clinical quality management (cqm) in the ryan white hiv/aids program- ryan white part a...
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Clinical Quality Management (CQM)in the Ryan White HIV/AIDS Program-
Ryan White Part A Administrative Reverse Site Visit Meeting
July 30, 2013CAPT. Tracy Matthews
Marlene MatoskyU.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
• 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)
All Ryan White HIV/AIDS Program grantees are required “to establish clinical quality management programs” to:
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
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
Key Characteristics of a Quality Management Program (cont.)
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
QM Plan
2013
2010
2011
2012
2009
Clinical Quality Management Plan
Components • 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 measurement of performance
Ongoing assessment by leaders
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
14
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.html
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
Responsibility
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
Contact Information
Tracy Matthews, MHA, RN301-443-7804
Marlene Matosky, MPH, RN301-443-0798
http://hab.hrsa.gov/