HAB HIV Performance Measures: 

Systems-Level 

Performance Measure: System Level: Waiting time for initial 

access to outpatient/ambulatory medical care 

Percent of Ryan White Program-funded outpatient/ambulatory care organizations in the system/network with 

a waiting time of 15 or fewer business days for a Ryan White Program-eligible patient to receive an 

appointment to enroll in outpatient/ambulatory medical care1 

Numerator: 

Number of Ryan White Program-funded outpatient/ambulatory medical care 

organizations in the system/network with a waiting time of 15 or fewer business days for 

a Ryan White Program-eligible patient to receive an appointment to enroll in 

outpatient/ambulatory medical care1 . 

Denominator: Number of Ryan White Program-funded outpatient/ambulatory medical care 

organizations in the system/network at a specific point in time in the measurement year. 

Exclusions: None 

Data Element: 

For each agency: 

1. Is the organization funded by the Ryan-White Program to provide 

outpatient/ambulatory medical care? (Y/N) 

a. In how many business days is the third next available appointment for 

a Ryan White Program-eligible patient to enroll in 

outpatient/ambulatory medical care at this organization? 

i. Is the third next available appointment < 15 business days? 

(Y/N) 

For the system: 

1. How many outpatient/ambulatory medical care organizations are funded by the 

Ryan White Program to provide outpatient/ambulatory medical care? 

a. Of those organizations, how many have < 15 business days for the third 

next available appointment to enroll in outpatient/ambulatory medical 

care? 

Data Sources: 

 Data reported to the system/network grantee at a common point in time on a quarterly 

basis by each of the organizations in the system/network that provides 

outpatient/ambulatory medical care using a standardized methodology. (See example 

below.) 

National 

Goals, 

Targets, or 

Benchmarks 

for 

Comparison: 

None available at this time. 

Outcome 

Measures for 

Consideration: 

 Percent of patients who are retained in outpatient/ambulatory medical care in the 

measurement year. 

 Percent of patients diagnosed with Pneumocystis jiroveci (PCP) in the measurement 

year. 

September 28, 2010| Page 1 of 13 

Final 
HAB HIV Performance Measures: 

Systems-Level 

Basis for Selection: 

This measure addresses the importance of access to health care for Ryan White Program eligible patients. 

Improving “access to healthcare is important to the quality of healthcare outcomes. Patients who can 

promptly schedule appointments with their healthcare providers will have higher satisfaction, will likely 

return to work sooner, and may well have better medical outcomes.” 2 A study of the characteristics of 

scheduled new HIV+ patients who failed to attend their initial visit found that in addition to patient 

characteristics (younger age, black race, and public insurance), “longer waiting time from the call to schedule 

a new patient visit to the appointment date was associated with failure to establish care.” 3 

US Public Health Service Guidelines: 

None 

References/Notes: 

1

 The type of visit for patient enrollment in outpatient/ambulatory medical care can be determined by each 

outpatient/ambulatory medical care provider in the system/network, but should be consistently defined at 

each data collection point. The type of appointment scheduled to enroll in outpatient/ambulatory medical care 

may vary among agencies within the system/network. For example, at one agency, to enroll in care, a new 

patient may first have an appointment to have routine laboratory tests and an initial health history taken by a 

nurse to then be followed by a subsequent appointment with a provider with prescribing privileges at the 

agency (i.e., MD, PA, NP), while at another agency, a new patient may first have an appointment with 

physician. Other examples of types of appointment to enroll in outpatient/ambulatory medical care may 

include an initial appointment with a case manager, social worker, patient navigator, peer advocate, clergy, or 

other designated staff.

2 National Quality Measures Clearinghouse, “Access: time to third next available appointment for an office 

visit”. Available at: http://www.qualitymeasures.ahrq.gov/summary/summary.aspx?ss=1&doc_id=10912 

Further information on this measure is also available at: http://www.wchq.org/measures/index.php 

(Wisconsin Collaborative for Healthcare Quality). 

3

 Mugavero MJ, Lin HY, Alison JJ, et al. Failure to Establish HIV Care: Characterizing the “No Show” 

Phenomenon. Clinical Infectious Diseases. 2007;45:127-130. 

Example: 

System A, which has six (6) outpatient medical care programs, decided to implement this measure on a 

quarterly basis. A point in time survey was scheduled to be conducted by telephone on the last Tuesday of the 

quarter. (Other methods of data collection, such as an on-line survey, e-mail, or fax may be used to collect 

data at the point in time by the system.) On the designated morning the System A administrative staff calls 

each outpatient program and asks the following question: “What are your three next available appointments 

for an individual who is seeking to enroll in outpatient/ambulatory medical care for his/her HIV disease at 

your clinic?” 

After data is collected from each of the agencies, the waiting time (number of business days from the date of 

data collection to the appointment date) are calculated for the third next available appointment. Those which 

are fifteen business days or fewer are identified and are counted as the numerator; while the denominator is 

the total number of ambulatory outpatient medical care providers in the system. 

September 28, 2010| Page 2 of 13 

Final 
 

 

 

 

 

HAB HIV Performance Measures: 

Systems-Level 

Results of System A Point in Time Survey 

Date of data collection: September 14, 2010 (N=6) 

Agency 1 Date Days Within 15 days? 

1st appointment 9/14/2010 0 

2nd appointment 9/23/2010 7 

3rd appointment 10/15/2010 23 No 

Agency 2 Date Days Within 15 days? 

1st appointment 9/14/2010 0 

2nd appointment 9/14/2010 * 0 

3rd appointment 9/14/2010 0 Yes 

Agency 3 Date Days Within 15 days? 

1st appointment 11/24/2010 50 

2nd appointment 12/15/2010 64 

3rd appointment 1/19/2011 88 No 

Agency 4 Date Days Within 15 days? 

1st appointment 9/21/2011 5 

2nd appointment 9/21/2011 5 

3rd appointment 9/21/2011 6 Yes 

Agency 5 Date Days Within 15 days? 

1st appointment None 

2nd appointment None 

3rd appointment None No 

Agency 6 Date Days Within 15 days? 

1st appointment 9/14/2010 0 

2nd appointment 9/17/2010 3 

3rd appointment 9/20/2010 4 Yes 

*Note: Different appointment times on the same day counts as separate appointment times. 

Using the data collected, the performance measure is calculated by identifying the number of 

agencies that indicate that their third next available appointment is within 15 or fewer business 

days. In the example above, three of the agencies meet this criteria (Agencies 2, 4 and 6) and 

three (Agencies 1, 3 and 5) do not. Even though Agency 5 is closed to new patients, they are 

still included. The numerator is 3 and the denominator is 6. The percent of Ryan White 

Program-funded outpatient/ambulatory medical care organizations in the system/network with a 

waiting time of 15 or fewer business days for a Ryan White Program-eligible patient to receive 

September 28, 2010| Page 3 of 13 

Final 
HAB HIV Performance Measures: 

Systems-Level 

an appointment to enroll in outpatient/ambulatory medical care at this point in time is 50%. 

(Calculated by dividing the numerator by the denominator: (3÷6) x 100= 50%) 

In addition to determining the rate of achievement of the performance measure, the average 

number of days until the third next available appointment across the system/network can also be 

calculated: Add the number of days for the third next available appointments (in this example 

the sum is 121 days) and then divide by the number of agencies in the system who report an 

available appointment (in this example the number is 5). The average number of days for the 

third next available appointment in the system/network reported on the date of data collection is 

24.2 days. (Note: In this example Agency 5 reports that it is not accepting new patients—no 

appointments are available. This agency should still be included in the denominator for the 

calculation of the performance measure rate [Example 1] but it should not be included in the 

denominator for the calculation of the average number of days [Example 2].) 

Figure 1 depicts percentage of agencies meeting the performance measure over three quarters. 

Example: Graph of wait time performance measure for System: Performance measure rate 

for Quarters 1-3 

80% 

70% 

60% 

50% 

40% 

30% 

20% 

10% 

0% 

52% 

72% 

50% 

Quarter 1 Quarter 2 Quarter 3 Quarter 4 

September 28, 2010| Page 4 of 13 

Final