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Lessons Learned for Part B Quality Programs: Experiences from HABNQC Part B Collaboratives Aug 25, 2

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Title: Lessons Learned for Part B Quality Programs: Experiences from HABNQC Part B Collaboratives Aug 25, 2


1
Lessons Learned for Part B Quality Programs
Experiences from HAB/NQC Part B
Collaboratives Aug 25, 2008
  • Clemens Steinbock, MBA
  • Director, National Quality Center
  • Panel Rosemary Donnelly, MSN, APRN-BC, ACRN Jay
    Adams, MA
  • Jamie Cotnoir, MPH Susan DiCocco, RN

2
Todays Agenda
  • Role of the State (Part B Programs)
  • Overview of HAB/NQC Part B Collaboratives Part B
    Collaborative and Part B Low Incidence Initiative
  • Lessons Learned and Tips for Part B Programs
  • Words of Wisdom from Collaborative Participants
  • QA
  • Workshop Evaluation

3
Role of the State
  • As State Health Departments, Part B programs play
    the dual role of sponsoring their own quality
    management programs and of championing quality
    improvement for subgrantees and other providers
    in the state.
  • Its dominant role provides an impetus to lead
    across the entire Ryan White HIV/AIDS
    Program-funded continuum and to build bridges
    between Ryan White HIV/AIDS Program-funded
    grantees within their constituency.

4
HAB/NQC Part B Collaborative
  • Managed by the National Quality Center (NQC)
  • Initiated in November 2004, and ended in November
    2006
  • 3 Face-to-face Learning Sessions
  • 8 Ryan White Part B grantees Alabama, District
    of Columbia, Florida, Georgia, Michigan,
    Missouri, Ohio, Oregon
  • Potential impact 129,000 people living with
    HIV/AIDS

5
Part B Collaborative Aim
  • Improve the quality of care for people living
    with HIV in the state or jurisdiction through
    creating an effective quality management programs
    in the following four domains
  • Alignment across jurisdictions and resources
  • Optimization and management of resources
  • Integration of data and information systems
  • Improving access to care and retention of
    HIV/AIDS clients

6
Part B Collaborative Timeline
  • Vanguard Meeting - November 2004
  • Expert Meeting - January 2005
  • Planning Group Meeting - May 2005
  • Learning Session 1 - June 2005
  • Learning Session 2 - November 2005
  • Virtual Meeting - May 2006
  • Learning Session 3 - November 2006
  • Synthesis Meeting - March 2007

7
Part B Collaborative Measures
  • Percent of ADAP applicants approved/denied for
    ADAP enrollment within two weeks of receiving a
    complete application
  • Percent of ADAP enrollees recertified for ADAP
    eligibility criteria annually
  • Percent of individuals newly reported with HIV
    infection who also have AIDS diagnosis
  • Percent of individuals newly reported with HIV
    infection who progress to AIDS diagnosis within
    12 months of HIV diagnosis

8
Part B Collaborative Measures (cont)
  • Ratio of individuals who die within 12 months of
    HIV diagnosis to the number of individuals newly
    reported with HIV infection
  • Percent of individuals with at least two general
    HIV medical care visits in the last 12 months
  • Percent of individuals with either a CD4 or viral
    load in the last 6 months

9
Part B Collaborative QM Program Assessments
A.1 quality management plan A.2 performance
measures A.3 work plan B.1 organizational
structure B.2 QM committee B.3 involvement of
stakeholders B.4 evaluation processes C.1
performance data collection C.2 QI projects C.3
QI training and TA
10
Part B Collaborative
Percentage of newly applying state ADAP clients
approved or denied for ADAP services within 2
weeks of ADAP receiving a complete application

11
Part B Collaborative
Percent of clients with an AIDS diagnosis at
first HIV disease report
12
Part B Collaborative
Percent of clients who progress to AIDS diagnosis

within 12 months of HIV diagnosis
13
Part B Collaborative
Percent of clients who die within 12 months of
HIV diagnosis
14
Part B Collaborative
Percent of clients with two (2) primary care
visits in the last 12
months
15
Part B Collaborative
Percentage of newly applying state ADAP clients
approved or denied for ADAP services within 2
weeks of ADAP receiving a complete application.

16
HAB/NQC Part B Low Incidence Initiative
  • Managed by the National Quality Center (NQC)
  • Jun 2006 - May 2008
  • 2 face-to-face and 1 virtual Learning Session
  • 17 states Alaska, Hawaii, Idaho, Iowa, Kansas,
    Maine, Montana, Nebraska, New Hampshire, New
    Mexico, North Dakota, Rhode Island, South Dakota,
    Utah, Vermont, West Virginia, and Wyoming
  • Potential impact over 20,000 people living with
    HIV/AIDS

17
Part B Low Incidence Initiative Aim
  • Development or refinement an effective quality
    management plan and program for the state or
    territory in accordance with the Ryan White
    Program legislation, and implementation of
    processes to ensure and demonstrate quality of
    care and services.

18
Part B Low Incidence Initiative Timeline
  • Major Milestones
  • Jun 06 - Consultative Meeting, Washington, DC
  • Dec 06 - Draft of needs assessment report
  • Apr 07 - Kick-off Meeting in Washington, DC
  • Aug 07 - Face-to-face QI training in Chicago, IL
  • Aug 07 - First performance data report (17 out of
    17 submitted)
  • Feb 08 - Virtual Meeting
  • May 08 - Final face-to-face meeting-

19
Low Incidence Initiative Goals
  • Completion of a comprehensive Quality Management
    Plan.
  • Development and/or strengthening of a Quality
    Management Committee within their
    State/Jurisdiction.
  • Ability to regularly collect, trend and report
    quality data.
  • Initiation of at least one improvement project
    within the 12-month period.
  • Improvement in the Quality Management Program
    core criteria self-assessment.

20
Low Incidence Initiative Key Measures
  • Percent of Ryan White funded clients who have a
    CD4 test done at least every six months
  • Percent of applying state ADAP clients
    approved/denied for ADAP services within two
    weeks of ADAP receiving a complete application
  • Percent of clients with at least two general HIV
    medical care visits in the last 12 months who are
    enrolled in case management

21
Low Incidence Initiative Results
  • States have developed/improved performance
    measurement systems to collect data for quality
    management and report on Initiative measures
    bi-monthly
  • 13 states submitted written QM Plans for review
  • All states formed QM Committees and 9 have met
  • States are beginning to initiate quality
    improvement projects to react to data
  • Several developing relationships with Part C
  • Several sharing data with stakeholders

22
Low Incidence Initiative CD 4 Tests at least
every six months
23
Low Incidence Initiative of ADAP clients
approved/denied within 2 weeks of application
24
Low Incidence Initiative of clients with at
least 2 HIV medical care visits in last 12 mths,
enrolled in CM
25
Map of all Part B Programs Engaged (2007) NQC
has recently also received TA requests from
Michigan, Pennsylvania, Texas and Nevada Part B
Programs
Part B Collaborative
Low Incidence Initiative
On-site TA Request
Regional Trainings
26
What Weve Learned and Gathered…
  • Real-World Tips on
  • Focusing on Key Activities
  • Staffing for Quality
  • Engaging Key Leaders
  • Integrating Quality Management Across Departments
  • Involving Senior Clinicians
  • Involving Consumers
  • Keeping Performance Measurement Simple
  • Planning Your Cross-Part Quality Meeting
  • Celebrating Success

27
Real-World Tips Focusing on Key Activities
  • Develop a Part B QM Plan and QM Committee
  • Identify measures, data sources, and indicators
  • Collect and analyze data
  • Interpret results
  • Identify and implement programmatic changes
  • Communicate outcomes of QM activities to leaders,
    subgrantees and others

28
Real-World Tips Staffing for Quality
  • Designate a single person to be responsible for
    QM activities
  • Determine how much time is necessary to fulfill
    the requirements of the position (i.e.,
    full-time, part-time)
  • Develop a job description
  • If unable to hire staff, explore use of a
    consultant with expertise in QM

29
Real-World Tips How to Engage Key Leaders
  • Emphasize that QM is a requirement for funding
    and use HABs quality language.
  • Share key performance data in clear and simple
    formats (e.g., graphs, charts, storyboards, etc.)
    as well as QI projects and outcomes.
  • Provide training on quality improvement make it
    a required activity if possible or provide it at
    regular meetings of senior management.
  • Share success stories from other states invite
    out-of-state speakers.
  • Ask senior leadership to officially sign off on
    the QM plan if they sign off on it, they are
    more interested in its success.

30
Real-World Tips How to Engage Key Leaders
(cont)
  • Turnover in senior management can make it
    difficult to sustain interest in QM cultivate
    mid-level staff, these members are less prone to
    political turnover.
  • Routinely bring up quality issues in meetings
    with senior leadership.
  • Show cost benefit and resource savings (taking
    money away from direct services can SAVE money
    and make more money available for direct
    services) consider focusing initially on
    high-cost areas where QM may result in larger
    savings.
  • Invite key leaders to give a presentation or
    participate on a panel at a QM-related meeting.
  • Work with others in your jurisdiction (e.g., Part
    A or Part C grantees, local health departments,
    other service providers) that may have more
    influence with senior leadership.

31
Real-World Tips Integrating Quality Management
Across Departments
  • Link QM activities the Statewide Coordinated
    Statement of Need (SCSN) process.
  • Link QM to other health department priorities,
    such as reducing health disparities.
  • Attend other quality-related meetings within the
    health department.
  • Link Part B QM to other QM efforts in the state
    (e.g., Healthy People 2010, public health
    accreditation).
  • Use QM as an opportunity to increase alignment
    across Ryan White HIV/AIDS Program grantees in
    the jurisdiction.
  • Integrate QM across diseases (e.g., STD, TB,
    chronic disease) and bureaus/departments.
  • Communicate your successes to other departments,
    especially those related to saving money or
    improving client outcomes.

32
Real-World Tips Involving Senior Clinicians
  • Convene a medical advisory panel that meet via
    email ask for volunteers as they are the most
    motivated to participate.
  • Start a dialogue with providers to engage them in
    the process with a communication process in
    place, providers will be more likely to provide
    advice on how to facilitate their involvement.
  • Include a clinician as a consultant to your
    program to provide advice and serve as a model
    for other providers.
  • Network with medical schools to reach future
    providers.

33
Real-World Tips Involving Consumers
  • Include consumers on your QM committee ask
    subgrantees and providers to recommend consumers
    for this purpose as a starting point consider
    developing an orientation package for this
    purpose.
  • Establish a state-wide consumer advisory
    committee for consumers to communicate concerns
    and ideas for improving quality of care be sure
    to follow-up on recommendations, where
    appropriate, and develop a communication link to
    your statewide QM committee.
  • Involve consumers in the process of developing
    quality performance indicators, often consumers
    and clinicians prioritize needs differently.

34
Real-World Tips Involving Consumers (cont)
  • Use patient satisfaction surveys, focus groups,
    and/or key informant interviews to obtain
    feedback on quality of care issues.
  • Include consumers on specific quality improvement
    projects and teams to improve specific HIV care
    issues.
  • Include consumers as staff for regular consumer
    feedback to your program and to
    facilitate/moderate other forms of consumer
    feedback in your state.
  • Build the capacity of consumers for quality
    improvement by provide learning opportunities and
    opportunities to meet key stakeholders.

35
Real-World Tips Keeping Performance Measurement
Simple
  • Realize that there is no perfect indicator.
  • Beg, borrow, and steal indicators (HAB, HIVQUAL,
    NQC, NY State, National Quality Measures
    Clearinghouse, etc.)
  • Use only as much data as necessary.
  • Train staff in data collection processes and
    address data interpretation issues.
  • Limit data analysis to the achievement of
    identified indicators.
  • Communicate project data early on dont wait to
    get perfect results.
  • Performance measurement is only the first
    stepuse your data for quality improvement.

36
Real World Tips Data Collection Techniques
  • Data collection should be coordinated for
    multiple projects, with different projects using
    the same datacollect mutually beneficial data.
  • Create a part-time data position to collect data
    from various efforts such as performance
    management, subgrantees, and client satisfaction
    surveys.
  • Make the data gathering process formal, either
    through letters of agreement with agencies or
    through a contract that provides access to data.
  • Engage clinicians and frontline staff through
    regular feedback on QM efforts.
  • Demonstrate how poor data reporting from staff
    and subgranteess can misinform decisions for
    example, show how incomplete forms submitted by
    clinicians can misrepresent who is being served
    and the services provided.
  • Provide consistent training on data collection.

37
Real World Tips Planning Your Cross-Part Quality
Meeting
  • Use existing cross-Part meetings to initiate
    discussion around QM (i.e. statewide HIV/AIDS
    conferences, etc).
  • Consider the use of an external facilitator with
    expertise in QM for your first meeting.
  • Form a planning group with representatives from
    each Part to develop the goals of meeting and to
    set the agenda and continue momentum after the
    meeting.
  • Develop common QM goals and priorities and
    measures.
  • Develop a cross-Part written QM plan and
    implementation plan with assigned roles and a
    timeline to ensure momentum is implemented.

38
Real World Tips Planning Your Cross-Part Quality
Meeting (cont)
  • Develop a final product/outcome from your initial
    meeting (i.e., an action plan) and use
    workgroups/breakout groups during meeting to get
    work done.
  • Have all Parts sign-off on shared documents
    created.
  • Include senior leaders from each Part to make the
    decision-making process easier.
  • Engage providers of HIV care who are not funded
    by the Ryan White HIV/AIDS Program in the QM
    effort in order to make it a truly state-wide
    improvement effort.
  • Include consumer input in the state-wide QM
    effort to strengthen efforts.

39
Real World Tip Celebrate Success!
  • Build excitement for quality by publicizing
    success stories in newsletters and journals.
  • Mount success storyboards openly so that
    providers and patients can see them.
  • Establish an annual awards program for quality
    improvement.
  • Report successes to funders and in reports to
    internal and external councils and stakeholders.

40
Stay Tuned for…
  • NQC Guide for Statewide Quality Management
    Programs Practical Approaches to Build the
    Capacity of Ryan White HIV/AIDS Program Part B
    Grantees
  • …to be published September 2008

41
Words of Wisdom from Collaborative Participants
  • Rosemary Donnelly, MSN, APRN-BC, ACRN
  • PHSO Nurse Consultant
  • HIV Division, Georgia Division of Public Health
  • rdonnelly_at_dhr.state.ga.us (404) 463-0415
  • Jay Adams, MA
  • HIV Care Coordinator
  • West Virginia Ryan White Part B Programs
  • jayadams3_at_sbcglobal.net (304) 232-6822
  • Jamie Cotnoir, MPH
  • Maine Center for Disease Control
  • jamie.cotnoir_at_maine.gov (207)287-5539
  • Susan DiCocco, RN
  • Quality Management Administrator
  • Ohio Part B Program
  • Susan.DiCocco_at_odh.ohio.gov (614)644-5686

42
National Quality Center (NQC) NYSDOH AIDS
Institute 90 Church Street13th Floor New York,
NY 10007-2919 888-NQC-QI-TA Info_at_NationalQualityCe
nter.org www.NationalQualityCenter.org
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