The Missouri Quality Management Plan QMP Prioritizing Data Stimulates Achievement

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The Missouri Quality Management Plan (QMP)
Prioritizing DataStimulatesAchievement

• Ryan White All Grantees Meeting
• Washington, DC,
• August 31, 2006
• By
• Bob Holtkamp, ADAP Director, Bureau of HIV, STDS,
  and Hepatitis
• Missouri Department of Health Senior Services
• Barbara Boshard, CQI Coordinator, Department of
  Internal Medicine
• School of Medicine, University of Missouri

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Goals

• Plant the seeds for development and
  implementation of Quality Management Plans
• Demonstrate that a QMP can be a living,
  breathing, document for program improvement

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Objectives

• Discuss Missouris approach to collaboration
• Share evolution of measures
• Discuss purpose, valuable components and possible
  outcomes of a formalized QMP
• Share Missouris Quality Management Plan
• Evaluate feasibility of developing a QMP with
  partners and stakeholders
• Identify one PDSA cycle participants could
  implement toward evolution of a QMP

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Setting the Stage

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Missouri QI Past

• 1996 - All Grantees Quarterly meetings defining
  what we needed from Surveillance data
• 2002 - Ranked data wants and needs from HRSA
  Outcomes Evaluation Technical Assistance Guide
• RW Title III and IV HIV-Qual activities
• 2003 GPRA/PART Goals started tracking and
  reporting out at grantee meetings outcomes by
  calendar year
• 2003 Participation on Title I EMA QI
  Collaborative in KC and membership on QM Group
• 2005 New Scope of Work with 3 collaboratively
  determined outcomes

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How we got started on Outcomes?

• All Grantees response to the Outcomes Evaluation
  Technical Assistance Guide
• Ranked data outcome priorities and capabilities
  during All-Grantees Retreat in May 2002
• Ranked data outcome priorities and capabilities
  through MACMIP
• Dedicated staff for Quality Improvement

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Survey Rankings of Data Priorities

• 3 Our title must have now or near future
• 2 Our title will need for future grant
  applications (Next 2-5 years)
• 1 Oh yow HRSA! In a perfect world this would
  be helpful but right now its just a dream.
• 0 You just cant pay me enough to collect this!

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Results of Survey

• NOW CD4 and VL by Calendar Year to reflect
  Primary Care access
• NEXT Retention in Primary Care, Med Adherence,
  Referral for Mental Health and Substance Abuse
• FUTURE Tracking Points of Entry, Service
  Referrals, Effective Care Plans

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Developing Missouris QM Team Efforts

• Responding to GPRA and PART Goals
• Tracking and reporting Missouris GPRA and PART
  outcomes by year for Stakeholders
• Linking with Outstate and Kansas City, St. Louis
  Title I, III, and IV QM efforts

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Missouri QI Present

• 2005 Grant Year applied for Title II QI
  Collaborative participation formalized QMP
  taking from all of the previous and adding what
  we were doing with Title II QI Collaborative
• 2005 Title I EMA St. Louis formal TA with NQC
  with inclusion of Title II and other Titles in EMA

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MO-Hat-ters Forms!

• Applied and accepted to be part of HAB Title II
  QI Demonstration Project
• Formed 12 member team representing multiple RW
  titles, providers, surveillance, key Ryan White
  Title II staff, and a consumer
• MO-Hat-ters to become QM subgroup of All Grantees
  meetings

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Principles of QI

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Six Hat Thinking MO-Hat-ters

• Blue Pulling It All Together
• Green Creating
• Red Feeling
• White Data
• Black Rules and Regulations
• Yellow - Cheerleading
• DeBono, Edward, Six Thinking Hats

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The Three Circles of CQI
Customer Focus
Outcomes Based
Scientific
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10 Questions

• 1. What do we want to accomplish?
• 2. Who cares what do they care about?
• 3. What are we doing now and how well are we
  doing it? (Quality Assurance)
• 4. What can we do better? (Quality Assurance)
• 5. What prevents us from doing better? What are
  the underlying problems?
• 6. What changes can we make to do better?
• 7. Do it.
• 8. How did we do? If it didnt work, try again.
• 9. If it worked, how can we do it every time?
• 10. What did we learn? Lets celebrate! (The
  Quality Improvement Process)

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Using PDSAs for Improvement

• Plan (Assess)
• Do (Implement Pilot)
• Study (Evaluate)
• Act (Implement Real Change)
• (Deming, Ishakawa,Shewhart)

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Missouri QMP Measures
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Components of the Missouri QM Plan

• Vision
• Purpose
• Goal
• Definitions
• Structure
• Improvement Plan Grid
• Outcomes
• Capacity Building
• Communicating and Acknowledging QM Results
• Signature/Date/Review Date Page

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Improvement Plan Grid Components

• Measures
• Evaluation Tools
• Target
• Frequency of Reports
• Responsible Person
• Program
• Outcomes
• PDSA Improvement Strategies
• Re-evaluation

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Measures
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Percent of ADAP Enrollees Recertified for ADAP
Annually
.P.02 Percent of ADAP enrollees recertified for
ADAP eligibility criteria at least annuallyTotal
number of ADAP clients (enrolls) who have reached
their twelve month anniversary from date of
enrollment.                                    
                                                  
                                                  
                                                  
                                                  
            
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Percent of clients who get into case management
within 30 days
                                                  
                                                  
                                                  
                                                  
                                               
                                                  
                                                  
                                                  
                                                  
                                              
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Percent of case management enrollees recertified
for case management annually
                                                  
                                                  
                                                  
                                                  
                                               
                                                  
                                                  
                                                  
                                                  
                                             
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Number of Enrollees in CM FY 06 with Documented
CD4/VL in 12 mos.
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Implementing the QM Plan

• Drafted and Presented QM Plan for Grantees and
  MACMIP in September
• Commitment from 9 Grantees and 1 ASO for QM Plan
• Signature page developed for All Grantee
  Directors to sign to signify adoption
• Final Version Presented November 2005
• Obtained Final Signatures

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Missouri QI Future

• MO-Hat-ters to become a subgroup of all grantees
  we will continue after the collaborative
• Continue to Collaborate Participate in other
  title and regional QM groups
• Offered QI 101 for all Contractors and
  Subcontractors through NQC

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Evaluating QM Plan

• Using the Improvement Plan Grid to assure that it
  is a living breathing document for all
  participating Grantees
• Structure through All Grantees and MO-Hat-ters
  for ongoing update and review of Improvement Plan
  Grid
• Review Date on QM Plan on All Grantee Signature
  page

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Updating the QM Plan

• Semi-monthly MO-hat-ters meetings via
  teleconference
• Ongoing update of Improvement Plan Grid
• Annual review at All Grantees meeting

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Challenges

• Training Stakeholders on the Benefits of Quality
  Management (QM 101)
• Not all grantees are on board
• Capacity Building with Continued Staff Turnover
• !!!!!!
• Engaging Providers in Change
• Incentives for Success

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Lessons Learned

• Document is always evolving
• Organizational structure for QM helpful
• Relationships with stakeholders is key
• Process helps to identify gaps
• Importance of baby steps
• Documentation helps promote forward movement

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Audience Discussion
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Brainstorming QI for Your State or Territory

• Form your team
• Include the Right Folks
• Ask the 10 QI Questions
• Formalize Quality Improvement Plan
• Implement PDSA Cycles
• Make Improvements
• Evaluate, Evaluate, Evaluate

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1. What do I want to accomplish?
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2. Who cares what do they care about?
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3. What are we doing now and how well are we
doing it? (Quality Assurance)
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4. What can we do better? (Quality Assurance)
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5. What prevents us from doing better? What are
the underlying problems?
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6. What changes can we make to do better?
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7. Do it.
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8. How did we do? If it didnt work, try again.
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9. If it worked, how can we do it every time?
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10. What did we learn? Lets celebrate!
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RW Grantee Action Plan

• This Ryan White Title _____________________
• In order to further evolve a formal quality
  management plan in our geographic region
  _______________________________________
• By this date _____________________________
• By whom_______________________________
• Will __________________________________
• _______________________________________

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Contacts Questions

• Bob Holtkamp, ADAP Director
• Missouri Department of Health Senior Services
• Bureau of HIV, STDS, and Hepatitis
• 930 Wildwood Dr., Jefferson City, MO 65102-0570
• T 573-751-6439 F 573-751-6447
• Bob.holtkamp_at_dhss.mo.gov
• Barbara Boshard, RN, BSN, MS
• Coordinator of Quality Improvement
• Department of Internal Medicine
• University of Missouri-Columbia
• One Hospital Drive, MA425B Health Science Center
• Columbia, MO 65212
• T 573-884-0770 F 573-884-4533
• boshardb_at_health.missouri.edu