Transcript Brainstorm - National Quality Center

Quality Improvement
in Ryan White Part D
Case Management
Alicia Beatty Circle of Care
Mary Caffery, RN MSN
UCSD Mother, Child & Adolescent HIV Program
Ryan White Part D Grantees
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Overview
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Definitions
Brainstorm key issues
Discuss QI activities in Case Management
Effective Quality Management Programs
Indicators of Quality in Case Management
Small group exercise
Next steps
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HAB Definition: CASE MANAGEMENT
 A range of client-centered services that link
clients with health care, psychosocial, and other
services
 Coordination and follow-up of medical treatments
 Services designed to ensure timely, coordinated
access to medically appropriate levels of health
and support services and continuity of care
through ongoing assessment of clients’ and key
family members’ needs and personal support
systems
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Medical Case Management
Treatment adherence counseling to ensure readiness for and
adherence to complex HIV/AIDS regimens
Key activities:
 Initial assessment of service needs
 Development of a comprehensive, individualized plan
 Coordination of services to implement the plan
 Client monitoring to assess the efficacy of the plan
 Periodic reevaluation and adaptation of the plan as
necessary over the life of the client
 Face-to-face meetings, phone contact, and any other forms
of communication
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Brainstorm
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What are the key challenges we face in providing
well coordinated HIV case management across
the continuum of HIV care?
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How do we ensure quality care for every case
management client every day?
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Focus on Quality:
Presentations by Part D grantees on their successes in
care coordination
• What case management indicators have your
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programs decided to work on?
• What has surprised you about QI activities?
• What have been the barriers to QI?
• What advice do you have for others?
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Putting it Together
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Effective Quality Improvement Programs
 Build a system of quality
 Monitor case management services based on
current established standards
HIV Clinical
Resource
NEW YORK CITY Part A
HIV QUALITY MANAGEMENT
PROGRAM
New York State
Department of Health
AIDS Institute
Quality Performance
Indicator Definitions and
Calculations for: Part A
HIV Case Management
2008
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Effective Quality Improvement Programs
 Define and measure relevant quality indicators
 Using quality indicators allows you to assess
specific aspects of care and services that are
linked to better health outcomes while being
consistent with current professional knowledge
and meeting client needs
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A well-defined quality indicator should
meet the following criteria
Relevance
Does the indicator relate to a condition that occurs frequently or
have a
great impact on patients?
Measurability
Can the indicator realistically and efficiently be measured given the
grantee’s finite resources?
Accuracy
Is the indicator based on accepted guidelines or developed
through formal group-decision making methods?
Improvability:
Can the performance rate associated with the indicator realistically
be improved given the limitations of your clinical services and patient
population?
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What should we be measuring to assess
and improve quality in case management?
 Eligibility/acuity documentation
 Completed comprehensive assessments,
reassessments according to timelines
 Service plan with short / long term goals
 Client involvement, coordination, visit frequency
 Comprehensive screening for mental
health/substance abuse issues
 Completion of referrals
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Achievement of case management
outcomes define quality
 Access to and use of primary care / labs
 ART adherence
 Service utilization: mental health, substance
abuse, dental care
 Self-management skills
 Stable housing
 Improved quality of life
 Hospitalizations or use of ER
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Quality Improvement Activities in Case Management
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Monitor Electronic Data
Home grown
systems
CAREWare
ARIES
HIVQUAL
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PDSA Cycles: A Path to Improve Quality
Changes That
Result in
Improvement
A P
S D
Implementation of
change
Wide-scale tests of
change
A P
Hunches
Theories
Ideas
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S D
Follow-up tests
Very small scale
test
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Continue to measure and sustain improvements
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Small Groups Activity
Group 1
Identify strategies to
overcome barriers to
QI in case management
Group 2
Key indicators to measure
quality of case management
Identify indicators
Relevance
Identify Strategies
Measurability
Accuracy
Improvability
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Next Steps for Your Programs
• Action plan
• Goals
• Resources
• Opportunities
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References
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Developing an Effective Quality Management Program in Accordance with the Ryan White HIV/AIDS Treatment
Modernization Act of 2006 Frequently Asked Questions 1/2008 www.NationalQualityCenter.org
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The HIV Care Management and Support Services Program addresses the needs of persons with HIV disease by
funding primary health care and support services that enhance access to and retention in medical care. The
model of HIV case management was developed as a formal and professional service that links clients with
chronic conditions and multiple service needs to a continuum of health and social service systems.
http://www.puc.state.or.us/DHS/ph/hiv/services/cmstdrds.shtml#standards
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NEW YORK CITY Part A HIV QUALITY MANAGEMENT PROGRAM New York State Department of Health
AIDS Institute Quality Performance Indicator Definitions and Calculations for: Part A HIV Case ManagementApril, 2008 http://www.hivguidelines.org/Content.aspx?PageID=42
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Standards of Service for HIV Case Management in Michigan Medical and Non-Medical February, 2008
Michigan Department of Community Health Division of Health, Wellness and Disease Control HIV/AIDS
Prevention and Intervention Section Continuum of Care
http://www.mihivnews.com/dhwdc/coc_rfp_07/casemanagement_standards.pdf
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Georgia HIV/AIDS Case Management Standards July 2008 Georgia Department of Human Resources Office of
Essential Preventive Clinical Services Communicable Diseases Section HIV Unit
http://health.state.ga.us/pdfs/hivaids/7-22-08%20Approved%20CM%20Standards.pdf
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Contact Information
National Quality Center (NQC)
212-417-4730
NationalQualityCenter.org
[email protected]
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HIVQUAL-US
212-417-4620
HIVQUAL.org
[email protected]
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