Transcript Slide 1

Welcome to the NQC National TA Conference Call:
Quality Management 101 and
HRSA/HAB Expectations
January 8, 2009
Presenters: Tracy Matthews, HAB; Donna Yutzy, NQC
Consultant; Meera Vohra, NQC
Funded by HRSA
HIV/AIDS Bureau
Presentation Overview
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HAB’s Quality Expectations
Definitions
Key characteristics of QM Programs
HRSA’s 9-step Model to Quality
Types of measures/sample measures
The Model for Improvement
QM Resources
Funded by HRSA
HIV/AIDS Bureau
HRSA/HAB Quality
Expectations
Tracy Matthews
Acting Chief Clinical Advisor
Division of Community Based Programs
[email protected]
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National Quality Center (NQC)
Ryan White HIV/AIDS Treatment Modernization
Act 0f 2006
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
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National Quality Center (NQC)
Ryan White HIV/AIDS Treatment Modernization
Act 0f 2006
“RWTMA grantees are directed to establish clinical quality
management programs..” which include:
 Development of a comprehensive clinical quality management
infrastructure, including routine QM Meetings with crossfunctional 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
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National Quality Center (NQC)
Ryan White HIV/AIDS Treatment Modernization
Act 0f 2006
• “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 indicators for
key clinical and service categories
 Routine performance measurement of key care aspects
 Sharing of performance data with program staff
 Use of data to improve the organization’s performance
on key services
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National Quality Center (NQC)
Ryan White HIV/AIDS Treatment Modernization
Act 0f 2006
• “develop strategies for ensuring that such
services are consistent with the guidelines for
improvement in access to and quality of HIV
services…” which includes:
 Linking performance data results to quality
improvement activities
 Establishment of Quality improvement teams with
cross-functional representation
 Integration of changes into routine program activities
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National Quality Center (NQC)
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
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National Quality Center (NQC)
Key Characteristics of a Quality Management
Program (cont.)
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
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National Quality Center (NQC)
HAB Clinical Performance Measures
http://hab.hrsa.gov/special/habmeasures.htm
• Measures focus on clinical services provided
to adults & adolescents
• Detail sheets outline specific information
related to each measure
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National Quality Center (NQC)
HAB Clinical Performance Measures:
Group 1
• Group 1 represents the 5 core clinical
performance measures deemed critical for
HIV programs to monitor
• Released 12/07
• Core clinical performance measures can be
used by all grantees
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National Quality Center (NQC)
HAB Clinical Performance Measures:
Group 2
• Group 2 has 9 clinical performance measures
• Measures reflect important aspect of care that
impacts HIV-related morbidity and focuses on
treatment decisions that affect a sizable
population
• Released 8/08
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National Quality Center (NQC)
HAB Clinical Performance Measures:
Group 3
• Group 3 includes 11 clinical performance
measures
• The measures focus on similar aspects of care
captured in measures listed in Groups 1 & 2
• To be released in final form early Spring 2009
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National Quality Center (NQC)
HAB Clinical Performance Measures
• Grantees are encouraged to include the 5
core clinical performance measures in their
quality management plan
• Grantees are not required to submit
performance measurement data to HAB
• FAQs developed as a companion guide and
is updated with each release of measures
and annually
 http://hab.hrsa.gov/special/habmeasures.htm
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National Quality Center (NQC)
Alignment with Other Measures
• HAB performance measures are specific to
the Ryan White HIV/AIDS Program
• Alignment with other measures such as those
developed by OPR, NCQA, IDSA, and AMA
• HIVQUAL measures are similar to the HAB
clinical performance measures
 HIVQUAL sites are encouraged to continue to
submit HIVQUAL data
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National Quality Center (NQC)
HAB Performance Measures: Next Steps
• Performance measures related to case
management, oral health, ADAP and systems
level
• FAQs will be updated as new measures are
released
• CAREWare Performance Measurement
Module
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National Quality Center (NQC)
HAB Performance Measures: Next Steps
Any comments or feedback on the utilization of
the measures is encouraged.
Any recommendations or suggestions for
additional measures is welcome.
• [email protected]
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National Quality Center (NQC)
Questions?
Thank you!
Tracy Matthews
Acting Chief Clinical Advisor
Division of Community Based Programs
[email protected]
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National Quality Center (NQC)
A Brief Into
to Quality Management
Donna Yutzy, NQC Consultant
[email protected]
Funded by HRSA
HIV/AIDS Bureau
Definitions
Quality = degree to which a health or
social service meets or exceeds
established professional standards
and user expectations.
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National Quality Center (NQC)
Definitions
Quality Assurance (QA) = a broad
spectrum of evaluation activities
aimed at ensuring compliance with
minimum quality standards.
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National Quality Center (NQC)
Definitions
Quality Improvement (QI) = refers to
activities aimed at improving
performance.
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National Quality Center (NQC)
Definitions
Continuous Quality Improvement
(CQI) = describes the ongoing
monitoring, evaluation and
improvement processes.
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National Quality Center (NQC)
Definitions
Indicator = measure used to
determine, over time, an
organization’s performance of a
particular element of care. The
indicator may measure function,
process or outcome.
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National Quality Center (NQC)
Definitions
Outcome = Benefits or other results
(positive or negative) for clients
that may occur during or after their
participation in a program.
Outcomes may be client-level or
system-level.
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National Quality Center (NQC)
HAB’s 9-Step Model to Quality
Goal of Manual:
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provide the tools to develop and
implement a quality management
program
outline a step-by-step process that can
be applied in any care setting
applicable for both the experienced and
non-experienced grantee
Developed by HIV/AIDS Bureau
Quality Institute
Available at hab.hrsa.gov/tools/QM
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National Quality Center (NQC)
HAB’s 9-Step Model to Quality
1.
Commit Leadership & Supportive Organizational
Structure
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Establish Quality Management Plan
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Establish Quality Committee to oversee the QM program
Develop an organizational QM plan which delineates goals and
objectives for the QM program
Determine Performance Measures & Collect Data
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Establish support of program leadership for Quality Management
Delineate specific QM responsibilities of staff
Based on QM priorities, develop/adopt indicators to measure
performance
Determine method of data collection and collect data
National Quality Center (NQC)
HAB’s 9-Step Model to Quality
4.
Analyze Data
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5.
Develop Project-Specific CQI Plan
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Establish project-specific QM team to improve specific aspects of
care/services
Develop timeline for reporting findings and improvement
Study and Understand the Process
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Analyze data and review the results
Identify areas where additional data is required
Utilize QI tools and techniques to understand the process
Report progress to senior leadership and staff
National Quality Center (NQC)
HAB’s 9-Step Model to Quality
7.
Develop and Implement an Improvement Plan
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Re-measurement
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9.
Re-measure indicator after change has been
implemented.
Determine need for and/or level of re-measurement on an
ongoing basis.
Celebrate Success
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Identify potential solutions to make improvement to the
systems of care.
Try a small test of change and analyze results.
Communicate results of the project to all levels of the
organization
Congratulate team in public forum
National Quality Center (NQC)
Developing Measures
• The QM Plan should be the vehicle for examining
how well your agency is doing in executing your
program’s priorities and strategies.
• The focus is not on the performance of individuals or
individuals agencies/contractors, but rather focuses
on how the systems are working to improve HIV care.
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National Quality Center (NQC)
Developing Measures
• The QM Committee should develop a core set of
measures that provide a snapshot of the overall
quality of care provided by your program.
• When possible, it’s smart to start with measures that
are already being collected and used in the system.
• Recommended to include HAB core clinical
indicators.
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National Quality Center (NQC)
Types of Measures
• Outcome measures are the voice of the customer.
• Outcome measures reflect the impact of our work on
the care provided to our clients.
• Examples: incidence of disease rates, functional
status indicators, mortality & morbidity rates,
client/care team satisfaction rates, or cost of care
delivered.
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National Quality Center (NQC)
Types of Measures
• Process measures are the voice of the system.
• Process measures tell us whether parts or steps in
the system are working as planned.
• Examples: Waiting time for appointments, no show
rates, percent of clients with self-management goals
in place, the number of clients organized by acuity
level in case management, length of time to process
ADAP applications or ADAP re-certification rates.
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National Quality Center (NQC)
Model for Improvement
How can we accelerate change and
improvements in HIV programs?
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National Quality Center (NQC)
Model for Improvement
What are we trying to
accomplish?
How will we know
that a change is an
improvement?
What change can we
make that will result in
improvement?
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National Quality Center (NQC)
The PDSA cycle
for learning and improvement
Act Objective
Plan
What changes
are to be
made?
Next cycle?
Questions and
predictions (why)
Plan to carry out the cycle
(who, what, where, when)
Study Do
Complete the
analysis of the data
Compare data to
predictions
Summarize what
was learned
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Carry out the plan
Document problems
and unexpected
observations
Begin analysis of
the data
National Quality Center (NQC)
PDSA Cycle to incorporate the use of a new
CM form
Improve
Access to HIV
Primary Care
A P
S D
Introduce new
CM Intake/
Assessment
Form
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A P
S D
Cycle 1E: Implement and
monitor the standards
Cycle 1D: Revise and test tool
with all clients for one week
Cycle 1C: Present refined tool to all 3
case managers and document feedback
Cycle 1B: Revise tool and test with Karl’s
clients next Monday
Cycle 1A: Adapt new CM form and test with one of Joanne’s
patients
National Quality Center (NQC)
Tips for PDSA Cycles
 Use shorter test cycles to
accelerate rate of
improvement (“What can
you test by next Tuesday?”)
 Collect just enough data, not
perfect data
 Scale down size of test (# of
patients, clinics)
 Test first in ‘safe zones’
 Formulate question and
predict results
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National Quality Center (NQC)
References
• 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
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National Quality Center (NQC)
Building Quality into Daily Work
• Make QM part of contracts with providers.
• Make QI 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 QI projects.
• Incorporate best practices into your service delivery.
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National Quality Center (NQC)
Quality Improvement Resources:
Websites, Publications, Technical Assistance
Meera Vohra, NQC
[email protected]
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National Quality Center (NQC)
Quality Improvement Websites
NationalQualityCenter.org
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HIV measures
Change ideas
Best practices
Tools/resources
Literature
FAQ
National Quality Center (NQC)
Quality Improvement Websites
www.HIVQUAL.org
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HIV QI publications
Measures
HIVQUAL Software
HIVQUAL Project
Clinical guidelines
Recent news and
events
National Quality Center (NQC)
Websites for Quality Improvement
hab.hrsa.gov
• HRSA QI expectations
• QI Tools
• TA Resources
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National Quality Center (NQC)
Quality Academy (Online Training Course)
• Online quality improvement
training course – at no cost
available 24/7 (also
available on CD-Rom)
• Interactivity through test
questions and online
exercises
• 20 QI topics from beginner
(e.g., QI 101, PDSA) to
advanced levels (e.g.,
dealing with resistance)
NationalQualityCenter.org/QualityAcademy
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National Quality Center (NQC)
Quality Improvement Publications
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National Quality Center (NQC)
Quality Improvement Publications
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National Quality Center (NQC)
Quality Improvement Publications
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National Quality Center (NQC)
NEW !! NQC QI Resources
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National Quality Center (NQC)
HAB QM TA Manual & FAQ’s
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National Quality Center (NQC)
QM Program Assessment Tools &
QM Plan Checklist
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National Quality Center (NQC)
QI Learning Resources
Starting to Learn about Quality
Improvement
Measuring Quality of HIV Care
Measurement
Setting up a QM Infrastructure
Writing a Quality Management Plan
Conducting Quality Improvement
Activities
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National Quality Center (NQC)
QI Teaching Resources
Teaching Quality Improvement
Fundamentals
Teaching Performance
Measurement
Teaching QM Infrastructure
Teaching Quality Improvement
Activities
Teaching Patients on Quality
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National Quality Center (NQC)
Consumer Involvement Training Materials
Soliciting Patient Feedback
Empowering Patients to Partner with
their Health Care Providers
Maintaining a Patient Health Record
Best Practices for Consumer
Involvement
Teaching Providers about Patient
Self-Management
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National Quality Center (NQC)
QM Training-of-Trainers (TOT)
• 3-day intensive
training to develop
capacity to train others
in QM
• Significant Pre-work
required
• Must lead at least 3
trainings within 120
days of completing the
TOT
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National Quality Center (NQC)
On-site TA for QM
On-site, individualized technical
assistance is available, free of
cost from:
• National Quality Center (All
Parts)
www.NationalQualityCenter.org
• National HIVQUAL Project (Part
C & D only) www.HIVQUAL.org
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National Quality Center (NQC)
National Quality Center (NQC)
888-NQC-QI-TA
[email protected]
NationalQualityCenter.org
Funded by HRSA
HIV/AIDS Bureau