Form 3 2018 RSR Client Level Data Elements Instrument

Ryan White HIV/AIDS Program Client-Level Data Reporting System

D- 2018 RSR Client Level Data Elements Instrument

Ryan White Services Client Report

OMB: 0906-0039

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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



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