In FY 2001 the Evaluation and QM Section of Ryan White Grant Administration implemented comprehensive outcomes evaluation for all funded service categories. Examples of outcomes measured in the Houston EMA include:

• Health outcomes such as changes in CD4+ counts, viral load tests and stage of illness
• KAP (knowledge, attitudes and practices) outcomes such as changes in service utilization rates and adherence to drug treatment regimens
• Cost-effectiveness outcomes such as fewer days of HIV-related hospitalization
• Quality of life outcomes such as increased ability to perform activities of daily living

Client-level outcomes and indicators are tailored to the goals and objectives of each service category. Data collection methods include the CPCDMS, self-administered pre- and post-tests and standardized provider assessments.

The Evaluation and QM Section performs data analysis on a quarterly basis, providing results to service providers and the Ryan White Planning Council.

In FY 2005 the Quality Management Section of Ryan White Grant Administration (RWGA) initiated chart review activities to ensure that U.S. Health and Human Services guidelines and other relevant standards of care are met or exceeded for the treatment of HIV. Primary medical care, rural dental care, vision care, and case management are the Part A-funded services participate in chart review activities.

On an annual basis, a stratified random 10% sample of client charts are reviewed. The CPCDMS is used to randomly select a sample population that reflects the demographics of the entire client population.

The RWGA Project Coordinator for Clinical Quality Improvement conducts the primary medical care and vision chart review activities. The RWGA Project Coordinator for Quality Management conducts the case management chart reviews. The RWGA Quality Management Section performs data analysis and provides results to service providers and the Ryan White Planning Council.

In FY 2006, the Evaluation and QM Section developed and implemented a standardized methodology for measuring client satisfaction that is consistent across all Part A-funded service categories.

This methodology employs the use of a self-administered survey tool that includes questions that address the service, questions that address the provider and questions that address the Part A system as a whole. The tool, printed directly from the CPCDMS by the client's service provider, includes the client's unique identifier embedded as a bar-code. Once the completed tool is scanned, this bar-code enables Ryan White Grant Administration to link survey results with the de-identified client demographic data found in the CPCDMS.

On an annual basis a 10% convenience sampling is surveyed for each service category. The Evaluation and QM Section performs data analysis and provides results to service providers and the Ryan White Planning Council. Below are the most recent Client Satisfaction reports.

Since FY 1999, the Evaluation and QM Section of Ryan White Grant Administration has facilitated annual work groups composed of Ryan White Planning Council members, service providers, consumers and subject experts to review and revise standards of care for each funded service category. These local standards are derived from U.S. Public Health Service guidelines as well as other relevant industry standards and federal, state and local licensing requirements. Measurement thresholds are set at 100%.

The Grants Management Section of Ryan White Grant Administration conducts regular site monitoring visits at all agencies to ensure compliance.