13 Jul Aug Sep Oct Nov Dec Jan Feb Mar Apr May Jun '13 '13 '13 '13 '13 '13 '14 '14 '14 '14 '14 '14 0 Females (PPW) Females (NPP) Males (PPW) Males (NPP) Females( PPW) Females (NPP) Males (PPW) Males (NPP) Avg 2,252/month Avg 779/month Avg 570/month Avg 247/month Average Number of Gonorrhea Tests per Month, Jan 2013 Apr 2014 (PPW) Jun 2014 (NPP) 1,600 1,400 1,200 1, , Females (PPW) Females (NPP) Males (PPW) Males (NPP) 1,800 1,600 1,400 1,200 1, Jan '13 Gonorrhea Testing Volume, Jan 2013 Jun 2014 Feb Mar Apr May Jun '13 '13 '13 '13 '13 Jul Aug Sep Oct Nov Dec Jan Feb Mar Apr May Jun '13 '13 '13 '13 '13 '13 '14 '14 '14 '14 '14 '14 Females( PPW) Females (NPP) Males (PPW) Males (NPP) Avg 1,462/month Avg 213/month Avg 444/month Avg 172/month 3

4 25% Chlamydia Positivity, 1 st Qtr nd Qtr % Chlamydia Test Positivity, 1 st Qtr nd Qtr % 15% 10% 5% 0% 20.0% 16.3% 9.4% 8.4% Females (PPW) Females (NPP) Males (PPW) Males (NPP) 20.0% 15.0% 10.0% 5.0% 0.0% 1st Qtr '13 2nd Qtr '13 3rd Qtr '13 4th Qtr '13 1st Qtr '14 2nd Qtr '14 Females( PPW) Females (NPP) Males (PPW) Males (NPP) Overall 9.4% Overall 8.4% Overall 20.0% Overall 16.4% 7% 6% 5% 4% 3% 2% 1% 0% 2.3% Gonorrhea Positivity, 1 st Qtr nd Qtr % 6.4% 1.7% Females (PPW) Females (NPP) Males (PPW) Males (NPP) 8.0% 7.0% 6.0% 5.0% 4.0% 3.0% 2.0% 1.0% Gonorrhea Test Positivity, 1 st Qtr nd Qtr % 1st Qtr '13 2nd Qtr '13 3rd Qtr '13 4th Qtr '13 1st Qtr '14 2nd Qtr '14 Females( PPW) Females (NPP) Males (PPW) Males (NPP) Overall 2.3% Overall 1.9% Overall 6.4% Overall 1.7% 4

5 Selective Screening Criteria, Chlamydia Non-PPW FP Females, Jan-Jun 2014 Selective Screening Criteria, Chlamydia Non-PPW FP Females, Jan-Jun 2014 # Tested % of Total # Positive % Positive Criteria (Not mutually exclusive) # with Criterion (# Tested) # Positive % Positive Selective Screening Criteria 4, % % Sex Partner Risk 3, % Contact % Symptomatic % Clinician Discretion % % No Criteria % 6 4.3% History of STD % Protocol Testing % Prenatal % Retest % Special Age Criteria % Clinician Discretion Criteria, Chlamydia Non-PPW FP Females, Jan-Jun 2014 Criteria (Not mutually exclusive) # with Criterion (# Tested) # Positive % Positive >90 Day Partner Change % LARC % Pregnancy Test % Clinician Assessment % 20 5

6 STD Re-testing in WI FP Settings STD Re-Testing of Positives, Non-PPW FP, Jan-Jun 2014 Why is it important to get patients back for re-testing? CDC recommends re-testing patients who test positive > 90 days up to one year post-treatment # Retests in 6 months # Positives in 6 Months Re-Test Estimate # Positive % Positive Previously positive patients are in one of the highest risk groups for infection; the potential for re-infection in this group strongly supports re-testing Baseline* CT positivity: 11% among previously positive patients who were re-tested; re-test rate < 50%; (7.2% positivity rate among all FP women tested) Re-testing visits provide an important opportunity to get patients back into their FP medical home to assess eligibility for FPOS and increase access to other important reproductive needs and services Female CT % % Male CT % % Female GC % 0 0.0% * 2009 data from chart audit in 2010 Male GC % 0 0.0% 21 STD Testing at Time of Pregnancy Test in WI FP settings Why test for an STD when I just want to know if I m pregnant? Exposure to a potential for pregnancy (transmission of sperm in a friendly egg environment) EQUALS Exposure to a potential for an STD (transmission of organisms in a friendly environment) Baseline* CT positivity: 6.8%; 12.9% (PPW; non-ppw FP) among patients tested with reason for test= prenatal (positivity among women tested at time of pregnancy test not yet available) Jan-Jun 2014, only 10 non-ppw FP women with reason for test= pregnant were tested for CT, with one positive Alternative Specimens Location, location, location: vaginal, urine, rectal, pharyngeal? All specimen types can be sent to the WSLH for NAATS testing Vaginal Self-Collect (VSC) swabs Preferred method for females for CT and GC Urine Preferred method for males Rectal & Pharyngeal Specimens are processed at the Milwaukee Health Department Laboratory (MHDL) * Data from Site Report

7 Chlamydia and Gonorrhea Specimen Types, WI Non-PP FP, Jan-Jun % 80% 60% 40% 20% 0% Female Ct Female GC Male Ct Male GC Pharyngeal Rectal Urethral S-C Vaginal Cervical 1, Urine 2, , Why do the WI SSC differ from CDC recommended SSC and the HEDIS CT Measure? HEDIS CT Measure Testing: Measures the proportion of sexually active females between the ages of 15 and 25 who were screened for chlamydial infection annually However, the age ranges for data collected by year for enrollees in Medicaid and Commercial plans combined by state and year included in the table on CDC HEDIS Measure website ( ): for 2000/2002; for 2004/2006; for * The CDC age criterion for CT testing recommendations for women: < 25 years; for retesting positive pregnant women in third trimester: <25 years *(WI combined rate in 2012: 42.3%) 26 Why do the WI SSC differ from CDC recommended SSC and the HEDIS CT Measure? Locally Measured CT HEDIS rates in WI in 2013: Females years of age tested for CT/Sexually active females years of age enrolled in: Non-PPW FP: 40% (4,378/11,923) Title X: 67% (9,576/14,281) PPW*: 50% (15,581/31,407) Locally Measured Medicaid CT HEDIS rates in WI in 2012: Females years of age tested for CT/Sexually active females years of age enrolled in: WI Medicaid 2012: 53% (29,301/54,948) Why do the WI SSC differ from CDC recommended SSC and the HEDIS CT Measure? WI SSC are more sensitive and specific for targeting testing at those more likely to be infected, and therefore more cost effective, in WI FP settings Site report data supports continued use of SSC as a risk assessment tool: Check all that apply on the LRF in WI FP settings Use your site reports to assess quality assurance of services provided and to create baseline measures to improve upon in your clinics * Includes Title X PPW

8 How to use your Site Reports for report period of testing Positivity rates by gender and disease: #positive CT/total #CT tests done in females #positive GC/total #GC tests done in males Positivity rates for On-SSC & Off-SSC by disease: #positive CT/# On-SSC CT tests done #positive GC/# Off-SSC GC tests done Rate of VSC swabs as specimen type: #VSC swabs for CT (or GC)/total #tests for CT (or GC) in females Re-test rate for CT or GC (estimate): #Retests done ( retest checked as reason for test) / # of positives Pregnancy test rate for CT: #CT tests done with pregnancy test as reason for CT test/total #pregnancy tests Pregnancy test positivity rate for CT: #positive CT/total #CT tests done with pregnancy test as reason for CT test Look at your site reports and use your data it IS about your patients!!! Contact Information: Lori Amsterdam, M.P.H. WI Infertility Prevention Program (WIPP) Coordinator Division of Public Health, BCDER STD Control Section-Room 256 Lori.Amsterdam@wisconsin.gov OFFICE