Transcript Slide 1
Welcome to the NQC National TA Conference Call:
Quality Improvement 101 and HRSA/HAB Expectations
May 12, 2011 Funded by HRSA HIV/AIDS Bureau
Presentation Overview • • • • • Quality Definitions Key Principles of Quality Improvement PDSA Cycle HRSA/HAB Quality Expectations QM Resources Funded by HRSA HIV/AIDS Bureau
A Brief Introduction to Quality Improvement
Kevin Garrett National Quality Center New York State AIDS Institute Funded by HRSA HIV/AIDS Bureau
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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) National Quality Center (NQC)
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.
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‘QI is not QA’ Motivation Means Focus Responsibility
Quality Assurance Quality Improvement
Measuring compliance with standards or agreed to commitments Inspection
Continuously improving processes to meet standards
Data analysis Outliers Few Processes Systems All National Quality Center (NQC)
Balance between Performance Measurement and QI Activities
7 Quality Management Program
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What We Want to Avoid
……..
8 Quality Management Program
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Principles on the Quality Improvement Journey…
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Success is achieved through meeting the needs of those we serve.
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Most problems are found in processes, not in people.
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Do not reinvent the wheel – Learn from best practices.
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Achieve continual improvement through small, incremental changes.
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Actions are based upon accurate and measured data.
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Set Priorities and Communicate clearly National Quality Center (NQC)
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Infrastructure enhances systematic implementation of improvement activities.
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How can we accelerate change and improvements in HIV programs?
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The PDSA cycle for learning and improvement
Act
What changes are to be made?
Next cycle?
Plan
Objective Questions and predictions (why) Plan to carry out the cycle (who, what, where, when)
Study
Complete the analysis of the data Compare data to predictions Summarize what was learned
Do
Carry out the plan Document problems and unexpected observations Begin analysis of the data National Quality Center (NQC)
Start Small and Build…
19 Small scale test Follow-up test Wide-scale tests Implementation
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Start Small and Build…
Introduce new CM Intake/ Assessment Form Improve Access to HIV Primary Care 20
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 National Quality Center (NQC)
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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?” National Quality Center (NQC)
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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 National Quality Center (NQC)
23 HRSA/HAB Quality Expectations Tracy Matthews Chief Clinical Advisor HRSA/HAB Division of Community Based Programs [email protected]
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24 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 National Quality Center (NQC)
25 HRSA/HAB Quality Expectations
“RWTMA grantees are directed to establish
clinical
management programs..” which include: quality Development of a
comprehensive
clinical quality 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
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26 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 National Quality Center (NQC)
27 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 National Quality Center (NQC)
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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 National Quality Center (NQC)
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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 National Quality Center (NQC)
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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
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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
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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.
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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 National Quality Center (NQC)
HAB PM: Oral Health • Measures include: Dental & Medical History Dental Treatment Plan Oral Health Education Periodontal Screening or Examination Phase I Treatment Plan Completion
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• • The measures are intended for use by programs providing direct oral health services.
Released 12/09 National Quality Center (NQC)
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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 National Quality Center (NQC)
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
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• • Intended to assess the system of care by an individual agency or by jurisdiction Released 08/10 National Quality Center (NQC)
HAB PM: Pediatrics
Target clients, birth to youth – depending on the measure Exposed and/or infected population Measures include:
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 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
Intended for use by programs monitoring pediatrics and adolescents Released 08/10 37
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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
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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 National Quality Center (NQC)
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Any comments or feedback on the utilization of the measures is encouraged.
Any recommendations or suggestions for additional measures is welcome.
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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 National Quality Center (NQC)
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• • • • • • • HIV measures Change ideas Best practices Tools/resources Literature FAQ “New to Quality Improvement” button National Quality Center (NQC)
References
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• 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.
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212.417.4730
NationalQualityCenter.org
Funded by HRSA HIV/AIDS Bureau