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

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Lessons Learned for Part B Quality Programs
Experiences from HAB/NQC Part B
CollaborativesAug 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

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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

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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.

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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

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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

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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

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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

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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

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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
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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

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

within 12 months of HIV diagnosis
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Part B Collaborative
Percent of clients who die within 12 months of
HIV diagnosis
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Part B Collaborative
Percent of clients with two (2) primary care
visits in the last 12
months
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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.

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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

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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.

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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-

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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.

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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

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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

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Low Incidence Initiative CD 4 Tests at least
every six months
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Low Incidence Initiative of ADAP clients
approved/denied within 2 weeks of application
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Low Incidence Initiative of clients with at
least 2 HIV medical care visits in last 12 mths,
enrolled in CM
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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
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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

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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

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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

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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.

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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.

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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.

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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.

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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.

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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.

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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.

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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.

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Real World TipsPlanning 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.

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Real World TipsPlanning 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.

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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.

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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

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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 [phone]
• Jay Adams, MA
• HIV Care Coordinator
• West Virginia Ryan White Part B Programs
• jayadams3_at_sbcglobal.net [phone]
• Jamie Cotnoir, MPH
• Maine Center for Disease Control
• jamie.cotnoir_at_maine.gov [phone]
• Susan DiCocco, RN
• Quality Management Administrator
• Ohio Part B Program
• Susan.DiCocco_at_odh.ohio.gov [phone]

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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