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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 [email protected] or fax to 604-742-1773. 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: Practice Name:
Name of Reporter: Email:
Telephone:
SECTION 1
Core
Measure
Program/
Practice
Target
Result
1Numerator ÷ Denominator
Calculation
1 Primary Care Visits *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
X100%
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
X100%
Total number of active HIV patients included in the Population of Focus.
Data limitations? Data collection challenges?
1
2
3 Antiretroviral Therapy (ART) uptake among those unequivocally in need of ARTTotal number of those in the denominator who are currently taking ARV
X100%
Total number of active HIV patients included in the Population of Focus who have ever had a CD4 cell count
<200 cells/mm3
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
X100%
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?
5 Patient
Experience: Q1
Sum of all responses that were Excellent and Very Good for question 1 on the Patient Access Survey.
X100% Sum of all responses from question 1 in the Patient
Access Survey.
5 Patient
Experience: Q2
Sum of all responses that were Excellent and Very Good for question 2 on the Patient Access Survey.
X100% Sum of all responses from question 2 in the Patient
Access Survey.
3
5 PatientExperience: Q3
Sum of all responses that were Excellent and Very Good for question 3 on the Patient Access Survey.
X100% Sum of all responses from question 3 in the Patient
Access Survey.
5 Patient
Experience: Q4
Sum of all responses that were Excellent and Very Good for question 4 on the Patient Access Survey.
X100% Sum of all responses from question 4 in the Patient
Access Survey.
5 Patient
Experience: Q5
Sum of all responses that were YES for question 5 from the patient access surveys.
X100% Sum of all responses from question 5 in the Patient
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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 Email Address Phone/Extension
Senior Clinical Leader Clinical/Technical Expert Day-to-day leader
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What was your best practice or innovative change this month as a result of your participation in theCollaborative?
Month/Year Best Practice/Innovative Change
What has been your biggest challenge to sustaining and spreading2 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
Month/Year Description of PDSAs Changes Implemented Spread
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.
6
Decision SupportMonth/Year Description of PDSAs Changes Implemented Spread
Self-Management Support
Month/Year Description of PDSAs Changes Implemented Spread
Delivery System Design
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Health SystemMonth/Year Description of PDSAs Changes Implemented Spread
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!
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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-11 Feb-11 Mar-11 Apr-11 May-11 June-11 July-11 Aug-11 Sept-11 Oct-11 Nov-11 Dec- 11 Jan-12 1 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 5 Patient Experience
