2012 nys hiv quality of care program
DESCRIPTION
2012 NYS HIV Quality of Care Program. Learning Network QI Project Updates. Quality Improvement Project Focus. Adolescent Quality Learning Network-VL Suppression & Transitioning Care Substance Use Learning Network-VL Suppression Community Health Center QLN-VL Suppression & Retention - PowerPoint PPT PresentationTRANSCRIPT
Learning Network QI Project Updates
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2012 NYS HIV Quality of Care Program
Quality Improvement Project Focus
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Adolescent Quality Learning Network-VL Suppression & Transitioning Care
Substance Use Learning Network-VL Suppression
Community Health Center QLN-VL Suppression & Retention
HHC QLN-Linkage to care, retention & VL suppression
Secondary Drivers
Primary Outcome Primary Drivers
Increase the viral load suppression
rate by 10% across clinics over a 10
month period
Retention
Psycho-Social
Support
ARV Adherence
Substance Use
Mental Health
Appointments
Transportation
Continuity of care
Treatment Education
Health Literacy
Health Insurance
Housing
Staff attitude
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Network Viral Load Suppression QI Project9/7/12
Dan Belanger TeamIHI IA Score: 3.5
Predicted Score by 12/31/12: 4.1
2012 Community Health Center Quality Learning Network Viral Load Suppression QI Project
Community Health Center Quality Learning Network HIV Viral Load Suppression QI Project
Improve the VL Suppression rate by 10% across 7
community health centers by
12/31/12
Psycho-Social
Support
Retention
ARV Adherence
Clinic system/processes
Clarity of purpose-goals, roles, responsibilities
Clinic QM infrastructure
Clinic environment
Staff communication
Clinic flow
Treatment education
Health literacy
Health insurance
Self efficacy
consumer involveme
nt
Housing
Substance Use
Mental Health
Case management/
SW Support
Patient support network
Appointments
Transportation
Continuity of care
Staff attitude
Staff/patient communication
Site – Cohort 1 patients
# whose most recent VL during the Jan-March period is >200#initiated with QI intervention as of 4/1/2012
# with a successful intervention
# who received a post-initiation viral load test
# who are suppressed
GHV – 8 patients
IFH – 47 patients
OD – 9 patients
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% of unsuppressed patients who received a QI intervention before 4/1/12 and a most recent viral load test since with a suppressed viral load test result
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QI Interventions Tested
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Addressed adherence at medical and Mental Health appointments
one-on-one educationchecklist of intervention itemspatient questionnairecase conferenceIncreased adherence counselingDOTViral Load Visualsteach backphone call adherence counselingincreasing clinic attendance (every 4-6 weeks)
Shewhart Chart Exercise: Providers agreed to begin to investigate using Shewhart Charts for QIA follow up webinar will be scheduled in July
Clinic Five
Clinic Five was well known for using incentives to improve various aspects of care. They had never incentivized adherence to ARV treatment regimen, however, until doing an eHIVQUAL review, and seeing that the viral load suppression rate was less than 40% clinic wide. They came up with a plan, broadly advertising incentives for adherence measured by a suppressed viral load. All patients with a suppressed viral load at their next visit would get a $50.00 gift card from a major credit card company that could be used almost anywhere to buy almost anything. They noticed a major increase in the viral load suppression rate. Unfortunately the gift cards were a one-time donation from the credit card company, so the incentives were not sustainable and neither was the increase in the viral load suppression rate. They believe the data showed that the incentives showed an improvement based on the data. Do you agree?
If you agree, please circle the area on the chart where the “special cause” occurred, showing significant improvement, and based on this background information annotate the chart. What is the rule that proves that this change is due to a special cause rather than a common cause?9
Next Steps
A webinar to further discuss understanding variation over time through the use of the Shewwhart chart will be scheduled
We will share QI project outcomes such as the rate of unsuppressed patients involved in QI interventions across clinics
We will also share with providers viral load suppression rates Sharing aggregate data on PDSA cycles with providers Co-facilitate analysis of data from tests
In addition we will share with providers results from other learning networks involved in QI activities to improve viral load suppression
We will assist providers in negotiating challenges
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Thanks to Leah Savitsky Andrew Lai Wei Miranda RosenbergChris ReisigClaire McCullough Johanna BuckDarryl NgRon MoenClemens Steinbock, IA MentorBruce Agins. IA Sponsor
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And…Beth BonacciJoAnn BeasleyFAYS Team
Marc SliferJanice BiglerSU Section
Terry HamiltonJudy YanEunice CaseyHHC Team12