Transcript Clinical Quality Management (CQM) in the Ryan White HIV/AIDS ProgramRyan White Part A Administrative Reverse Site Visit Meeting July 30, 2013 CAPT.

Clinical Quality Management (CQM)
in the Ryan White HIV/AIDS ProgramRyan White Part A Administrative
Reverse Site Visit Meeting
July 30, 2013
CAPT. Tracy Matthews
Marlene Matosky
U.S. Department of Health and Human Services (HHS)
Health Resources and Services Administration (HRSA)
HIV/AIDS Bureau (HAB)
Clinical Unit
Learning Objectives
1. Understand Ryan White legislative
requirements for clinical quality management
2. Identify major components of a clinical quality
management program
3. Locate clinical quality management resources
Ryan White Program
2009 Legislation on Quality
All Ryan White HIV/AIDS Program 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”
 Part A: Sec. 2604.(h)(5)
 Part B: Sec. 2618.(b)(3)(E)
 Part C Sec. 2664.(g)(5)
 Part D Sec. 2671.(f)(2)
Part
Legislation
Amount to Budget
A
Sec. 2604.(h)(5)
Not to exceed the lesser of 5% of amounts
received under the grant or $3,000,000
B
Sec. 2618.(b)(3)(E) Not to exceed the lesser of 5% of amounts
received under the grant or $3,000,000
C
Sec. 2664.(g)(5)
Reasonable amount
D
Sec. 2671.(f)(2)
Reasonable amount
Program Funding Opportunity
Announcement
• FOA provides minimum expectations for grantees
 Established and implemented a CQM plan
 Established processes for ensuring that Primary Medical Care
services are provided in accordance with the Department of
Health and Human Services (HHS) treatment guidelines and
standards of care
 Incorporated quality-related expectations into Requests for
Proposals (RFP) and contracts
• CQM program information as well as client-level health outcomes
data should be used for:
 Jurisdiction’s planning process
 Ongoing assessment of progress toward achieving program
goals and objectives
 Examination and refinement of services based on outcomes
Program Monitoring
Expectations
• Section D: Quality Management
 Grantee Responsibility
 Provider/Subgrantee Responsibility
Elements of Quality
Management Program
Key elements have been identified as being critical to
development & implementation of a CQM program
Quality Infrastructure
Quality Improvement Projects
Quality Planning
Staff & Consumer
Involvement
Performance Measurement
Evaluation of CQM Program
Key Characteristics of a Quality
Management Program
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
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
What is the Difference Between a
Clinical Quality Management Program and a
Quality Management Plan?
‘Clinical quality management program’ encompasses all
grantee-specific quality activities, including the formal
organizational quality infrastructure, performance
measurement, and quality improvement related activities
‘Quality management plan’ is a written document that
outlines the grantee-wide clinical quality management
program, including a clear indication of accountability,
performance measurement strategies and goals, and
elaboration of processes for ongoing evaluation
Clinical Quality
Management Program
Quality Management Plan
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Clinical Quality Management
Plan
Components
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Quality statement
Quality infrastructure
Performance measurement
Annual quality goals
Participation of stakeholders
Evaluation
Capacity Building
Process to update QM Plan
Communication
Formatting
QM Plan implementation
Tips
• Reviewed/updated
annually
• Sign-in off process
• Shared with stakeholders
• Timeline for
implementation of goals
 Responsible person
 Timeline for
implementation
Active Roles Leaders Play in
Clinical Quality Management
Clearly articulated
mission & vision
statement
Ongoing
assessment
by leaders
Ongoing
measurement
of performance
Active
coaching by
leaders
Engagement of Stakeholders
Staff, providers, consumers and others should be
involved in the CQM program.
• Engage internal and external stakeholders
• Communicate information about quality
improvement activities
• Provide opportunities for learning about
quality
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Tips for Performance
Measurement
Include a portfolio of process
and outcome measures
Representative across all funded
services
Reporting strategies
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Performance Measures
• 2007: Started developing and releasing measures under the
guidance of Dr. Cheever
• Currently 50+ measures spanning clinical care, oral health
care, ADAP, case management, and systems
• 4 measures received National Quality Forum (NQF)
endorsement in February 2013
• http://hab.hrsa.gov/deliverhivaidscare/habperformmeasures.ht
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HAB Guiding Principles
to Measurement
• Measure when it is specific to HIV care
 Ex: Prescribed ART vs. influenza vaccination
• Measures align and supported by other agencies in
U.S. Department of Health and Human Services
(HHS)
• Paring down the list of measures to those that are
most important
• Clinical measures ability to be used in an electronic
health record (EHR)
• Core set of HHS and HRSA primary care measures
Alignment & Parsimony
• Working toward a set of National Quality Forum
(NQF) endorsed measures
 Some are HRSA developed/stewarded and others
not
• Working with other HHS partners to identify shared
measurement priorities and develop together
 Reduction in number of HIV measures reported
by grantees
Model for Improvement
The PDSA Cycle
Performance Measurement and
Quality Improvement Activities Balance
Quality Management
Program Infrastructure
Imbalance
Balance
Quality
Assurance
Quality
Improvement
Clinical
Research
Program
Evaluation
Intent
Measuring
compliance with
standards with
repercussions
Continuously
improve practices
to meet standards
and improve the
quality of care
Develop or contribute
to generalizable
knowledge
Intent is to
improve a
specific program
or system
Means
Inspection
Prevention,
ongoing process
Driven by a protocol
Periodic or ad
hoc systematic
study
Focus
Compliance,
Individuals,
reprimands, and
finding “bad
apples”
Improving a
process and /or
system
Identify new
knowledge
Determine
effectiveness and
efficiency of a
program
Responsibi
lity
Few – designated
staff, monitors
All staff
Few – investigators
Few – evaluators
and program staff
Example
Did service
adhere to
standards of
care?
Improve the rate of
viral load
suppression among
patients
Does the new
medication out
perform the standard
medication?
What is the
impact of a
particular service
on patients?
National Quality Center
• Cooperative Agreement that provides no-cost, technical assistance
to all Ryan White funded grantees:
http://nationalqualitycenter.org
• Sharing: Website, various documents/publications, phone
consultation, and in+care campaign
• Coaching: Intensive on-site consultation
 Based on referrals by Project Officers, grantees, or NQC
coaches
 Technical assistance form available at:
http://nationalqualitycenter.org/index.cfm/5847/37117
• Regional Groups
• Training: On-line Tutorials, National TA Conference Calls, Training
of Quality Leaders, Training on Coaching Basics, Training of
Consumers in Quality, Regional trainings
• PENDING: Part A/B organizational assessment
• Sign up for the monthly newsletter by sending an email to [email protected]
Contact Information
Tracy Matthews, MHA, RN
301-443-7804
[email protected]
Marlene Matosky, MPH, RN
301-443-0798
[email protected]
http://hab.hrsa.gov/