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Welcome to the NQC National TA Conference Call: Quality Improvement 101 and HRSA/HAB Expectations. May 12, 2011. Presentation Overview. Quality Definitions Key Principles of Quality Improvement PDSA Cycle HRSA/HAB Quality Expectations QM Resources. A Brief Introduction
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Welcome to the NQC National TA Conference Call: Quality Improvement 101 and HRSA/HAB Expectations May 12, 2011
Presentation Overview Quality Definitions Key Principles of Quality Improvement PDSA Cycle HRSA/HAB Quality Expectations QM Resources
A Brief Introduction to Quality Improvement Kevin Garrett National Quality Center New York State AIDS Institute
IOM - Definition of Quality “Quality of care is the degree to which health services for individuals and populations increase the likelihood of desired health outcomes and are consistent with current professional knowledge.” Institute of Medicine. Medicare: A Strategy for Quality Assurance. Vol. 1. (1990)
Quality Improvement/Quality Assurance What is the difference between Quality Assurance and Quality Improvement??? • Quality Assurance (QA) = a broad spectrum of evaluation activities aimed at ensuring compliance with pre-established quality standards. • Quality Improvement (QI) = refers to activities aimed at improving performance/improving processes to enhance the quality of care and services.
Balance between Performance Measurement and QI Activities Quality Management Program
What We Want to Avoid…….. Quality Management Program
Infrastructure enhances systematic implementation of improvement activities.
The PDSA cycle for learning and improvement Act Plan Objective Questions and predictions (why) Plan to carry out the cycle (who, what, where, when) What changes are to be made? Next cycle? Study Do • Complete the • analysis of the data • Compare data to • predictions • Summarize what • was learned Carry out the plan Document problems and unexpected observations Begin analysis of the data
Start Small and Build… Small- scale test Follow-up test Wide-scale tests Implementation
Start Small and Build… Introduce new CM Intake/Assessment Form Improve Access to HIV Primary Care Cycle 1A: Adapt new CM form and test with one of Mary’s patients on Monday Cycle 1B: Revise tool and test with 3 case managers and document feedback Cycle 1C: Revise and test tool with all clients for one week Cycle 1E: Implement new tool and monitor
Tips for PDSA Cycles • Formulate question and predict results • Test first in ‘safe zones’, use volunteers • Use shorter test cycles to accelerate rate of improvement • Scale down size of test (# of patients, clinics, time) • Collect just enough data, not perfect data • Learn from others ‘Steal shamelessly, Share senselessly’ • Just get started! “What can you test by next Tuesday?”
Building Quality into Daily Work • Make quality management a part of contracts with providers • Make quality improvement a part of job descriptions • Incorporate quality concepts into new employee training • Provide ongoing quality training to internal staff and to contractors • Provide opportunities for internal staff and contractors to participate in quality improvement projects • Incorporate best practices into your service delivery
HRSA/HAB Quality Expectations Tracy Matthews Chief Clinical Advisor HRSA/HAB Division of Community Based Programs TMatthews@hrsa.gov
HRSA/HAB Quality Expectations All RWTMA grantees are required to establish clinical quality management programs to: Assess the extent to which HIV health services are consistent with the most recent Public Health Service guidelines for the treatment of HIV disease and related opportunistic infections; and Develop strategies for ensuring that such services are consistent with the guidelines for improvement in the access to and quality of HIV services
HRSA/HAB Quality Expectations “RWTMA grantees are directed to establish clinical quality management programs..” which include: Development of a comprehensive clinicalquality management infrastructure, including routine QM Meetings with cross-functional representation Description of QM Program in a quality plan, with a clear indication of responsibilities and responsible parties Inclusion and involvement of key stakeholders in your quality program Designated leaders for quality improvement and accountability
HRSA/HAB Quality Expectations “assess the extent to which HIV health services are consistent with the most recent Public Health Service (PHS) guidelines…” which includes: Development and/or adaptation of quality measures for key clinical and service categories Routine collection of performance measurement data for key care aspects Analyze and share performance measurement data with program staff Use of data to improve the organization’s performance on key services
HRSA/HAB Quality Expectations “develop strategies for ensuring that such services are consistent with the guidelines for improvement in access to and quality of HIV services…” which includes: Establishment of quality improvement teams with cross-functional representation Linking performance data results to quality improvement activities Integration of changes into routine program activities
Key Characteristics of a Quality Management Program Patient-centeredness is a fundamental focus of quality care and supports the 5 characteristics that follow. 1. A systematic process with identified leadership, accountability, and dedicated resources available to the program 2. Use data and measurable outcomes to determine progress toward relevant, evidenced-based benchmarks 3. Focus on linkages, efficiencies, and provider and client expectation in addressing outcome improvement
4. A continuous process that is adaptive to change and that fits within the framework of other programmatic quality assurance and quality improvement activities 5. Ensure that data collected are fed back into the quality improvement process to assure that goals are accomplished and that they are concurrent with improved outcomes Key Characteristics of a Quality Management Program (cont.)
HAB Performance Measures Six (6) sets of performance measures clinical care (Groups 1, 2, 3) medical case management oral health AIDS Drug Assistance Program systems level pediatrics http://hab.hrsa.gov/special/habmeasures.htm
HAB Performance Measures • Grantees are encouraged to: • track and trend data on these measures to monitor the quality of care provided. • select measures that are most important to their agencies and the populations they serve. • identify areas for improvement and to include these in their quality management plans. • Can be used as defined or can be further modified by the grantee to meet that agency’s individual needs.
HAB Clinical Performance Measures • Measures focus on clinical services provided to adults & adolescents • Categorized into three groups: • Group 1 measures provide an excellent start and can serve as a foundation on which to build. • Group 2 measures are important measures for a robust clinical management program and should be seriously considered. • Group 3 measures represent areas of care that are considered "best practice," but may lack written clinical guidelines or rely on data that are difficult to collect.
HAB PM: Medical Case Management • Targets all clients, regardless of age and focus on two key issues: • Care plan • Medical visits • Medical case management programs are encouraged to utilize the core clinical performance measures as appropriate. • Released 12/09
HAB PM: Oral Health • Measures include: • Dental & Medical History • Dental Treatment Plan • Oral Health Education • Periodontal Screening or Examination • Phase I Treatment Plan Completion • The measures are intended for use by programs providing direct oral health services. • Released 12/09
HAB PM: AIDS Drug Assistance Program • Target all clients, regardless of age • Measures include: • Application Determination • Eligibility Recertification • Formulary • Inappropriate Antiretroviral Regimen • Intended for use by the ADAP programs • Released 12/09
HAB PM: System level • Target all clients, regardless of age • Measures include: • Waiting time for initial access to outpatient/ambulatory medical care • HIV test results for PLWHA • Disease status at time of entry into care • Quality Management Program • System level performance • Intended to assess the system of care by an individual agency or by jurisdiction • Released 08/10
HAB PM: Pediatrics Target clients, birth to youth – depending on the measure Exposed and/or infected population Measures include: Intended for use by programs monitoring pediatrics and adolescents Released 08/10 Lipid Screening Medical Visit MMR Vaccination Neonatal Zidovudine Prophylaxis PCP Prophylaxis for HIV Exposed Infants PCP Prophylaxis for HIV Infected Children Planning for Disclosure of HIV Status to Child TB Screening • Adherence Assessment and Counseling • ARV Therapy • CD4 Value • Developmental Surveillance • Diagnostic Testing to Exclude HIV Infection in Exposed Infants • Health Care Transition Planning for HIV infected Youth • HIV Drug Resistance Testing before initiation of therapy
HAB Performance Measures Grantees are not required to submit performance measurement data to HAB FAQs developed as a companion guide and has been updated with the release of new measures http://hab.hrsa.gov/special/habmeasures.htm
HAB Performance Measures: Next Steps Performance measures related to: viral load Ensure performance measures are in alignment with National HIV/AIDS Strategy Submit HIV performance measures for national endorsement
Any comments or feedback on the utilization of the measures is encouraged. Any recommendations or suggestions for additional measures is welcome. HIVMeasures@hrsa.gov
Key Quality Improvement Learning Opportunities • NQC Website www.NationalQualityCenter.org • Publications • Online Quality Academy-32 Tutorials (8 in Spanish!) • Monthly TA Calls • On-site TA for Ryan White grantees (NQC and HIVQUAL) • Training of Trainers (TOT) • Training for Quality Leaders (TQL) • Training on Coaching Basics (TCB) • Regional Trainings • Quality Link
NationalQualityCenter.org • HIV measures • Change ideas • Best practices • Tools/resources • Literature • FAQ • “New to Quality Improvement” button
References • http://www.IHI.org/IHI/Improvement/ ImprovementMethods provides information on improvement methods, strategies, and changes. • Moen, Ronald, Thomas Nolan; “Process Improvement” Quality Progress, 1987, p62. • Langley, Gerald, Kevin Nolan and Thomas Nolan; “The Foundation of Improvement,” Quality Progress, June 1994, p. 81. • Langley, Gerald, Kevin Nolan, Thomas Nolan, Cliff Norman, and Lloyd Provost; The Improvement Guide. San Francisco, CA; Jossey-Bass, 1996. • Nolan, Kevin; “ASQs Accelerating Change Collaborative Series: A Challenge for Industry,” Quality Progress, Jan 1999, p55.
National Quality Center (NQC) 212.417.4730 Info@NationalQualityCenter.org NationalQualityCenter.org