Sexually Transmitted Diseases  >  Program Guidelines  >  Partner Services

Program Operations Guidelines for STD Prevention
Partner Services

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Sections on this page:

• EVALUATION AND QUALITY ASSURANCE
• Case Management
• Components of Case Management Quality Assurance
• Using Information Gathered to Describe and Reach Target Populations
• Measures for Evaluating Program Effectiveness

EVALUATION AND QUALITY ASSURANCE

Case Management

Supervisors and managers should regularly and carefully review information obtained through patient and cluster interviews to assure that cases are being vigorously pursued, properly documented, effectively analyzed, and that the findings are appropriately applied to continuing intervention activities. Managers should also assure that case information involving other program areas is being shared promptly and cooperatively.

Performance expectations of the program and personnel for all aspects of disease control should be established. Performance guidelines are relatively detailed instructions and standards about the process by which staff are expected to apply acquired knowledge and skills to critical elements of daily work in STD control. For supervisors, guidelines are an aid to evaluating the capabilities and deficiencies of workers. Beyond simply establishing program expectation, "guidelines" describe the process by which those expectations can be achieved. Programs should develop, disseminate, and maintain signed copies of local process performance standards, indicating that an employee has received, reviewed, understood, and agreed to these standards.

Components of case management quality assurance

Involved program managers and firstline supervisors are critical to successful case management. Active involvement of supervisors is necessary to maximize DIS intervention activities. There must be the expectation that DIS will obtain complete locating information on partners, negotiate a risk reduction plan, and cluster to determine who may benefit from examination or to identify locations where high risk activities occur.

Supervisors should regularly and directly observe individual DIS in the performance of their day-to-day activities and should be willing and able to demonstrate appropriate skills and behaviors. Forms should be in place to fully document these audits and demonstrations (pouch, interview, and field audits). Completed forms should be shared with the individual employee regularly and immediately following the audit. Such forms can be used when writing individual evaluations to call attention to areas of strength and to those requiring improvement. An example of tools that can be used to assess the quality of partner service work is the skills inventory assessment, included in Appendix H.

Supervisors should conduct sessions (sometimes called "Chalk Talks") that facilitate DIS discussion of case management efforts and provide opportunity for input from others. Such discussions can be used to share information on marginal partners—those partners for whom insufficient information has been elicited to initiate. Such meetings should also be used to discuss other case management issues, safety concerns, social network analysis, and newly developed investigative resources. Chalk talks provide the opportunity for peer-to-peer sharing of interviewing and investigative techniques and approaches. They also provide opportunities for program management to encourage appropriate attitudes and philosophies.

Programs should establish the expectation that case management—and the interview and investigative activities that support it—will be rigorously approached, fully documented, and carefully analyzed. This will place the STD prevention program in position to obtain the information necessary to address STD morbidity within communities.

Using information gathered to describe and reach target populations

Much of the information gathered in the partner services process may be used to describe and reach target populations in the program's jurisdiction. Information that may be used includes, but is not limited to, disease outcomes, risk behaviors (i.e., drug use or commercial sex work), location of home and "hang-outs", as well as information about partners, suspects, and associates. At the most basic level, trends in disease found through evaluating partners should be used to monitor disease transmission and to increase program awareness regarding potential outbreaks. Once this system is in place, more advanced analyses of data should take place regularly. For example, tabulate monthly the number (and type, where applicable) of risk behaviors that the original patient discusses in the original interview (i.e., sex for drugs), partners testing positive, partners testing negative, and the number of partners tested.

Measures for evaluating program effectiveness

The list of measures that follow are aids to help evaluate the effectiveness of the partner services component and to help reallocate resources if necessary. These measures are not an end in themselves but a means to analyze and improve program effectiveness. They should be reviewed regularly (i.e., monthly or quarterly) and tailored to meet the program's identified needs. Many states have developed detailed monthly reports of DIS productivity. In addition, programs may wish to use the tables in Appendix PS-I as analysis tools. Tables may be completed for each disease for which patients are interviewed; separate tables for suspects and associates may be done as well. These measures can be calculated using STD*MIS.

Essential Measures (for each disease):

• Number of original patients interviewed
• Total number of partners elicited
• Number of partners initiated to field follow-up
• Number of partners out of jurisdiction
• Number of partners identified but not located
• Number of partners identified and located but not notified (i.e., located in records as previously treated)
• Number of partners located and notified by provider;
• Time frames for locating and notifying partners (i.e., How many were notified within seven days of the interview of the original patient);
• Number of partners notified of their exposure to an STD, including:
  • Number of STD negative and no subsequent STD infection
  • Number of STD negative who have at least one subsequent STD infection
  • Number of STD positive who have at least one subsequent STD infection
  • Number of STD positive with no subsequent STD infection

Programs should also be able to evaluate partner services by:

• Individual Program Area (e.g., county, district, region, etc.)
• Provider Type (STD Clinic, Family Planning, Correctional Facilities, PMD, HMO, etc.)
• Sex of the patient
• Referral strategy (patient, provider, or other)
• Any selected time frame

The ability to delineate partner services information in a variety of ways enables a program to more easily determine activities that appear to be effective from those that do not. Is one program area or type of activity more effective or worthwhile than another? What are the individual strengths and weaknesses of field staff? Individual employee reports may help a supervisor and the program identify interviewing deficiencies that can be remedied by training. For example, managers can generate reports for a particular area before a scheduled visit. They may identify possible areas of concern that can then be examined more closely during the visit.

Programs should also collect data on reinterviews (number reinterviewed and results), on new partners, suspects, and associates initiated, and on the numbers of partners, suspects, and associates afforded prophylaxis. Programs should also develop reports that routinely examine the speed and effectiveness by which services are delivered to partners, suspects, and associates. Finally, these reports should be available to and used by all levels of management.

Other types of analysis and measures:

The measures discussed above are the traditional "bottom line" measures of success of partner services, but they are not the only ones. Using the number of original patients interviewed as the denominator, one can calculate various indices for each time period such as:

• Number or percentage of patients being interviewed; percent in 24 hours.
• Number or percentage of patients coming from: clinic, corrections settings, substance-abuse programs. Knowing this can help target screening resources more effectively.
• Number of partners elicited compared to the number initiated.
• Number of out of jurisdiction partners initiated and the timeframe on receiving disposition on these out of jurisdiction partners.
• Number of incoming out-of-jurisdiction partners actively pursued. Number and timeframe of incoming out-of-jurisdiction partners where disposition was given to other jurisdictions.
• Number of partners closed as unable to locate. Additional locating resources or training in the use of those resources may be needed (e.g., Internet directories as well as updated cross-directories; closer relationship with the department of motor vehicles or other agencies).
• Number of partners refusing service.
• Number of partners treated prior to being notified by the DIS.
• Percentage of original patients, partners, suspects, and associates with more than one STD.
• Number of partners, suspects, and associates that were located, notified, examined, and treated.

These calculations may be done for each individual DIS as well as the entire program. Useful calculations include the percentage of partners located and tested in a timely manner, for example, in less than a week. The ultimate question that these data should answer is how the program is doing in terms of controlling disease.

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