Form 3 2018 RSR Client Level Data Elements Instrument

Summary of Changes from the Existing RSR Package (0915-0323)

Ryan White Services Report

Client Level Variables

Deletions/Modifications

• Vital Enrollment Status - Active, continuing in program, Referred to another program or services, or self-sufficient, Removed from treatment due to violation of rules, Incarcerated, Relocated, Deceased to Alive, Deceased, Unknown

• ID #14: HIV Infection Risk Factor - Male who have sex with male(s) to Male-to-male sexual contact (MSM), Injecting to Injection drug use (IDU), Hemophilia/coagulation disorder (no change), Heterosexual contact (no change), Receipt of blood transfusion, blood components, or tissue, Mother w/at risk for HIV infection (perinatal transmission) to Perinatal transmission, Risk factor not reported or not identified (no change)

• ID #15Medical Insurance to Health Coverage

• Federal Poverty Level – change response options to continuous variable rather than categorical variable

• ID #28-35: Support Services Delivered – change from yes/no options to # of support services visits

• ID #52: Prescribed ART – change response options from Yes, No, not ready (as determined by clinician), No, client refused, No, intolerance, side-effect, toxicity, No, ART payment assistance unavailable, No, other reason to Yes, No

• Delete each of the following variables: HIV Risk-Reduction Screening/Counseling Provided, Screened for TB Since HIV-diagnosis, Screened for Hepatitis B Since HIV Diagnosis, Vaccinated for Hepatitis B, Screened for Hepatitis C Since HIV Diagnosis, Screened for Substance Abuse, Screened for Mental Health, Received Cervical Pap Smear , Prescribed PCP prophylaxis

• Add the following variable: Date Housing Status Collected

• ID #8: Self-Reported Transgender Status – Deleted – changed in 2017

• ID #7: Self-Reported Gender – Transgender Male to Female, Transgender Female to Male, Transgender Unknown added response options – changed in 2017

Services

Deletions/Modifications

• ID #19: Core Medical Services Delivered – Parts A and B removed as qualifiers for Early Intervention Services – changed in 2017

• ID #35: Support Services – Legal Services deleted – changed in 2017

• ID #39: Support Services – Permanency Planning deleted – changed in 2017

Additions

• Core Medical Services Delivered – AIDS Drug Assistance Program Treatments added as a response option – changed in 2017

• Support Services – Other Professional Services added as a response option – changed in 2017

Clinical Information

Modifications

• ID #47: Date First HIV Outpatient/Ambulatory Care Visit – changed to Date of First HIV Outpatient/Ambulatory Health Services Visit – changed in 2017

• ID #48 Dates of all Outpatient Ambulatory Care Visits – changed to Dates of All Outpatient/Ambulatory Health Services Visits. – changed in 2017

• Item #74 OAMC Link Date – changed to OAHS Link Date – changed in 2017

TABLE 3

Ryan White Services Report (RSR) Variables

Public Burden Statement: An agency may not conduct or sponsor, and a person is not required to respond to, a collection of information unless it displays a currently valid OMB control number. The OMB control number for this project is 0906-XXXX. Public reporting burden for this collection of information is estimated to average 113 hours per response, including the time for reviewing instructions, searching existing data sources, and completing and reviewing the collection of information. Send comments regarding this burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden, to HRSA Reports Clearance Officer, 5600 Fishers Lane, Room 14N136B, Rockville, Maryland, 20857.

RSR Client-Level Data – Demographics

ID	Variable Name		Definition		Required		Occurrence	Allowed Values
Demographics
	EnrollmentStatusID	The client’s vital enrollment status at the end of the reporting period.		CM, OA		1 per client			EnrollmentStatusID: Active, continuing in program - modify Referred to another program or services, or discharged  because self-sufficient – delete Removed from treatment due to violation of rules – delete Incarcerated – delete Relocated – delete Deceased – keep Unknown – add
	BirthYear	Client’s year of birth. This value should be on or before all service date years for the client.		All (including C&T)		1 per client			BirthYear: yyyy
	EthnicityID	Client’s ethnicity.		All (including C&T)		1 per client			EthnicityID: Hispanic/Latino/a, or Spanish origin Non-Hispanic/Latino(a),or Spanish origin
	RaceID	Client’s race.		All (including C&T)		1-5 per client			RaceID: White Black or African American Asian Native Hawaiian/Pacific Islander American Indian or Alaska Native
	GenderID	Client’s current gender identity. This is the variable that is used for the eUCI.		All (including C&T)		1 per client			GenderID: Male Female Transgender Unknown
	Transgender	Client’s current transgender status.		All (including C&T)		To be completed only if the response is “Transgender” in Item #6			Male-to-Female Female-to-Male Unknown
	PovertyLevelID	Client’s percent of the Federal poverty level at the end of the reporting period.		CM, OA		1 per client			PovertyLevelID: Below 100% of the Federal poverty level 100 -138% of the Federal poverty level 139 - 200% of the Federal poverty level 201 – 250% of the Federal poverty level 250 – 400% of the Federal poverty level 401 – 500% of the Federal poverty level More than 500% of the Federal poverty level
	HousingStatusID	Client’s housing status at the end of the reporting period.		CM, OA or Housing services		1 per client			HousingStatusID: Stable/permanent Temporary Unstable
	HivAidsStatusID	Client’s HIV/AIDS status at the end of the reporting period. For HIV affected clients for whom HIV/AIDS status is not known, leave this value blank.		CM, OA		1 per client			HivAidsStatusID: HIV negative HIV +, not AIDS HIV-positive, AIDS status unknown CDC-defined AIDS HIV indeterminate (infants <2 only)
14	HivRiskFactorID	Client’s HIV/AIDS risk factor. Report all that apply.		CM, OA (including C&T)		1-7 per client			HivRiskFactorID: Male who has sex with male(s) Male to Male Sexual Contact (MSM) – modify Injecting Injection drug use (IDU) – modify Hemophilia/coagulation disorder – keep Heterosexual contact – keep Receipt of blood transfusion, blood components, or tissue – keep Mother w/at risk for HIV infection Perinatal transmission – modify Risk factor not reported or not identified – keep
15	MedicalInsuranceID Health Coverage – modify	Client’s medical insurance. Report all that apply.		CM, OA, HI – ALL Core Services including C&T)		1-8 per client			MedicalInsuranceID: Private – Employer Private - Individual Medicare Medicaid, CHIP or other public plan VA, Tricare and other military health care IHS No Insurance/ uninsured Other plan

Client-Level Data – Core Medical Service Visits

ID			Variable Name		Definition		Required	Occurrence		Allowed Values
Core Medical Service Visits
16-25*	ClientReportServiceVisits ServiceID Visits			The number of visits received for each core medical service during the reporting period.		All At least one core or support entry per client			1-number of visits per service per client	Item ID: Core Medical Services: ID 16: Outpatient ambulatory health services ID 17: Oral health care ID 18: Early intervention services (Parts A and B) ID 19: Home health care ID 20: Home and community-based health services ID 21: Hospice services ID 22: Mental health services ID 23: Medical nutrition therapy ID 24: Medical case Management (including treatment adherence) ID 25: Substance abuse services-outpatient Visits: 1-365 (must be an integer)
26- 45*		ClientReportService-Delivered ServiceID DeliveredID		The service and service delivered indicator (yes) for each core medical or support service received by the client during the reporting period.		All At least one core or support entry per client			0-1 per service per client	Core Medical Services: Item ID: ID 26: Local AIDS Pharmaceutical Assistance (APA, not ADAP) ID 27: Health Insurance Program(HIP) Support Services: Item ID: ID 28: Case management (non-medical) services ID 29: Child care services ID 30: Developmental assessment/early intervention services ID 31: Emergency financial assistance ID 32: Food bank/home-delivered meals ID 33: Health education/risk reduction ID 34: Housing services ID 35: Legal services ID 36: Linguistic services ID 37: Transportation services ID 38: Outreach services ID 39: Permanency planning ID 40: Psychosocial support services ID 41: Referral for health care/supportive services ID 42: Rehabilitation services ID 43: Respite care ID 44: Substance abuse services-residential ID 45: Treatment adherence counseling DeliveredID: Yes/No - # of services delivered – modify

*Element ID#s are listed consecutively according to the RSR Data Dictionary; the 2018 RSR Instruction Manual is pending update.

Client-Level Data – Clinical Information

Client Level Data
ID	Variable Name		Definition		Required		Occurrences		Allowed Values
Clinical Information
46	RiskScreeningProvidedID	Value indicating whether the client received risk reduction screening/counseling during this reporting period.		OA				1 per client	RiskScreeningProvidedID: No Yes
47	FirstAmbulatoryCareDate	Date of client’s first HIV ambulatory health services date at this provider agency. This value must be on or before the last date of the reporting period.		OA				0-1 per client	FirstAmbulatoryServicesVisitDate: mm,dd,yyyy
48	ClientReportAmbulatory- Service ServiceDate	All the dates of the client’s outpatient ambulatory health services visits in this provider’s HIV care setting with a clinical care provider during this reporting period. The service dates must be within the reporting period.		OA				0-number of days in reporting period per client	ServiceDate: mm,dd,yyyy Must be within the reporting period start and end dates.
49	ClientReportCd4Test Count ServiceDate	Values indicating all CD4 counts and their dates for this client during this report period. The service dates must be within the reporting period.		OA				0-number of days in reporting period per client	Count: Integer ServiceDate: mm,dd,yyyy Must be within the reporting period start and end dates.
50	ClientReportViralLoadTest Count ServiceDate	All Viral Load counts and their dates for this client during this report period		OA				1-number of days in reporting period	Count: Integer Report undetectable values as the lower bound of the test limit. If the lower bound is not available, report 0. ServiceDate: mm,dd,yyyy Must be within the reporting period start and end dates.
51	PrescribedPcp-ProphylaxisID	Value indicating whether the client was prescribed PCP Prophylaxis anytime during this reporting period.		OA				1 per client	PrescribedPcpProphylaxisID: No Yes Not medically indicated No, client refused
52	PrescribedHaartID	Value indicating whether the client prescribed HAART at any time during this reporting period.		OA				1 per client	PrescribedHaartID: Yes – keep No, not ready (as determined by clinician) – delete No, client refused – delete No, intolerance, side-effect, toxicity – delete No, HAART payment assistance unavailable – delete No, other reason – delete No – add
54	ScreenedTBSinceHiv- DiagnosisID	Value indicating whether the client has been screened for TB since his/her HIV diagnosis.		OA				0-1 per client	ScreenedTBSinceHivDiagnosisID: No Yes Not medically indicated Unknown
55	ScreenedSyphilisID	Value indicating whether the client was screened for syphilis during this reporting period (exclude all clients under the age of 18 who are not sexually active)		OA if client is 18 years of age, or older				0-1 per client	ScreenedSyphilisID: No Yes Not medically indicated
57	ScreenedHepatitisBSince-HivDiagnosisID	Value indicating whether the client has been screened for Hepatitis B since his/her HIV diagnosis.				OA		0-1 per client	ScreenedHepatitisBSinceHiv-DiagnosisID: No Yes Not medically indicated Unknown
58	VaccinatedHepatitisBID	Value indicating whether the client has completed the vaccine series for Hepatitis B.				OA		1 per client	VaccinatedHepatitisBID: No Yes Not medically indicated
60	ScreenedHepatitisC Since-HivDiagnosisID	Value indicating whether the client has been screened for Hepatitis C since his/her HIV diagnosis.				OA		0-1 per client	ScreenedHepatitisCSinceHiv-DiagnosisID: No Yes Not medically indicated Unknown
61	ScreenedSubstance-AbuseID	Value indicating whether the client was screened for substance use (alcohol and drugs) during this reporting period.				OA		1 per client	ScreenedSubstanceAbuseID: No Yes Not medically indicated
62	ScreenedMentalHealthID	Value indicating whether the client was screened for mental health during this reporting period.				OA		1 per client	ScreenedMentalHealthID: No Yes Not medically indicated
63	ReceivedCervical-PapSmearID	Value indicating whether the client received a Pap smear during the reporting period. This should be completed for HIV+ women only.				OA if the client is an HIV+ female		0-1 per client	ReceivedCervicalPapSmearID: No Yes Not medically indicated Not applicable
	HousingStatusDateID	Value indicating date when housing status is collected. The service date must be within the reporting period.				OA		0-number of days in reporting period per client	Count: Integer ServiceDate: mm,dd,yyyy Must be within the reporting period start and end dates.
64	PregnantID	Value indicating whether the client was pregnant during this reporting period. This should be completed for HIV+ women only.				OA if the client is an HIV+ female		0-1 per client	PregnantID: No Yes Not applicable

Client Level Data
ID	Variable Name		Definition	Required		Occurrences		Allowed Values
New Variables
Demographics
68	HispanicSubgroupID	If EthnicityID = Hispanic/Latino(a), Client’s Hispanic Sub-group (choose all that apply)			All (included C&T)		0-4 per client	Mexican, Mexican American, Chicano/a Puerto Rican Cuban Another Hispanic, Latino/a or Spanish origin
69	AsianSubgroupID	If RaceID = Asian, Client’s Asian subgroup. (choose all that apply)			All (included C&T)		0-7 per client	Asian Indian Chinese Filipino Japanese Korean Vietnamese Other Asian
70	NHPISubgroupID	If RaceID=Native Hawaiian/Pacific Islander, Client’s Native Hawaiian/Pacific Islander subgroup.(choose all that apply)			All (included C&T)		0-4 per client	Native Hawaiian Guamanian or Chamorro Samoan Other Pacific Islander
72	HIVDiagnosisYear	Year of client’s HIV diagnosis, if known. To be completed for a new client when the response is not “HIV-negative” or HIV indeterminate” in 12. This value must be on or before the last date of the reporting period.			CM, OA For a new client, if the response is not “HIV-negative” or HIV indeterminate” in 12.		1 per client	HIVDiagnosisYear: yyyy Must be less than or equal to the reporting period year.
71	SexAtBirth ID	The biological sex assigned to the client at birth			All (included C&T)		1 per client	1 = Male 2 = Female
HIV Counseling and Testing
73	HIVPosTestDate	Date of client’s confidential confirmatory HIV test with a positive result within the reporting period.			All C&T clients with confidential positive HIV confirmatory test during the reporting period		0-1 per client	HIV Positive Test Date: mm,dd,yyyy Must be within the reporting period.
74	OAHSlinkDate	Date of client’s first OAMC medical care visit after positive HIV test. Date must be the same day or after the date of client’s confidential confirmatory HIV test with a positive result.			All C & T clients with a confidential positive HIV confirmatory test during the reporting period		0-1 per client	HIV OAMC linkage date: mm,dd,yyyy Must be within the reporting period and on the same day or later than HIV positive test date.

7 Final September 24, 2018