Transcript Slide 1

Cross-Part Collaboration :
An Opportunity to Provide Seamless HIV Care
December 10, 2009
Objectives
• Review the benefits and challenges of collaborating
across Parts to improve HIV care.
• Learn about experiences from the 5-State
HAB/NQC Cross-Part Collaborative in initiating
cross-Part efforts.
• Hear from other grantees about successful strategies
they have identified for building a Statewide crossPart team.
• Get your questions about Cross-Part Quality work
answered.
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Presenters
• Jane Caruso, M.S.
Ryan White Part D Project Director, NJ
[email protected]
• Kathleen Clanon, MD NQC Consultant [email protected]
• Marlene Matosky, MPH, RN
HIV Care Quality Management Coordinator
Philadelphia Part A [email protected]
• Jack Rustico, MPA, RW Part D Project Director, Community
Health Center Association of Connecticut (CHCACT)
[email protected]
• Bob Sideleau, New Haven/Fairfield Part A Planning Council, CT
[email protected]
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Why collaborate with other RW
Parts in your state/region?
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Goal: One Sandbox!
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Can individual agencies pull on the
same rope?
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Potential Benefits of Statewide/Regional
Collaboration
• Create seamless access to quality HIV care and services for
consumers, regardless of “Part”
• Develop unified processes for better care coordination &
performance data systems (avoiding resource-consuming
redundancies)
• Jointly work on common priorities and challenges
• Benefit from expertise and best practices outside your agency
• Pool resources for quality improvement training and capacity
building
• Others?
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HAB/NQC Cross-Part Collaborative
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18-month Collaborative managed by NQC
Launched in Oct 2008
5 states participating: CT, NJ, PA, TX, VA
5 states represent 96 grantees
Cross-Part Teams in each state developed to drive work
(Travel Team)
HAB/NQC Cross-Part Collaborative: Aims
• Strengthened partnerships across Parts: regular communication
strategies for the purpose of collaboration for quality management;
state-wide quality management priorities; and joint training
opportunities to avoid duplication.
• A portfolio of performance measures in place for strategic
planning and quality improvement processes and data are routinely
collected
• A unified statewide written Cross-Part quality management
plan
• At least one joint quality improvement project initiated by
cross-Part teams.
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Lessons on Strengthening Partnerships:
Communicating and Sharing the Work
• Establish infrastructure upfront to support input and
cohesiveness
• Share the work: VA developed a strategy to share and rotate
roles periodically for Team Leader, Recorder,
• CT developed task-related subcommittees to work on:
data, capacity building, communication, etc.
• As NJ has demonstrated, state-specific website aids in
collaboration, communication and the dissemination of
useful tips
• A state-wide newsletter connects dispersed Ryan White
grantees in TX.
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Statewide Performance Measurement
• Cross-Part Teams report bimonthly on aggregate statewide data for 6
required indicators and 1 optional
• 4 core HAB Group 1 measures:
 CD4 T-cell Count: Percentage of clients with HIV infection who had 2
or more CD4 T-cell counts performed in the measurement year
 HAART: Percentage of clients with AIDS who are prescribed HAART
 Medical Visits: Percentage of clients with HIV infection who had two
or more medical visits in an HIV care setting in the measurement year
 PCP Prophylaxis: Percentage of clients with HIV infection and a CD4
T-cell count below 200 cells/mm3 who were prescribed PCP prophylaxis
• Measure on collaboration: Percentage of Grantees Submitting
Performance Data to the Collaborative Team
• Disparities measure: Percentage of Grantees Reporting Performance Data
Broken out by Race/Ethnicity
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Grantees Reporting to Aggregate
Statewide Data 2009
100%
90%
Average
80%
Scores
70%
Across
60%
5 States
50%
40%
30%
20%
10%
0%
Jan
13
Mar
May
July
Sept
Nov
Quality Plans and QI Projects
• All 5 Teams have cross-Part QM Plans
• More grantees submitting data
• Teams moving forward with statewide QI
projects: syphilis screening (NJ&CT), retention
(TX), TB (VA)
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Voices of Experience
Connecticut
New Jersey
Pennsylvania
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Connecticut
Jack Rustico and Bob Sideleau
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CT Successes…
Working Collaboratively
• We learned about each other, and had lots of buy-in from team
members
• Same members from the start & new members have joined the CPC!
• We developed a Sub Committee structure
• 92% Participation from RW Grantees in Connecticut (12 Grantees
out of 13 participate)
• Limited AETC participation – low funding means CT has only one
AETC worker statewide
• The SPNS dental grant holder is not at the table
• SPNS Technology grant holders at table which is CAREWare
collaboration among six partner grantees
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CT Top 5 Achievements
1. Cross-Part Quality Management Plan
Development
2. Our Commitment!!
3. Successful PDSA & QI Projects
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CAREWare Training
Syphilis QI Data
4. Excellent Data Analysis (thank you Mike Ostapoff!)
5. QA Self Assessment Scores Improved!
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New Jersey
Jane Caruso
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New Jersey
Partners
Funding streams create
silos
Breaking down silos
through partnership
Share data and best
practices
Coordinate efforts &
promote a statewide
delivery system geared
towards improving patient
outcomes.
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The Cross Part Model
A team of dedicated and diverse leaders is needed to provide support and guidance
to the network of providers who can impact change.
Integrated
efforts bring
improved
outcomes to
fruition
NJ Collaborative
Team: The roots of
innovation for
improved service
delivery
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40 agencies
providing
medical care
are each now
a branch on
the same tree
Services are the
trunk support of
positive client
outcomes
A common work plan with different
approaches
Sample
PDSA
cycle
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Results
When all providers unite in one effort to promote the improvement
of one medical care indicator, results are realized.
New Jersey Statewide Syphilis Screening Rates
80
68
%
70
63
61
62
8,004
7,440
6,335
7,696
8,328
8,886
13,232
12,088
10,880
12,167
12,181
12,443
Mar. 09
May 09
Jul. 09
Sept. 09
58
60
50
71
40
Nov. 08
Jan. 09
Data Cycles
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Learning About Health Disparities
Understanding any existing health care disparities can lead to targeted
efforts for improving outcomes.
Percent
NJ CPC Cycle 6 Data by Race & Ethnicity
100
90
80
70
60
50
40
30
20
10
0
87 92 92
75 78 79
80
86 84
66
48
2 CD4s
HAART
2 Visits
African American
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74
White
69 70
54
PCP
Prophylaxis
Hispanic
Syphilis
Best Practices
in Partnering
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Gather a team of people with
different skill/mind sets but share
the same vision
Move from suspicion to trust
Move from self-serving to sharing
Allow Team members to contribute
what they can, what they are
skilled at, and what they are
comfortable with to assure
sustainable participation
Create & maintain effective
avenues for communication
Provide constant feedback and
encouragement. Develop Team
cheerleaders
NJ’s “Buddy System”
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NJ’s Six Top Achievements
1.
2.
3.
4.
5.
6.
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Full participation from 100% of the NJ RW agencies from
the first cycle
Cleaner, more comprehensive electronic data sets
Awareness of other key players in the state, and who excels in
which skills….closer sandboxes
Created a Statewide networking and support system, thus
opening avenues of communication amongst providers from
different Parts, as well as with the AETC
Alleviated the fear that people will be penalized if their QM
plans are still in their earliest stages
Use of education and capacity building to garner support and
enthusiasm, and build confidence
Pennsylvania Ryan White
Cross Part
Quality Management Project
Think Statewide
Act Locally
Marlene Matosky
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Top Pennsylvania Achievements
1. Built a sound foundation: Design
Team, Quality Council & budget
2. Work products: Newsletter,
Summit-All Parts, statewide
management plan & QIP
3. Streamlined data collection
process
4. Increased communication: Cross
Parts & Cross State
5. Personal growth & development
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Pennsylvania: Current Status of Data
• Review each data
submission for
inaccuracies
• Bi-monthly report to
grantees/subgrantees
• Used data to narrow
focus of QIP
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It’s easy to
collect data
every 2
months!
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Where is Pennsylvania heading with
the data?
• Focus on disparities in care in 2010
• Begin collecting HAB group 2 measures in
December 2009
• Implement HAB MCM measures as soon as
released
• Strive for full participation
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Sustainability in Pennsylvania
• Never saw collaborative as the
driving force for the Statewide
Project
• Work plan & implementation plans
extend beyond collaborative
• Creating a culture of quality
 Coordinate!!!
 Build common consensus
 Supportive to grantees/subgrantees
 Continually increase buy-in & strive
towards commitment
 Realistic
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How to Get Started?
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Tips for Getting Started…..
• Build on existing cross-Part relationships.
• Use an external facilitator with expertise in quality management
for your first meeting.
• Form a planning group with representatives from each Part to
develop the goals and agenda of meeting and to maintain
momentum after the meeting.
• Engage senior leaders from each Part as well as key stakeholders
who are not funded by Ryan White in order to make the effort
truly statewide.
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More Tips for Getting Started……
• Include consumer representatives in your cross-Part work.
• Build on common quality improvement and related capacity
building needs for a joint approach to enhance impact and use
resources efficiently.
• Develop common quality management goals and an action
plan; at minimum, concrete and accountable next steps.
• Have all Parts sign off on documents created.
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National Quality Center (NQC)
212.417.4730
[email protected]
NationalQualityCenter.org