OVERVIEW - Ambulatory Care-Primary Care (HIV Health Services) PERFORMANCE OBJECTIVES FY

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2 erformance bjectives FY 05-6 Ambulatory Care-rimary Care (HIV Services) VERVIEW - Ambulatory Care-rimary Care (HIV Services) ERFRMANCE BJECTIVES FY 05-6 Measuring client improvement and successful completion of target objectives is an important part of SFDH contracting. The HIV Services (HHS) and Contract Development and Technical Assistance (CDTA) sections have been working this past year to create a group of performance objectives that are standardized across most service categories. ur goal was to build from current objectives, and create meaningful, measurable, demonstrable objectives that will accurately reflect the good work that you provide to your clients, and will lead to a clearly understood and interpreted review of performance in meeting objectives. These new performance objectives are effective on the first date of the contract year for For example, contracts with Ryan White funding are required to begin using the new objectives on March, 05, and contracts with General Fund dollars are required to begin using the new objectives on July, 05. Contracts that contain more than one source of funding are required to begin using the new objectives on whichever funding cycle is earliest: in most cases this will be March, 05. If you are unsure as to when the new objectives are effective for your program please call the CDTA rogram Manager assigned to your contract. Not all objectives apply to all programs. roviders should review this document carefully to determine the objectives that are applicable to the funded program(s). Contractors are responsible for compliance with all applicable items in the erformance bjectives and the Declaration of Compliance.

3 Ambulatory Care-rimary Care (HIV Service) erformance bjectives FY 05-6 A B C D E F G H I J K L M N Q R S T Note: lease review the "Unique rogram" bjectives to determine if your program has objectives in addition to, or instead of, those that have been TYE F BJECTIVE Ambulatory utpatient Home Care utpatient Mental utreach sychosocial Support bjectives rogram Review) eriod NTES 3 70% of clients with HIV (rimary Care documented in ARIES) will have had two or more medical visits at least three months apart. s Enrolled 6 months ARIES report of documentation required in database of client records. % may vary; program s CDTA rogram Manager to discuss with HHS; if lower % approved, separate agreement signed, shared with HHS & BCC. Evaluation & is "Medical Visit Indicator" in ARIES / HRSA HIV/AIDS Bureau (HAB) Quality Management (QM) Report NTE: This bjective not applicable to SFDH- JHS-HIV-IS or City Clinic. 4 85% of clients with HIV (rimary Care documented in ARIES) who received primary care services will have been offered and prescribed HAART. s Enrolled 6 months ARIES report of documentation required in database of client records. % may vary; program s CDTA rogram Manager to discuss with HHS; if lower % approved, separate agreement signed, shared with HHS & BCC.. Evaluation & is "HAART Indicator" in ARIES HAB QM Report NTE: UCSF HAST rogram has a goal of 55% for this objective. 5 90% of clients with HIV who received primary care services (documented in ARIES) will have had at least one viral load test. s Enrolled 6 months ARIES report of documentation required in database of client records. % may vary; program s CDTA rogram Manager to discuss with HHS; if lower % approved, separate agreement signed, shared with HHS & BCC.. Evaluation & is "Viral Load Test Table" filtered by primary care services in ARIES STAR Report 3

4 Ambulatory Care-rimary Care (HIV Service) erformance bjectives FY 05-6 A B C D E F G H I J K L M N Q R S T Note: lease review the "Unique rogram" bjectives to determine if your program has objectives in addition to, or instead of, those that have been 6 TYE F BJECTIVE Ambulatory utpatient Home Care utpatient Mental utreach sychosocial Support bjectives 70%, of clients on HAART (rimary Care documented in ARIES) will have a viral load 00 copies/ml which will indicate viral suppression and successful treatment adherence. 3 s Enrolled 6 months rogram Review) ARIES report of documentation required in database of client records eriod NTES. % may vary; program s CDTA rogram Manager to discuss with HHS; if lower % approved, separate agreement signed, shared with HHS & BCC.. For Medical Case Management rate is 75% of clients on HAART. 3. Evaluation & ment is "Viral Load Values Table" filtered by primary care services in QM HAB Report NTE: UCSF HAST rogram has a goal of 50% for this objective. 80% of clients with HIV (rimary Care documented in ARIES) with CD4 T-cell count below 00 cells/mm3 will be prescribed C prophylaxis. All rimary Care s with T- cell Counts Below the Threshold ARIES report of documentation required in database of client records. Evaluation & ment is "C rophylaxis Indicator" in ARIES HAB QM Report NTE: This bjective not applicable to SFDH- JHS-HIV-IS or City Clinic. For UCSF HAST rogram the goal for this objective is 75% % of clients with HIV who received primary care services (documented in ARIES) will be tested for syphilis at least once, with results documented. s Enrolled 6 months ARIES report of documentation required in database of client records. % may vary; program s CDTA rogram Manager to discuss with HHS; if lower % approved, separate agreement signed, shared with HHS & BCC.. Evaluation & ment is "Syphilis Screen Indicator" in ARIES HAB QM Report 4

5 Ambulatory Care-rimary Care (HIV Service) erformance bjectives FY 05-6 A B C D E F G H I J K L M N Q R S T Note: lease review the "Unique rogram" bjectives to determine if your program has objectives in addition to, or instead of, those that have been TYE F BJECTIVE Ambulatory utpatient Home Care utpatient Mental utreach sychosocial Support bjectives rogram Review) eriod NTES 9 60% of clients with HIV who received primary care services (documented in ARIES) are screened for Hepatitis C. s Enrolled 6 mos., except those who previously tested HepC+ ARIES report of documentation required in database of client records. % may vary; program s CDTA rogram Manager to discuss with HHS; if lower % approved, separate agreement signed; shared with HHS & BCC.. Evaluation & ment is "Hepatitis C Screen since HIV Dx Indicator" in ARIES RSR. Values of "Hepatitis C Screen since HIV Dx Indicator" for Yes & Not Medically Indicated qualify as screening & should be added to calculate compliance with 60% target 0 80% of clients identified as out of care will be linked to primary care (documented in ARIES) as measured by attendance at a medical appointment within 30 days of being identified as out of care. All clients who are out of care ARIES (rograms will provide a list of out of care clients). % may vary; program s CDTA rogram Manager to discuss with HHS; if lower % approved; separate agreement signed; shared with HHS & BCC. ut of Care = any client that hasn't had primary care app't. 3 or more mos. apart 90% of clients will be assessed for mental health and substance use treatment needs within 30 days of program enrollment. All New s 5

6 Ambulatory Care-rimary Care (HIV Service) erformance bjectives FY 05-6 A B C D E F G H I J K L M N Q R S T Note: lease review the "Unique rogram" bjectives to determine if your program has objectives in addition to, or instead of, those that have been TYE F BJECTIVE Ambulatory utpatient Home Care utpatient Mental utreach sychosocial Support bjectives rogram Review) eriod NTES 80% of individualized service plans will be developed within 90 days of initial client intake. All s (include acuity scale, harm reduction & tx plan). Comprehensive individualized plan includes Mental & Substance Use assessment. Tx plan signed by client and clinician 3 80% of individualized service plans will be updated at least every 6 mos. All s (include acuity scale, harm reduction & tx plan). Comprehensive individualized plan includes Mental Heath & Substance Use assessment 4 90% of residents will be adherent to their treatment regimen. All Residents Medication logs. % may vary; program s CDTA rogram Manager to discuss with HHS. If lower % is approved, separate agreement signed, shared with HHS & BCC 5 No more than 0% of unduplicated mental health clients will be lost to follow-up. All New s Receiving Services 6 Months. Lost to follow-up = one who assigned clinician has been unable to contact or locate after several attempts (does not include clients who declines services in favor of others, relocate outside service area, or are deceased). 6 At least 90% of residents will have an "End of Life lan" and documentation will exist prominently in resident's chart. All rogram s Applicable to Maitri AIDS Hospice 6

7 Ambulatory Care-rimary Care (HIV Service) erformance bjectives FY 05-6 A B C D E F G H I J K L M N Q R S T Note: lease review the "Unique rogram" bjectives to determine if your program has objectives in addition to, or instead of, those that have been TYE F BJECTIVE Ambulatory utpatient Home Care utpatient Mental utreach sychosocial Support bjectives rogram Review) eriod NTES At least 90% of applicable resident records will contain documentation that referral has been made to the Alliance roject Dementia Team for evaluation. atients with Dementia Symptoms Applicable to Maitri AIDS Hospice. symptoms that impact physical or mental health, or pose a risk of falls or elopement 7 8 At least 70% of clients will experience a stabilization or decrease in pain resulting from implementation of the pain management plan. All s Receiving ain Meds, client self report Applicable to Maitri AIDS Hospice and SFDH at Home rogram. % may vary; program s CDTA rogram Manager to discuss with HHS; if lower % approved, separate agreement signed, shared with HHS & BCC. ain is assessed at entry to the program and at least every 60 days NTE: SFDH at Home Goal for this bjective is 50%. 9 At least 80% of clients who agree to obtain medical care will receive a primary care evaluation visit within 4 weeks of testing positive or being identified as "out-of-care". HIV+ s utof-care MNHC Data and ARIES (rogram provides list of out of care clients) Applicable to MNHC HIV Treatment, utreach and Linkage rogram. A client identified as "out of care" is one who hasn't had at least primary care appts 3 mos. apart. 7

8 Ambulatory Care-rimary Care (HIV Service) erformance bjectives FY 05-6 A B C D E F G H I J K L M N Q R S T Note: lease review the "Unique rogram" bjectives to determine if your program has objectives in addition to, or instead of, those that have been TYE F BJECTIVE Ambulatory utpatient Home Care utpatient Mental utreach sychosocial Support bjectives rogram Review) eriod NTES 0 At least 80% of clients who do not agree to obtain medical care will receive a follow-up contact within one week; if the client allows, follow-up will continue on a monthly basis until the client engages in medical care. HIV+ s utof-care who've not yet Agreed to Receive MNHC Charts and Data, and ARIES Applicable to MNHC HIV Treatment, utreach and Linkage rogram. At least 60% of clients that receive a primary care appt will remain engaged in primary care and will return for at least one follow-up primary care appointment. HIV+ s Receiving rimary Care at MNHC MNHC Charts and Data, and ARIES Applicable to MNHC HIV Treatment, utreach and Linkage rogram. At least 50% of clients accessing HIV Testing for whom a referral for medical, mental health, or substance abuse counseling services is indicated, and who are willing to accept the referral, will have accessed the service(s). rogram s that btain an HIV Test Tracking Sheet or Summary of MNHC Follow-Up Notes Applicable to MNHC HIV Treatment, utreach and Linkage rogram. 3 At least 75% of HIV+ clients diagnosed with diabetes will achieve blood sugar control of 9 on the Hemoglobin AC blood test (HgbAC 9). HIV+ s with Diabetes Agency Report from Internal Database of AC blood test Applicable to MNHC and UCSF 360 ositive Care Center Nutrition Services 8

9 Ambulatory Care-rimary Care (HIV Service) erformance bjectives FY 05-6 A B C D E F G H I J K L M N Q R S T Note: lease review the "Unique rogram" bjectives to determine if your program has objectives in addition to, or instead of, those that have been TYE F BJECTIVE Ambulatory utpatient Home Care utpatient Mental utreach sychosocial Support bjectives rogram Review) eriod NTES 4 At least 90% of clients will develop an individual plan to access entitlement programs and other available resources. All rogram s Applicable to RC rogram & SFAF Services NTE: HRSA Categories are Non Medical Case Management & Referral for care and Supportive Services 5 At least 60% of clients who complete the Satisfaction Survey will report a decreased level of stress since attending/participating in the program. s Annual Survey Agency Report on Responses of Decreased I Feel Less Stress Now Applicable to Shanti Emotional and ractical Support rogram and UCSF 360 ositive Care African American HIV Men's Support Group. (objective is in addition to other unique objectives for each program) 6 At least 95% of clients will exhibit an improvement of the dental condition due to the dental disease being managed. All s Receiving Dental rocedure & a Tx lan Randomly Audited Records (paper or electronic) Applicable to U Dental rogram and DH HIV Dental rogram.. Sample size = 0 or 0% of annual UDC, whichever is smaller; a list of random clients is created (via ARIES or other process) & tracking sheet lists clients by anonymous unique ID & reports on meeting this goal for each client 9

10 Ambulatory Care-rimary Care (HIV Service) erformance bjectives FY 05-6 A B C D E F G H I J K L M N Q R S T Note: lease review the "Unique rogram" bjectives to determine if your program has objectives in addition to, or instead of, those that have been TYE F BJECTIVE Ambulatory utpatient Home Care utpatient Mental utreach sychosocial Support bjectives rogram Review) eriod NTES 7 UNIQUE RGRAM BJECTIVES 8 At least 95% of valid client requests for Emergency Assistance payments to 3rd party vendors will be processed within 0 business days after completion of client file documentation. All s Applicable to AIDS Emergency Fund 9 At least 95% of valid client requests for Eviction revention payments to 3rd party vendors will be processed within 5 business days after completion of client file documentation. All s Applicable to AIDS Emergency Fund 30 AEF services will prevent eviction of at least 40 clients. All s Agency self report via internal monthly and quarterly reports Applicable to AIDS Emergency Fund 3 AEF services will enable at least 40 clients to move into permanent affordable or subsidized housing. All s Agency self report via internal monthly and quarterly reports Applicable to AIDS Emergency Fund 3 ALR will provide at minimum 8 legal trainings or seminars to pro-bono attorneys. ro-bono Attorneys Training Logs Applicable to ALR HIV Legal Services: Advocacy rogram 0

11 Ambulatory Care-rimary Care (HIV Service) erformance bjectives FY 05-6 A B C D E F G H I J K L M N Q R S T Note: lease review the "Unique rogram" bjectives to determine if your program has objectives in addition to, or instead of, those that have been TYE F BJECTIVE Ambulatory utpatient Home Care utpatient Mental utreach sychosocial Support bjectives rogram Review) eriod NTES ALR will maintain a baseline of 380 active anel Attorneys by recruiting at least 5% of its baseline to address attrition and expand its capacity in areas of law with the greatest client demand for services. anel Attorneys Agency Report Applicable to ALR HIV Legal Services: Advocacy rogram ALR will conduct at least 4 outreach presentations to community based organizations and client groups on rights of people with HIV/AIDS Community and Groups Tracking Files Applicable to ALR HIV Legal Services: Advocacy rogram 35 At least 90% of cases in which there is no legal remedy will be referred for a nd opinion and/or to an appropriate HIV/AIDS provider, or to another system of care to support the client through resolution of the issue. Cases in which ALR Determines No Legal Remedy Applicable to ALR HIV Legal Services: Advocacy rogram 36 At least 85% of closed cases will be successfully resolved. All Closed Cases Agency Report on Review of 00 Cases from Tracking Logs and Database Applicable to ALR HIV Legal Services: Advocacy rogram. Successful resolution defined as drafting client's legal documents, resolving dispute, or exhausting reasonable legal avenues

12 Ambulatory Care-rimary Care (HIV Service) erformance bjectives FY 05-6 A B C D E F G H I J K L M N Q R S T Note: lease review the "Unique rogram" bjectives to determine if your program has objectives in addition to, or instead of, those that have been TYE F BJECTIVE Ambulatory utpatient Home Care utpatient Mental utreach sychosocial Support bjectives rogram Review) eriod NTES 37 HIV Consumer Advocacy roject (HCA) attorney participates in 6 continuing education training sessions related to active listening, mediation of consumer grievances, harm reduction, working with individuals with mental health issues, & other topics as needed. HCA Attorney N/A for s Training Logs Applicable to ALR HIV Consumer Advocacy roject 38 HCA Attorney conducts consumer outreach presentations and outreach presentations to HIV/AIDS service providers. HIV Consumers and roviders utreach Logs Applicable to ALR HIV Consumer Advocacy roject 39 At least 85% of HIV consumers served will be residents of SF; 5% may be residents of San Mateo and/or Marin. HIV Consumers of Local EMA rogram Database Applicable to ALR HIV Consumer Advocacy roject 40 At least 80% of provider attendees of ALR HCA outreach presentations report that presentation was relevant & useful to work with clients. Attendees at resentations Agency Attendance Lists and Survey Results Applicable to ALR HIV Consumer Advocacy roject 4 At least 85% of respondents to the consumer survey will report they were "satisfied with the service received from the HCA Attorney". Consumer Respondents of Survey Agency Summary Report of Annual Survey Applicable to ALR HIV Consumer Advocacy roject

13 Ambulatory Care-rimary Care (HIV Service) erformance bjectives FY 05-6 A B C D E F G H I J K L M N Q R S T Note: lease review the "Unique rogram" bjectives to determine if your program has objectives in addition to, or instead of, those that have been TYE F BJECTIVE Ambulatory utpatient Home Care utpatient Mental utreach sychosocial Support bjectives rogram Review) eriod NTES 4 Less than 0% of residents will need to be transferred to a higher level of care in order to meet their needs. All s Applicable to Catholic Charities eter Claver and Leland Houses; and Dolores Street Services At least 90% of clients referred for services will be evaluated for psychosocial services, long range plans, and end of life decisions. At least 70% of active clients will maintain or improve function in ambulation, bathing, dressing, grooming, and transferring. All s All rogram s, or client self report Applicable to at Home rogram Applicable to at Home rogram 45 At least 90% of clients in the Treatment Adherence rogram will demonstrate adherence to the medication regimen prescribed. All clients of Treatment Adherence rogram Records (all Rx Meds Taken Documented) Applicable to at Home rogram 46 90% of clients with HIV who received primary care services (documented in ARIES) will have had at least one viral load test. s Enrolled 6 months ARIES report of documentation required in database of client records Applicable to Larkin St Youth Services 3

14 Ambulatory Care-rimary Care (HIV Service) erformance bjectives FY 05-6 A B C D E F G H I J K L M N Q R S T Note: lease review the "Unique rogram" bjectives to determine if your program has objectives in addition to, or instead of, those that have been TYE F BJECTIVE Ambulatory utpatient Home Care utpatient Mental utreach sychosocial Support bjectives rogram Review) eriod NTES 47 The Youth Advocate will provide 90% Aftercare rogram clients in scattered site housing with home visits, and/or practical support visits (going to appts, etc.) per month. s Receiving HIV Specialty Svcs 60 Days Applicable to Larkin St Youth Services 48 At least 80% of LSYS HIV+ youth who age out of services (5 yr) will be linked to adult HIV care. HIV+ Youth that Age ut Applicable to Larkin St Youth Services 49 80% of youth housed in Assisted Care receiving nursing care or peer advocacy support through HIV Specialty Services will demonstrate increased medication adherence. HIV+ Youth Agency Report from Internal Database; Files (physical or electronic) rogram Entry, Updated Quarterly, Reported at FY End Applicable to Larkin St Youth Services 75% of clients receiving money management services will maintain stability in housing for 6 months. s Enrolled 6 Months Applicable to Lutheran Social Services Money Management % of clients receiving services will be able to retain housing due to guarantee that rent will be paid. At least 55% of unduplicated clients referred by the SFDH will respond to the annual client satisfaction survey. All rogram s All rogram s Agency Summary Report of Annual Survey Applicable to Lutheran Social Services Money Management Applicable to Native American Center Dental rogram (patients referred through DH dental services) This objective is in place of other dentistry services 4

15 Ambulatory Care-rimary Care (HIV Service) erformance bjectives FY 05-6 A B C D E F G H I J K L M N Q R S T Note: lease review the "Unique rogram" bjectives to determine if your program has objectives in addition to, or instead of, those that have been TYE F BJECTIVE Ambulatory utpatient Home Care utpatient Mental utreach sychosocial Support bjectives At least 75% of those who complete survey will report that the dental issue they were referred for by SFDH was addressed in a satisfactory manner. At least 85% of the client cases in which claims for benefits have been filed and have been fully adjudicated by program representation will result in a favorable decision or an award for the client. s Surveyed s Who Filed Benefits Claims & Which Have Been Fully Adjudicated rogram Review) Agency Summary Report of Annual Survey Annual Agency Self Report to HHS and BCC eriod NTES Applicable to Native American Center Dental rogram (patients referred through DH dental services) This objective is in place of other dentistry services standardized objectives. Applicable to ositive Resource Center Benefits Counseling rogram. Agency Report includes % of claims awarded at initial, reconsideration, Administrative Law Hearing, or Appeals level; decisions at same, and for Continuing Disability Reviews; by proof of award (notice received from SSA, or documented in SSA or CalMED database). 55 At least 30% of clients who develop an Individual Service lan will receive authorizations to work with a Dept of Rehab (DR) Vocational Counselor on an Employment lan. s Who Develop an IS Applicable to ositive Resource Center Employment Services rogram 56 At least 70% of clients who develop an Individual Service lan will enroll in a single or multi-session training curriculum designed to increase their capacity to become employed. s Who Develop an IS Applicable to ositive Resource Center Employment Services rogram 5

16 Ambulatory Care-rimary Care (HIV Service) erformance bjectives FY 05-6 A B C D E F G H I J K L M N Q R S T Note: lease review the "Unique rogram" bjectives to determine if your program has objectives in addition to, or instead of, those that have been TYE F BJECTIVE Ambulatory utpatient Home Care utpatient Mental utreach sychosocial Support bjectives rogram Review) eriod NTES 57 At least 5% of clients who develop an Individual Service lan will secure a permanent or temporary full-time or part-time job placement. s Who Develop an IS, client self report Applicable to ositive Resource Center Employment Services rogram 58 The Employment Specialist will track client income and benefits before and after securing a permanent placement to quantify the impact of employment. s Who Secure a ermanent lacement Agency Database Applicable to ositive Resource Center Employment Services rogram 59 H Food perations Committee will assure the nutritional quality and safety of the prepared meals for HIV+ clients. All HIV+ s committee meetings via minutes Applicable to roject pen Hand 60 H Grocery Center Committee will review operations and the grocery food items offered to HIV+ clients. All HIV+ s Agency report of committee meetings via minutes Applicable to roject pen Hand 6 H will provide at least one nutrition education opportunity to all clients in the program. All HIV+ s Applicable to roject pen Hand 6 H will collect nutritional and medical data from each new and renewing client and/or the client's medical provider(s). All HIV+ s Applicable to roject pen Hand 6

17 Ambulatory Care-rimary Care (HIV Service) erformance bjectives FY 05-6 A B C D E F G H I J K L M N Q R S T Note: lease review the "Unique rogram" bjectives to determine if your program has objectives in addition to, or instead of, those that have been TYE F BJECTIVE Ambulatory utpatient Home Care utpatient Mental utreach sychosocial Support bjectives rogram Review) eriod NTES H will measure engagement rates of clients with 6 months of service. At least 60% of HIV+ clients who return survey will report "program helps maintain or improve my health". At least 60% of HIV+ clients who return survey will report "nutrition education increased my knowledge of nutrition in addressing HIV and overall health". All HIV+ s s Annual Survey s Annual Survey Records Survey Results Survey Results Applicable to roject pen Hand Applicable to roject pen Hand Applicable to roject pen Hand 66 At least 75% of clients served with a comprehensive s Receiving evaluation will demonstrate receipt of, or in process Comp Evaluation of receiving eligible benefits., client self report Applicable to SFAF Non Medical Case Management & Services Lab staff will conduct initial screening and complete confirmatory HIV testing of specimens within 5 working days. At least 95% of HIV Viral Load specimens are processed, tested, and results are reviewed and reported by Sr. Microbiologist 7 business days from specimen collection date. Tests erformed Tests erformed achievement utilizing lab database Testing Accuracy per Nat'l roficiency Testing rogram Scoring 80% Applicable to SFDH Microbiology Lab. Lab performs confirmatory testing on all preliminary positive test results Applicable to SFDH Microbiology Lab 7

18 Ambulatory Care-rimary Care (HIV Service) erformance bjectives FY 05-6 A B C D E F G H I J K L M N Q R S T Note: lease review the "Unique rogram" bjectives to determine if your program has objectives in addition to, or instead of, those that have been TYE F BJECTIVE Ambulatory utpatient Home Care utpatient Mental utreach sychosocial Support bjectives rogram Review) eriod NTES 69 At least 80% of clients that complete a survey will show an improvement in oral health through a reduction or elimination of pain/discomfort by a rating 3. s Annual Survey Agency Annual Summary Report of Results based on a 5 point Likert Scale Applicable to SFDH HIV Dental rogram. Work continues with HHS to write standardized objectives with other dental programs for implementation in FY6-7 (does not apply to NAHC ) 70 At least 80% of clients that complete a survey will show an improvement in oral health through an increase or improvement in ability to chew/maintain healthy nutrition by a rating 3. s Annual Survey Agency Annual Summary Report of Results based on a 5 point Likert Scale Applicable to SFDH HIV Dental rogram. Work continues with HHS to write standardized objectives with other dental programs for implementation in FY6-7 (does not apply to NAHC ) 7 At least 80% of clients that complete a survey will show an improvement in oral health through an increase or improvement in self confidence/ability to smile by a rating 3 s Annual Survey Agency Annual Summary Report of Results based on a 5 point Likert Scale Applicable to SFDH HIV Dental rogram. Work continues with HHS to write standardized objectives with other dental programs for implementation in FY6-7 (does not apply to NAHC ) 7 At least 80% of clients that complete a survey will show an improvement in oral health through an improvement in overall quality of life as a result of dental care by a rating 3. s Annual Survey Agency Annual Summary Report of Results based on a 5 point Likert Scale Applicable to SFDH HIV Dental rogram. Work continues with HHS to write standardized objectives with other dental programs for implementation in FY6-7 (does not apply to NAHC ) 8

19 Ambulatory Care-rimary Care (HIV Service) erformance bjectives FY 05-6 A B C D E F G H I J K L M N Q R S T Note: lease review the "Unique rogram" bjectives to determine if your program has objectives in addition to, or instead of, those that have been TYE F BJECTIVE Ambulatory utpatient Home Care utpatient Mental utreach sychosocial Support bjectives rogram Review) eriod NTES At least 90% of clients assessed as eligible for SSI Disability will have the SSI evaluation written within weeks of the initial assessment. s Eligible for SSI Disability Benefits List of SSI Disability eligible clients & monthly stat form Applicable to SFDH South Van Ness Adult Behavioral Services SF Food Bank will maintain an average product nutrition rating of.5 on a scale of 0-3 based on nutrient content provided by Nutrition Facts Label. Inventory Available to Agencies Funded by HHS nutrition evaluation tool: CHEW (Choosing y Eating Well) Applicable to SF Food Bank 75 At least 75% of the HHS funded agencies will report that food received helps their clients meet nutritional needs in response to a provider satisfaction survey. HHS-funded Service roviders Receiving SFFB Food Agency Summary Report of rovider Satisfaction Survey Applicable to SF Food Bank 76 The AIDS/HIV Nightline will conduct an outreach campaign consisting of 0 MUNI posters, 500 posters and 0,000 cards distributed at social service agencies. Not Applicable Agency Report Applicable to SF Suicide revention Nightline HIV Nightline will respond to,05 calls from SF residents living with HIV. Not Applicable Agency Report Applicable to SF Suicide revention Nightline 77 9

20 Ambulatory Care-rimary Care (HIV Service) erformance bjectives FY 05-6 A B C D E F G H I J K L M N Q R S T Note: lease review the "Unique rogram" bjectives to determine if your program has objectives in addition to, or instead of, those that have been 78 TYE F BJECTIVE Ambulatory utpatient Home Care utpatient Mental utreach sychosocial Support bjectives At least volunteer training classes will be completed assuring that each new volunteer receives 3 hrs. of in-class instruction and 8 hrs. of actual telephone on-line training. New Volunteers rogram Review) Training Attendance Logs eriod NTES Applicable to SF Suicide revention Nightline 79 At least 75% of new clients seeking practical support are matched to staff or a volunteer within 5 business days. New s Applicable to Shanti Emotional and ractical Support 80 At least 70% of clients who complete the annual client satisfaction survey will report a decreased level of isolation since being connected with program staff or volunteers. s Annual Survey Responses of "Decreased - I feel less isolated now." on client surveys. Applicable to Shanti Emotional and ractical Support 8 At least 60% of clients who complete the annual client satisfaction survey will report an increased level of self sufficiency since being connected with program staff or volunteers. s Annual Survey Responses of "Increased - I feel more self-sufficient now." on client surveys. Applicable to Shanti Emotional and ractical Support 8 rogram will generate and review a list of clients not engaged in rimary Care and will follow-up with the identified clients on a quarterly basis. All s not Engaged in rimary Care ARIES Report Applicable to Shanti Medical Case Management rogram. rogram must retain all generated quarterly ARIES reports for review by BCC. NTE: Case Manager coordinates with RN(subcontractor) quarterly for follow up by the eer Advocate. 0

21 Ambulatory Care-rimary Care (HIV Service) erformance bjectives FY 05-6 A B C D E F G H I J K L M N Q R S T Note: lease review the "Unique rogram" bjectives to determine if your program has objectives in addition to, or instead of, those that have been TYE F BJECTIVE Ambulatory utpatient Home Care utpatient Mental utreach sychosocial Support bjectives rogram Review) eriod NTES 83 The Director reviews timelines in the Comprehensive lan to ensure topics for discussion are included on appropriate meeting agendas in a timely manner. Not Applicable Steering Committee Retreat Calendar Applicable to Shanti lanning Council Support 84 The Director coordinates various presentations to the lanning Council to ensure the materials and information reviewed fulfill all legislative requirements and council directives. Not Applicable resentation Summary during rioritization and Allocations process Applicable to Shanti lanning Council Support 85 All new lanning Council (C) members are provided rientation Training at the beginning of their terms. At least 3 additional skills-development trainings are provided to new and continuing members in subjects which may include, but are not limited to: Ryan White lanning Council Members rogram Documentation - Training Logs Applicable to Shanti lanning Council Support. Robert's Rules of rder, Rules of Respective Engagement, rivacy Rights, Cultural Humility, Chairing/Leading Meetings, and/or other trainings identified by the C Director.. No site visit required; C Director prepares written report for HHS The lanning Council Director participates in the evaluation of success in meeting goals of the Comprehensive lan and provides a written report to lan Council members each year. Ryan White lanning Council Members rogram Report to Council Applicable to Shanti lanning Council Support. No site visit required; C Director prepares written report for HHS 86

22 Ambulatory Care-rimary Care (HIV Service) erformance bjectives FY 05-6 A B C D E F G H I J K L M N Q R S T Note: lease review the "Unique rogram" bjectives to determine if your program has objectives in addition to, or instead of, those that have been TYE F BJECTIVE Ambulatory utpatient Home Care utpatient Mental utreach sychosocial Support bjectives rogram Review) eriod NTES 87 All lanning Council members receive ongoing core competency training in areas identified by the Training Needs Analysis to be conducted and updated by the Training and Evaluation Coordinator. Ryan White lanning Council Members rogram Documentation - Training Logs Calendar Year Applicable to Shanti lanning Council Support 88 90% of neuropsychological testing findings will be reported to referring provider weeks from completion of neuropsychological testing.. As Defined by Agency rotocol Records, Call Logs Applicable to UCSF Alliance roject utpatient Mental rogram 89 80% of treatment of care plans will be developed within 90 days of client being assigned to a provider As Defined by Agency rotocol Records, Call Logs Applicable to UCSF Alliance roject utpatient Mental rogram 80% of treatment of care plans will be reviewed and updated for clients still engaged in care for more than one year. As Defined by Agency rotocol Records, Call Logs Applicable to UCSF Alliance roject utpatient Mental rogram 90

23 Ambulatory Care-rimary Care (HIV Service) erformance bjectives FY 05-6 A B C D E F G H I J K L M N Q R S T Note: lease review the "Unique rogram" bjectives to determine if your program has objectives in addition to, or instead of, those that have been TYE F BJECTIVE Ambulatory utpatient Home Care utpatient Mental utreach sychosocial Support bjectives rogram Review) eriod NTES 9 No more than 0% of unduplicated mental health clients will be lost to follow-up within the contract year As Defined by Agency rotocol Records, Call Logs Applicable to UCSF Alliance roject utpatient Mental rogram (Note: lost to follow-up is defined as one who the assigned clinician has been unable to contact or locate after several attempts. This does not include clients who decline services in favor of others, relocate outside of the service area or are deceased.) 80% of CW treatment of care plans will be developed within 90 days of client being assigned to a provider. As Defined by Agency rotocol Records, Call Logs Applicable to UCSF Alliance roject - Considering Work rogram 9 93 No more than 0% of unduplicated CW clients will be lost to follow-up within the contract year. As Defined by Agency rotocol Records, Call Logs Applicable to UCSF Alliance roject - Considering Work rogram (Note: lost to followup is defined as one who the assigned clinician has been unable to contact or locate after several attempts. This does not include clients who decline services in favor of others, relocate outside of the service area or are deceased.) 3

24 Ambulatory Care-rimary Care (HIV Service) erformance bjectives FY 05-6 A B C D E F G H I J K L M N Q R S T Note: lease review the "Unique rogram" bjectives to determine if your program has objectives in addition to, or instead of, those that have been TYE F BJECTIVE Ambulatory utpatient Home Care utpatient Mental utreach sychosocial Support bjectives rogram Review) eriod NTES 94 60% of clients who complete a pre- and post-test Q-45. utcome Questionnaire, and who identify problem areas on the pre-test, will show improvement in at least one of these areas on the post-test. As Defined by Agency rotocol Records, Call Logs Applicable to UCSF Alliance roject utpatient Mental rogram % of clients who complete a Satisfaction Questionnaire will report that the services they received: a. "Helped a great deal" or "Helped somewhat" to deal more effectively with their concerns or problems. b. "Helped very much" or "Helped somewhat" to protect themselves form HIV infection. c. "Helped very much" or "Helped somewhat" to talk to their partners about their HIV infection status. The number of HIV- genotypic drug resistance tests completed at the different clinic sites will be tabulated for program monitoring. As Defined by Agency rotocol Tests Completed Records, Call Logs data upon request, tabulated on Excel database Applicable to UCSF Alliance roject utpatient Mental rogram Applicable to UCSF/ARI Clinical Virology Lab 97 Key data will be tabulated for each HIV- genotypic resistance test performed under the contract, including selected patient demographics and requesting provider clinic site. Tests Completed data upon request, tabulated on Excel database Applicable to UCSF/ARI Clinical Virology Lab 4

25 Ambulatory Care-rimary Care (HIV Service) erformance bjectives FY 05-6 A B C D E F G H I J K L M N Q R S T Note: lease review the "Unique rogram" bjectives to determine if your program has objectives in addition to, or instead of, those that have been TYE F BJECTIVE Ambulatory utpatient Home Care utpatient Mental utreach sychosocial Support bjectives rogram Review) eriod NTES 98 At least 90% of clients completing 3 months will have received basic HIV disease education from a Nurse ractitioner or RN. s 3 Mos. of Service Applicable to UCSF/DSAAM W At least 70% of clients with inconsistent or no primary care will have met with a primary care provider at least once within 3 mos. of initiating substance abuse treatment. s Referred with Inconsistent or No rimary Care Applicable to UCSF/DSAAM W At least 70% of clients identified as needing a mental health assessment will have completed a psychiatric evaluation within 6 mos. of initiating substance abuse treatment. At least 60% of clients will report increased level of understanding HIV treatments and importance of remaining engaged in medical care. s Needing Mental Assessments s Annual Survey responses: Increased Understanding" of HIV Care and Tx, & Applicable to UCSF/DSAAM W93. Applicable to UCSF 360 ositive Care Center African American HIV Men's Support Group 0 At least 80% of clients surveyed will report that "Ease of Scheduling My Appointment" as "Excellent" or "Good". ¹ s Survey Responses Submitted to HHS & BCC Applicable to U Dental School. 80% Yes on Yes/No questions and 80% "Excellent" or "Good" on four point scale (as opposed to Fair or oor). 5

26 Ambulatory Care-rimary Care (HIV Service) erformance bjectives FY 05-6 A B C D E F G H I J K L M N Q R S T Note: lease review the "Unique rogram" bjectives to determine if your program has objectives in addition to, or instead of, those that have been TYE F BJECTIVE Ambulatory utpatient Home Care utpatient Mental utreach sychosocial Support bjectives rogram Review) eriod NTES 03 At least 80% of clients surveyed will report "verall Cultural Sensitivity" as "Excellent" or "Good" for Students, Faculty and Staff. ¹ s Survey Responses Submitted to HHS & BCC Applicable to U Dental School. 80% Yes on Yes/No questions and 80% "Excellent" or "Good" on four point scale (as opposed to Fair or oor). 04 At least 80% of clients surveyed will report "How My roposed Treatment was Explained to Me" as "Excellent" or "Good". ¹ s Survey Responses Submitted to HHS & BCC Applicable to U Dental School. 80% Yes on Yes/No questions and 80% "Excellent" or "Good" on four point scale (as opposed to Fair or oor). 05 At least 80% of clients surveyed will report "verall Quality of Treatment" as "Excellent" or "Good". ¹ s Survey Responses Submitted to HHS & BCC Applicable to U Dental School. 80% Yes on Yes/No questions and 80% "Excellent" or "Good" on four point scale (as opposed to Fair or oor). 06 At least 80% of clients surveyed will report "My Dental has improved with treatment at University of the acific" as "Yes". s Survey Responses Submitted to HHS & BCC Applicable to U Dental School. 80% Yes on Yes/No questions and 80% "Excellent" or "Good" on four point scale (as opposed to Fair or oor) % of clients will be assessed for Dementia and other cognitive impairments every 60 days. All rogram s electronic (ARIES) or paper Applicable to Westside HIV Home Nursing and Attendant Care Services 6

27 Ambulatory Care-rimary Care (HIV Service) erformance bjectives FY 05-6 A B C D E F G H I J K L M N Q R S T Note: lease review the "Unique rogram" bjectives to determine if your program has objectives in addition to, or instead of, those that have been TYE F BJECTIVE Ambulatory utpatient Home Care utpatient Mental utreach sychosocial Support bjectives rogram Review) eriod NTES 00% of clients exhibiting signs and symptoms of substance abuse or mental illness will be referred to a provider best suited to their needs. All rogram s Applicable to Westside HIV Home Nursing and Attendant Care Services, and SFDH at Home rogram % of clients served for 0 days will report improved quality of life since the inception of Attendant Care or Homemaker Services. s Served 0 days, client self report Applicable to Westside HIV Home Nursing and Attendant Care Services. RN/SW observation of client and/or client self report in improvement on ability to maintain independent living 0 All clients served for 90 days will demonstrate an improved home environment. All active clients will be assessed for Dementia and other cognitive impairments every 60 days. s Served 90 days with or More Assessments of Home Environment All Active s Home Environment Assessment Tool Agency Self Report of sychosocial Benefits, Nursing Assess, Svc lan, rogram Notes & chart review Applicable to Westside HIV Home Nursing and Attendant Care Services. Assess client homes for safety, etc.; problems identified & efforts to improve documented by Social Worker in subsequent assessments Applicable to Westside HIV Home Nursing and Attendant Care Services 7