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Region I IPP Infrastructure UpdatesAdvisory Board Meeting
November 12, 2009Boston, MA
Data Overview
• Positivity• Progress towards Regional Goals and
Objectives
Region I Chlamydia Project Clinic Type by Year
2000 2001 2002 2003 2004 2005 2006 2007 2008 2009
(Q1/Q2)
Family Planning
72 85 93 94 113 109 106 107 110 113
STD 15 17 18 13 12 10 12 13 13 13
High School 3 7 26 30 25 22 34 35 35 35
Jails 4 5 5 4 4 4 4 4 4 4
DYS 2 7 9 8 12 12 15 15 16 16
Drop-in Clinics
3 4 4 1 1 1 0 0 0
0
Other Clinic Type
1 4 6 3 2 2 2 2 5 3
Total Clinics 100 129 161 153 169 160 173 176 183 184
Total Tested 38,194 46,043 60,322 62,722 60,672 71,280 68,142 64,367 54,447 25,165
Chlamydia Positivity in Region I Family Planning Females by Year
0
2
4
6
8
10
1996
1997
1998
1999
2000
2001
2002
2003
2004
2005
2006
2007
2008
(Q1/Q
2)2009
Region I
% P
ositi
ve
Chlamydia Positivity in Region I Family Planning Females by Year
02468
10
19961997
19981999
20002001
20022003
20042005
20062007
2008
(Q1/Q
2)2009
Vermont Rhode Island New HampshireMassachusetts Maine ConnecticutRegion I
% P
ositi
ve
Regional Goals and Objectives
Objective 1.1 By 2010, increase CT screening by 10% of
sexually active 15-24 year old women and men. Using 2004 data as the baseline, increase from 38,718 to 42,590 in IPP sites.
Objective 1.1
38718
46153 45398
42040
3598334914
300003250035000
37500400004250045000
4750050000
2004 2005 2006 2007 2008 2009Estimated
# of Tests
Objective 1.1
9.6 12
21.615 15.2 16.6
20.8 18
7.914.7 12.7 10.3
0
20
40
60
80
100
2004 2005 2006 2007 2008 Q1/Q22009
%
>25/26 With Risk >25/26 No Risk
% of tests >25/26 ~30%
Regional Goals and Objectives
Objective 2.2 By 2010, no more than 5% of women
more than 25 years of age with no risk factors will be screened in IPP-funded clinics (i.e., 95% will be screened according to regional screening criteria).
0
20
40
60
80
100
2004
2005
2006
2007
2008
(Q1/Q
2)2009
% w
ith R
isk
Fact
ors
Connecticut Maine Massachusetts New Hampshire Rhode Island Vermont Region I
Risk FactorsFamily Planning Clinics, Women, 25+
(Objective 2.2: ≥95% screened)
Provider Assessment
•Highlights
•Screening behavior •Knowledge of CDC screening criteria•Significance
•State Specific Results
•Next Steps
Provider AssessmentQ10a. I offer Chlamydia testing to everyone and leave it up to
them to decide.
71.8
56.150.0
63.0
0
10
20
30
40
50
60
70
80
90
100
FP CHC STD Clinic Other
%
Provider AssessmentQ10b. I screen all women under 26.
61.8
75.6
85.7
44.4
0
10
20
30
40
50
60
70
80
90
100
FP CHC STD Clinic Other
%
Provider AssessmentQ10c. I screen all men and women under 26.
56.1
36.6
82.1
44.4
0
10
20
30
40
50
60
70
80
90
100
FP CHC STD Clinic Other
%
Provider AssessmentQ10d. I screen men and women above 26 if they are at increased risk (i.e. new, multiple partners, STD in past 12 months, exposures
or symptoms).94.7
73.2
85.7
59.3
0
10
20
30
40
50
60
70
80
90
100
FP CHC STD Clinic Other
%
Provider AssessmentQ10e. I screen everyone I can (if they cannot show me a
documented recent negative).
37.9
53.7
78.6
59.3
0
10
20
30
40
50
60
70
80
90
100
FP CHC STD Clinic Other
%
Provider AssessmentQ10a. I offer Chlamydia testing to everyone and leave it up to them
to decide.
60.2
40.6
80.774.2
0
10
20
30
40
50
60
70
80
90
100
MD/NP/CNM/PA RN/LPN FP/HIV Counselor Other
%
Provider AssessmentQ10b. I screen all women under 26.
68.9
84.4
51.6
60.6
0
10
20
30
40
50
60
70
80
90
100
MD/NP/CNM/PA RN/LPN FP/HIV Counselor Other
%
Provider AssessmentQ10c. I screen all men and women under 26.
60.2
71.9
44.448.5
0
10
20
30
40
50
60
70
80
90
100
MD/NP/CNM/PA RN/LPN FP/HIV Counselor Other
%
Provider AssessmentQ10d. I screen men and women above 26 if they are at increased risk (i.e. new, multiple partners, STD in past 12 months, exposures or symptoms).
86.481.3
85.5
92.4
0
10
20
30
40
50
60
70
80
90
100
MD/NP/CNM/PA RN/LPN FP/HIV Counselor Other
%
Provider AssessmentQ10e. I screen everyone I can (if they cannot show me a
documented recent negative).
48.5
62.5
45.239.4
0
10
20
30
40
50
60
70
80
90
100
MD/NP/CNM/PA RN/LPN FP/HIV Counselor Other
%
Provider AssessmentQ11a. The CDC Chlamydia screening criteria is: Screen all sexually active females under 26 at least once a year and women over 26
who are at increased risk because of new, multiple partners, exposure to STD, recent previous STD, or
40.4
63.2
45.8 44.0
0102030405060708090
100
FP CHC STD Clinic Other
%
symptoms. No screening criteria for males.
Provider AssessmentQ11b. The CDC Chlamydia screening criteria is: Screen all sexually
active males and females under 26 at least once a year and women and men over 26 who are at increased risk because of new,
multiple partners, exposure to STD,
71.265.8
70.864.0
0102030405060708090
100
FP CHC STD Clinic Other
%
recent previous STD, or symptoms.
Provider AssessmentQ11c. The CDC Chlamydia screening criteria is: Screen all
women of childbearing age and pregnant women.
41.9
52.6
62.5
44.0
0102030405060708090
100
FP CHC STD Clinic Other
%
Provider Assessment
0102030405060708090
100
FP CHC STD Clinic Other
%
11a. The CDC Chlamydia screening criteria is: Screen all sexually active females under 26 at least once ayear and women over 26 who are at increased risk because of new, multiple partners, exposure to STD,recent previous STD, or symptoms11b. The CDC Chlamydia screening criteria is: Screen all sexually active males and females under 26 atleast once a year and women and men over 26 who are at increased risk because of new, multiplepartners, exposure to STD, recent previous STD
11c. The CDC Chlamydia screening criteria is: Screen all women of childbearing age and pregnant women.
. No screening criteria for males.
, or symptoms.
Provider AssessmentQ11a. The CDC Chlamydia screening criteria is: Screen all sexually
active females under 26 at least once a year and women over 26 who are at increased risk because of new, multiple partners, exposure to
STD, recent previous STD, or symptoms. No screening
52.944.8
40.033.9
0102030405060708090
100
MD/NP/CNM/PA RN/LPN FP/HIV Counselor Other
%
criteria for males.
Provider AssessmentQ11b. The CDC Chlamydia screening criteria is: Screen all sexually
active males and females under 26 at least once a year and women and men over 26 who are at increased risk because of new, multiple
partners, exposure to STD, recent previous STD,
57.8
72.477.2
83.1
0102030405060708090
100
MD/NP/CNM/PA RN/LPN FP/HIV Counselor Other
%
or symptoms.
Provider AssessmentQ11c. The CDC Chlamydia screening criteria is: Screen all women of
childbearing age and pregnant women.
34.3
51.7 49.1
59.3
0
10
20
30
40
50
60
70
80
90
100
MD/NP/CNM/PA RN/LPN FP/HIV Counselor Other
%
Provider Assessment
0102030405060708090
100
MD/NP/CNM/PA RN/LPN FP/HIV Counselor Other
%
11a. The CDC Chlamydia screening criteria is: Screen all sexually active females under 26 at least once ayear and women over 26 who are at increased risk because of new, multiple partners, exposure to STD,recent previous STD, or symptoms. No screening11b. The CDC Chlamydia screening criteria is: Screen all sexually active males and females under 26 atleast once a year and women and men over 26 who are at increased risk because of new, multiplepartners, exposure to STD, recent previous STD,11c. The CDC Chlamydia screening criteria is: Screen all women of childbearing age and pregnantwomen.
criteria for males.
or symptoms.
Provider AssessmentQ12a. Our policy is to screen all urine samples received
for a pregnancy test (at least in women under 26) unless the patient declines.
44.4
30.626.1
33.3
0102030405060708090
100
FP CHC STD Clinic Other
%
Provider AssessmentQ12b. Our policy is to offer screening of all urine samples received for pregnancy tests (at least in women under 26)
and if they think they need it then we screen.
48.8 50.0
30.4
37.5
0102030405060708090
100
FP CHC STD Clinic Other
%
Provider AssessmentQ12c. Our policy is not to differentiate between those
under 26 and those over 26 in STD screening for Pregnancy Test "Only" patients.
43.138.9
60.9
33.3
0102030405060708090
100
FP CHC STD Clinic Other
%
Provider AssessmentQ12d. Our policy is to only do Chlamydia testing
during scheduled visits and annual exams.
19.3
38.9
26.129.2
0102030405060708090
100
FP CHC STD Clinic Other
%
Provider AssessmentQ12e. I do not have time to do STD screening on
walk-in Pregnancy Test "Only" visits.
8.816.7
8.70.0
0102030405060708090
100
FP CHC STD Clinic Other
%
Maps
OVERVIEW BULLET POINTS HERE
Maps
Maps
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Maps
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Maps
Questions?
Other Activities
• Cost Analysis Definitions/Glossary PTO IHS
0
20
40
60
80
100
% w
ith
Ris
k Fa
ctor
s
Connecticut Region I
Connecticut Risk FactorsFamily Planning Clinics, Women, 25+
(Objective 2.2: ≥95% screened)
0
20
40
60
80
100
20042005
20062007
2008
(Q1/Q
2)2009
% w
ith R
isk
Fact
ors
Maine Region I
Maine Risk FactorsFamily Planning Clinics, Women, 25+
(Objective 2.2: ≥95% screened)
0
20
40
60
80
100
20042005
20062007
2008
(Q1/Q
2)2009
% w
ith R
isk
Fact
ors
Massachusetts Region I
Massachusetts Risk FactorsFamily Planning Clinics, Women, 25+
(Objective 2.2: ≥95% screened)
0
20
40
60
80
100
20042005
20062007
2008
(Q1/Q
2)2009
% w
ith R
isk
Fact
ors
New Hampshire Region I
New Hampshire Risk FactorsFamily Planning Clinics, Women, 25+
(Objective 2.2: ≥95% screened)
0
20
40
60
80
100
20042005
20062007
2008
(Q1/Q
2)2009
% w
ith R
isk
Fact
ors
Rhode Island Region I
Rhode Island Risk FactorsFamily Planning Clinics, Women, 25+
(Objective 2.2: ≥95% screened)
0
20
40
60
80
100
% w
ith
Ris
k Fa
ctor
s
Vermont Region I
Vermont Risk FactorsFamily Planning Clinics, Women, 25+
(Objective 2.2: ≥95% screened)
Infrastructure Performance Measures
• Performance Measure 1
– Screening Coverage Estimate
• Numerator: Number of women screened
• Denominator: Number of women eligible to be screened
Infrastructure Performance Measures
Estimated Screening Coverage by Age Category2005-2009
35.637.4
42.5
45.8
34.436.1
40.2
47.4
40.5
31.632.8
37.7 37.3
34.437.3
42.6
0
10
20
30
40
50
15-19 20-24 >24 Total
2005200620072008(Q1/Q2)2009
Infrastructure Performance Measures
– Increased screening in the 15-19 and 20-24 age categories over the past 2 years
• 15-19 screening rose from 35.6% in 2005 to 45.8% in 2007• 20-24 screening rose from 34.4% in 2005 to 47.4% in 2007
– Decreased screening in females over 24 over the past 2 years
• Screening >24 went from 40.5% in 2005 to 37.7% in 2007
– Goals• Increase the number of women age 24 and under by at least 3% • Decrease the number of women age 24+ by at least 3%
Infrastructure Performance Measures
• Performance Measure 2
– Chlamydia Screening Test Utilization
• Proportion of total tests given by age category
– Numerator: Number of women tested by age category
– Denominator: Total number of women tested
Infrastructure Performance Measures
Proportion of female Tests Utilized, 2005-2009
0.31 0.31 0.3 0.320.31
0.3 0.31 0.31 0.320.32
0.11 0.11 0.110.110.11
0.28 0.27 0.280.25
0.26
0
0.2
0.4
0.6
0.8
1
15-19 20-24 24-29 >29
2005200620072008(Q1/Q2)2009
Infrastructure Performance Measures
• Overview– Very little change over the past 3 years for all 4 age categories
• Could be a result of budget cuts– Proportion of tests done on women age 29+ is high
• Could be because data is not broken down by those with and without risk factors, CDC recommends testing age 25+ with risk factors
• Goal: Increase the proportion of tests utilized by women between the ages of 15-24 from 0.32 to 0.35 – Decrease the proportion of tests utilized by women 29+ from 0.25 to
0.22
