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
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
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.
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
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)
Clinical Measure ≠
Clinical Guideline
• Clinical measure =
– a tool for measuring performance
– quantifiable
• Clinical guideline =
– detailed protocol for management
of a particular healthcare condition
Clinical Performance Measures
Format
OMB No.: 0915-0285. Expiration Date: 08/31/2010
DEPARTMENT OF HEALTH AND HUMAN SERVICES
Health Resources and Services Administration
FOR HRSA USE ONLY
Grant Number
Application Tracking Number
CLINICAL PERFORMANCE MEASURES
Project Period Date
Focus Area: Diabetes
Performance Measure: Percentage of diabetic patients whose HbA1c levels are less than or equal to 9 percent
Is this Performance Measure Applicable to your Organization?
[_] Yes [_] No
Target Goal Description
Number of adult patients age 18 to 75 years with a diagnosis of Type 1 or Type 2 diabetes
Numerator Description
whose most recent hemoglobin A1c level during the measurement year is <= 9%, among
those patients included in the denominator.
Denominator Description
Number of adult patients age 18 to 75 years as of December 31 of the
Baseline Data
Data Source & Methodology
Key Factor and Major Planned Action #1
measurement year with a diagnosis of Type 1 or Type 2 diabetes, who have been
seen in the clinic at least twice during the reporting year and do not meet any of
the exclusion criteria
Baseline Year:
Projected Data (by
Measure Type:
End of Project
Numerator:
Period)
Denominator:
Key Factor Type: [_] Contributing [_] Restricting [_] Not Applicable
Key Factor Description:
Major Planned Action Description:
Key Factor and Major Planned Action #2
Key Factor Type: [_] Contributing [_] Restricting [_] Not Applicable
Key Factor Description:
Major Planned Action Description:
Key Factor and Major Planned Action #3
Key Factor Type: [_] Contributing [_] Restricting [_] Not Applicable
Key Factor Description:
Major Planned Action Description:
Comments
“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”.
“Applicable” Measures
OMB No.: 0915-0285. Expiration Date: 08/31/2010
DEPARTMENT OF HEALTH AND HUMAN SERVICES
Health Resources and Services Administration
FOR HRSA USE ONLY
Grant Number
Application Tracking Number
CLINICAL PERFORMANCE MEASURES
Project Period Date
Focus Area: Diabetes
Performance Measure: Percentage of diabetic patients whose HbA1c levels are less than or equal to 9 percent
Is this Performance Measure Applicable to your Organization?
[_] Yes [_] No
Target Goal Description
Number of adult patients age 18 to 75 years with a diagnosis of Type 1 or Type 2 diabetes
Numerator Description
whose most recent hemoglobin A1c level during the measurement year is <= 9%, among
those patients included in the denominator.
Denominator Description
Number of adult patients age 18 to 75 years as of December 31 of the
Baseline Data
Data Source & Methodology
Key Factor and Major Planned Action #1
measurement year with a diagnosis of Type 1 or Type 2 diabetes, who have been
seen in the clinic at least twice during the reporting year and do not meet any of
the exclusion criteria
Baseline Year:
Projected Data (by
Measure Type:
End of Project
Numerator:
Period)
Denominator:
Key Factor Type: [_] Contributing [_] Restricting [_] Not Applicable
Key Factor Description:
Major Planned Action Description:
Key Factor and Major Planned Action #2
Key Factor Type: [_] Contributing [_] Restricting [_] Not Applicable
Key Factor Description:
Major Planned Action Description:
Key Factor and Major Planned Action #3
Key Factor Type: [_] Contributing [_] Restricting [_] Not Applicable
Key Factor Description:
Major Planned Action Description:
Comments
9
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
Clinical Performance Measures
Baseline
OMB No.: 0915-0285. Expiration Date: 08/31/2010
DEPARTMENT OF HEALTH AND HUMAN SERVICES
Health Resources and Services Administration
FOR HRSA USE ONLY
Grant Number
Application Tracking Number
CLINICAL PERFORMANCE MEASURES
Project Period Date
Focus Area: Diabetes
Performance Measure: Percentage of diabetic patients whose HbA1c levels are less than or equal to 9 percent
Is this Performance Measure Applicable to your Organization?
[_] Yes [_] No
Target Goal Description
Number of adult patients age 18 to 75 years with a diagnosis of Type 1 or Type 2 diabetes
Numerator Description
whose most recent hemoglobin A1c level during the measurement year is <= 9%, among
those patients included in the denominator.
Denominator Description
Number of adult patients age 18 to 75 years as of December 31 of the
Baseline Data
Data Source & Methodology
Key Factor and Major Planned Action #1
measurement year with a diagnosis of Type 1 or Type 2 diabetes, who have been
seen in the clinic at least twice during the reporting year and do not meet any of
the exclusion criteria
Baseline Year:
Projected Data (by
Measure Type:
End of Project
Numerator:
Period)
Denominator:
Key Factor Type: [_] Contributing [_] Restricting [_] Not Applicable
Key Factor Description:
Major Planned Action Description:
Key Factor and Major Planned Action #2
Key Factor Type: [_] Contributing [_] Restricting [_] Not Applicable
Key Factor Description:
Major Planned Action Description:
Key Factor and Major Planned Action #3
Key Factor Type: [_] Contributing [_] Restricting [_] Not Applicable
Key Factor Description:
Major Planned Action Description:
Comments
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)
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
Clinical Performance Measures
Goals
OMB No.: 0915-0285. Expiration Date: 08/31/2010
DEPARTMENT OF HEALTH AND HUMAN SERVICES
Health Resources and Services Administration
FOR HRSA USE ONLY
Grant Number
Application Tracking Number
CLINICAL PERFORMANCE MEASURES
Project Period Date
Focus Area: Diabetes
Performance Measure: Percentage of diabetic patients whose HbA1c levels are less than or equal to 9 percent
Is this Performance Measure Applicable to your Organization?
[_] Yes [_] No
Target Goal Description
Number of adult patients age 18 to 75 years with a diagnosis of Type 1 or Type 2 diabetes
Numerator Description
whose most recent hemoglobin A1c level during the measurement year is <= 9%, among
those patients included in the denominator.
Denominator Description
Number of adult patients age 18 to 75 years as of December 31 of the
Baseline Data
Data Source & Methodology
Key Factor and Major Planned Action #1
measurement year with a diagnosis of Type 1 or Type 2 diabetes, who have been
seen in the clinic at least twice during the reporting year and do not meet any of
the exclusion criteria
Baseline Year:
Projected Data (by
Measure Type:
End of Project
Numerator:
Period)
Denominator:
Key Factor Type: [_] Contributing [_] Restricting [_] Not Applicable
Key Factor Description:
Major Planned Action Description:
Key Factor and Major Planned Action #2
Key Factor Type: [_] Contributing [_] Restricting [_] Not Applicable
Key Factor Description:
Major Planned Action Description:
Key Factor and Major Planned Action #3
Key Factor Type: [_] Contributing [_] Restricting [_] Not Applicable
Key Factor Description:
Major Planned Action Description:
Comments
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
Contributing and Restricting Factors
Performance Measure Description: Percentage of diabetic patients age 18 to 75 whose HbAlc levels are less than or
equal to 9 percent
Is this Performance Measure Applicable
to your Organization?
Target Goal Description
By End of Project Period, increase the % of adult patients age 18 to 75 years
with type 1 or 2 diabetes whose most recent hemoglobin A1c (HbA1c) is ≤ 9%
(under control).
Numerator Description
Number of adult patients age 18 to 75 years with a diagnosis of Type 1 or Type
2 diabetes whose most recent hemoglobin A1c level during the measurement
year is ≤ 9%, among those patients included in the denominator.
Denominator Description
Number of adult patients age 18 to 75 years as of December 31 of the
Baseline Data
Data Source & Methodology
Key Factor and Major Planned Action #1
measurement year (for measurement year 2009, date of birth on or after
January 1, 1934 and on or before December 31, 1991) with a diagnosis of
Type 1 or Type 2 diabetes, who have been seen in the clinic at least twice
during the reporting year and do not meet any of the exclusion criteria
Baseline Year:
Projected Data (by
Measure Type:
End of Project Period)
Numerator:
Denominator:
Key Factor Type: [_] Contributing [_] Restricting [_] Not Applicable
Key Factor Description:
Major Planned Action Description:
Key Factor and Major Planned Action #2
Key Factor Type: [_] Contributing [_] Restricting [_] Not Applicable
Key Factor Description:
Major Planned Action Description:
Key Factor and Major Planned Action #3
Key Factor Type: [_] Contributing [_] Restricting [_] Not Applicable
Key Factor Description:
Major Planned Action Description:
Comments
Sample Clinical Measure
Sample Clinical Measure
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: healthdisparities.net
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
Optional/Supplemental Measures
• Special populations (recommended if applying for special
populations funding)
– Migrant measures: Migrant Clinicians Network
http://www.migrantclinician.org/
– Homeless/Public Housing
• Others
– Special initiatives
– Measures monitored over time: HDC, program specific
• Reporting not required
Resources
• HRSA/BPHC: http://www.bphc.hrsa.gov/
• NAP website:
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/datastatistics/health-center-data/index.html
• Clinical Performance Measures:
– http://www.hrsa.gov/grants/apply/assistance/NAP/perfor
mancemeasures.pdf
– http://bphc.hrsa.gov/about/performancemeasures.htm
Resources
• National Quality Center—Improving HIV Care:
http://www.nationalqualitycenter.org/index.cfm/22
• National Quality Forum: http://www.qualityforum.org/
• National Committee for Quality Assurance:
http://www.ncqa.org/
• Institute for Healthcare Improvement: http://www.ihi.org/
Contact
Candace Kugel, FNP, CNM, MS
ckugel@migrantclinician.org